Bird flu? Meh.

Worried about bird flu—by which I mean avian influenza H5N1? We've been told, again and again, that it's killing birds and people in Southeast Asia, and with just a couple of minor genetic tweaks it could be the basis for the next killer flu pandemic that will destroy us all.

And...maybe. Sure. But according to this recent editorial in the British Medical Journal, maybe not. The tricky bit is, for all the time public health folks have been watching H5N1, it has stubbornly resisted mutating into the form easily transmitted from human to human. One theory is that the virus infects a part of the lungs so deep that viruses don't get coughed up, so people don't pass it around after they've caught it from their birdies.

Salient bits from BMJ:

Somewhere, I imagine, there's a small group of people proud^ ^to be counted among the Friends of Avian Flu, or FAF for short.^ ^I suspect they have a catchy mission statement, such as "Keeping^ ^the nightmare alive," and lapel badges of vaguely bird-like^ ^shape. ^

Their challenge is to keep bird flu forever in the public eye.^ ^This should be getting harder, as influenza H5N1 is proving^ ^particularly resistant to undergoing the killer mutation that^ ^would allow efficient human to human transmission of the virus.^ ^Ten years after the strain first appeared in humans, it has^ ^killed just 191 people. This is despite the most propitious^ ^of circumstances: millions of people and poultry living in very^ ^close proximity in South East Asia. Although these deaths are^ ^a tragedy for the victims and their families, it's as well to^ ^remember that a similar number of people die on the roads world^ ^wide every 84 minutes.^ ^

Traditionally, we've blamed the drug companies for talking up^ ^the risks of diseases, or even inventing diseases, but this^ ^is not the case with bird flu. The track record of oseltamivir^ ^(Tamiflu) as a treatment for H5N1 is decidedly mixed, and its^ ^use in seasonal flu has been linked to suicides and neuropsychiatric^ ^symptoms in Japanese teenagers. FAF has incorporated this pharmaceutical^ ^failure into its story for bird flu: The Drugs Don't Work. Be^ ^afraid. Be very afraid.

BMJ's point? We have bigger apocalypses to fry. AIDS. Maybe other influenzas. Worth thinking about. The writer doesn't guess why people are trying to scare us about H5N1 as opposed to these others. Too cynical to think it has something to do with research funding? Probably. And there's no question that H5N1 is at minimum an economic threat to a bunch of developing economies. As usual, this may be a question of the allocation of resources. How do we decide which threat to face.

(Channeling my in-house public health expert—by which I mean my wife—the answer probably has something to do with structuring heavy-duty, global disease surveillance that doesn't care what the bug is, as long as it gets caught early.)

Avian flu: Influenze virus receptors in the human airway (abstract from Nature)

FAFing about (BMJ)

Idea from Charlie over at the Knight Science Journalism Tracker, as typical. He got it from SciDev.net.

Photo of a Vietnamese poultry market from AP/Boston Globe