Field of Science

It’s the 2009 Mexican flu - or is it S-OIV H1N1(A)?

Millions of people have already been infected by the new pandemic influenza virus, and the number may well climb over a billion. The CDC recently estimated that up to 40% of U.S. citizens may be infected over the next year, a startlingly high number. Close to home (for me), several children in my neighborhood came down with influenza just last week. They all recovered, fairly quickly. They almost certainly had the new H1N1 pandemic strain, which seems to be spreading rapidly despite the fact that flu season is normally in the winter. A postdoc in my lab was the first person I know who caught the new pandemic flu – he came down with it in early May, and was very sick for a week. (He stayed home, and no one else was infected, as far as I know.)

But the media are still calling this “swine flu”, in headlines all over the world. Government authorities decided early on to call it 2009 H1N1(A), a catchy name if there ever was one. In one of the earliest scientific publications, CDC scientists called it S-OIV, for “swine-origin influenza virus”.

Nice try, but the media aren't buying it. The problem with the name "swine flu" is that it’s not a swine flu any more. Once an influenza virus has become established in humans, it’s a human flu. If you catch the “swine flu”, you’ll get it from another human – not from a pig. So what to call it?

The choice of a name is actually pretty clear: each of the three 20th-century flu pandemics was named after the geographic location where people believed it originated: the 1918 Spanish flu, the 1957 Asian flu, and the 1968 Hong Kong flu. As best we can tell, the new H1N1(A) virus originated in Mexico, and therefore we should call it the 2009 Mexican flu. This will be accurate and consistent with historical precedent.

And by the way, this idea has already been proposed, but the Mexican government objected, so government health authorities, including the WHO, immediately backed down and looked for a more politically acceptable name. Several countries have already started using the term Mexican flu, including Belgium and Israel, as the AP reported yesterday – although the English-speaking world is still using “swine flu.”

As a side note, we now know that the Spanish flu should have been called “American flu” or possibly “Kansas flu” (where it really started), but during World War I, the U.S. didn’t want to admit that it had a serious health crisis, nor did any of the European countries involved in WWI. The Spanish got stuck with the name – incorrectly – because they didn’t try to hide the fact that they had a pandemic on their hands.

So a note to headline writers in the media: I don’t blame you for calling it swine flu and ignoring alternative names such as S-OIV and H1N1(A). But it’s misleading to use the term “swine flu”, which is already used to refer to influenza viruses circulating among pigs. Calling it “swine flu” also led to the foolish decision by some countries to slaughter large numbers of pigs, which was completely ineffective at controlling the spread of the new virus.

It’s a human flu, and it started in Mexico, so let’s call it Mexican flu.

Stimulus funds for pseudoscience

The stimulus funds that the U.S. Congress recently gave to NIH will include $31 million in additional funding for NCCAM, the National Center for Complementary and Alternative Medicine. This is in addition to the $125 million they already had in the current year’s budget. Great. If we spent those funds digging holes and filling them in again, at least a few people might get some exercise, which would benefit their health. That would be a better use than giving the money to NCCAM. Why? Because funding bad science is worse – in many ways – than not funding anything at all. NCCAM continues to provide a home for all sorts of pseudoscience, quackery, and practices that are really no different from voodoo or witchcraft. Allowing NCCAM to operate out of NIH not only gives it an unearned veneer of respectability, it also damages the reputation of NIH. I hate to see this, because NIH is the crown jewel of our biomedical research system.

Let’s look at what NCCAM features on its home page right now. It features the headline “Take charge of your health” followed by six topics. A visitor to the site would have every reason to expect to find sound, science-based advice that would benefit your health under each of these topics. Alas, this is not the case. The first topic is acupuncture, so let’s look at what NCCAM says about it.

The NCCAM accupuncture page is, frankly, an embarrassment. It is one long apologia for acupuncture, dancing around the facts while trying not to admit that the evidence for acupuncture is nonexistent. Indeed, it appears that the authors of the page know that acupuncture doesn’t work, and are trying, in a tortured way, to avoid admitting the truth. The NCCAM's “Key points” on acupuncture are:
“(1) Acupuncture has been practiced in China and other Asian countries for thousands of years. (2) Scientists are studying the efficacy of acupuncture for a wide range of conditions. (3) Relatively few complications have been reported from the use of acupuncture. However, acupuncture can cause potentially serious side effects if not delivered properly by a qualified practitioner. (4) Tell your health care providers about any complementary and alternative practices you use.“
Interesting – the key points don’t include any specific benefits! That’s because every study done has shown that acupuncture doesn’t work any better than placebo, and of course placebo treatments don’t require sticking needles in your body. Let’s look at those key points more closely: the first one is merely an “argument from authority” – i.e., people have been doing this for a long time, and we are supposed to infer that therefore it works. Hardly! If we used the same medical practices that were used in China thousands of years ago, we’d have the same life expectancy – perhaps 30-40 years. Not good. Point 2 just states that studies are under way (funded by NCCAM, I might add), but doesn’t point out that all the studies are negative! The third point just says that you probably won’t be injured by acupuncture (but you never know). So it seems that the NCCAM folks know that science doesn’t support any benefit from the use of acupuncture, but they can’t just say that on their website – why? Because NCCAM’s staff view its mission (apparently) as the promotion of “alternatives” to medicine, even if those alternatives are nonsense.

Ah, but you might have heard that acupuncture does help to control some types of pain – that’s what its proponents argue. NCCAM has a lengthy page devoted to this topic. What are the key points here? Let’s look:
“(1) People use acupuncture for various types of pain. Back pain is the most commonly reported use, followed by joint pain, neck pain, and headache. (2) Acupuncture is being studied for its efficacy in alleviating many kinds of pain. There are promising findings in some conditions, such as chronic low-back pain and osteoarthritis of the knee; but, for most other conditions, additional research is needed. The National Center for Complementary and Alternative Medicine (NCCAM) sponsors a wide range of acupuncture research. (3) Acupuncture is generally considered safe when performed correctly. (4) In traditional Chinese medicine theory, acupuncture regulates the flow of qi (vital energy) through the body. Research to test scientific theories about how acupuncture might work to relieve pain is under way.”
These points are a pathetic attempt to apologize for acupuncture, without admitting that it doesn’t work. First they say that lots of people use it – true enough, but are we supposed to believe that means it works? In that case, why do any science at all? Why not just look at what people are doing, and follow their lead? Then they say that acupuncture is being studied by NCCAM, and they claim “promising” results in some conditions. But “additional research is needed” for others. Sorry, NCCAM, but more research is not needed – multiple studies have shown that acupuncture doesn’t work. If it weren’t for lobbying efforts by acupuncturists and their ilk, who have a major financial interest in seeing these studies continue, this topic would be dead. And point (4) about qi is just embarrassing. There's never been any evidence that qi exists, and NIH/NCCAM should not even mention it.

Recent studies have shown that “sham” acupuncture, where the needles are inserted in random locations, works just as well as “real” acupuncture. Furthermore, it doesn’t even matter if the needles pierce the skin! The patients get the same benefit as long as they think the needles went in. See a longer discussion of this at Science-Based Medicine, where Steven Novella describes one recent trial on acupuncture for back pain – exactly what the NCCAM site claims it works for. Novella expresses the results eloquently:
“Imagine if we were evaluating the efficacy of a new pain drug. This drug, when tested in open trials (no blinding or control) has an effect on reducing pain - it is superior to no treatment. When compared to a placebo, however, the drug is no more effective than the placebo, although both are more effective than no treatment.

Now imagine that the pharmaceutical company who manufactures this drug sends out a press release declaring that their drug is effective for pain, but that their research shows that a placebo of their drug is also effective (FDA applications are pending). Therefore more research is needed to determine how their drug works. Would you buy it?

That is the exact situation we are facing with acupuncture research.”
Despite the claims at the NCCAM site, acupuncture has not been shown effective for any type of pain, and it does have potential side effects – infection from improperly sterilized needles, for example. Why risk infection for a treatment with no benefit?

But wait, I’m not done. Recently, NCCAM proudly announced two new members of its Advisory Council. One of them, Xiaoming Tian, is an acupuncturist. (By Congressional mandate, a majority of the NCCAM board must be selected from proponents of “CAM”. Hmm, voodoo is an "alternative" medicine - I hope they included a voodoo-ist.) So who is this new advisor? His bio says that he is Director of the Academy of Acupuncture and Chinese Medicine at Wildwood Acupuncture Center in Bethesda, Maryland. It’s hard to find much about this school, or Mr. Tian, except from his bio on the website where it says he “has been practicing acupuncture and Chinese herbal medicine in Bethesda, Maryland since 1986” and he is “considered one of the leading researchers in acupuncture and Chinese herbal medicine.” However, he doesn’t seem to have any serious credibility as a researcher: I could locate only one study on which he appears as the second author. And in that study (R.E. Harris et al. The Journal of Alternative and Complementary Medicine. August 2005, 11(4): 663-671) the authors used acupuncture and sham acupuncture to treat fibromyalgia, and found no difference between the “real” and sham versions. That’s because all acupuncture is a sham.

NCCAM is worse than a waste of money. By allowing it to operate within NIH, Congress is giving a false veneer of respect to all sorts of bogus treatments that range from worthless to harmful. To those who argue that some of its funding goes to useful research: if a treatment is promising and scientifically sound, it can be funded by the existing NIH institutes and centers – it doesn’t need the special “free pass” for low-quality research that NCCAM offers. Let's find a better use for that $156 million that NCCAM is getting this year.