brainpanhandler » 17 Jul 2015 02:14 wrote:Does the state ever have a right to intervene between parents and their children? For instance, if a parent is attempting to "treat" their child for autism with bleach enemas can the state intervene and prevent this? If a parent for religious reasons refuses to bring a child to a doctor to treat a perfectly treatable disease and the child dies, is the parent criminally liable? Where do the rights of the parents end? Is there some limit on autonomy?
82_28 » 17 Jul 2015 00:48 wrote:Damn, slomo. You be much smarter than me! Thanks for the new terms that I will probably never use again though. Fantastic encapsulation. Muchos Gracias!
alwyn » 17 Jul 2015 13:07 wrote:on another note entirely, SLOMO, have you done any looking at the simpson oil and cancer? (i think it's fascinating that you are working in this field, and, forgive me for saying it, your integrity shines. ) Thanks for your considered input in this particular thread...
slomo » Fri Jul 17, 2015 10:16 am wrote:Again, my issue is not with vaccination per se, it is compulsory vaccination without any checks/balances on the system that is set up to deliver these vaccines. While vaccine efficacy is certainly part of the public debate, why is nobody in the general public commenting on the corruption issue? The fact that medical research and the pharmaceutical industry is rife with corruption is well known and documented, and yet it seems to be left out of the public debate.
Big pharma and the Mafia, October 23, 2013
By Mauricio J. Solorzano "Software Engineer"
One of the biggest canaries at the moment is Peter Gøtzsche, none other than the head of the Nordic Cochrane Centre, the Scandanavian arm of the Cochrane Collaboration, an independent research and information centre committed to preparing, maintaining, and disseminating reviews of the various treatments of mainstream medicine and examining whether they have adequate evidence of safety and effectiveness. Cochrane was the first group of individuals to champion the notion of`evidence-based' medicine - that is, medicine shouldn't be used unless there's evidence that the stuff works.
Gøtzsche is a guy after my own heart. When asked to speak at a Danish Society for Rheumatology event, called `Collaboration with the drug industry. Is it THAT harmful?' Peter's opening gambit was to highlight the fact that Pfizer, one of the meeting's sponsors, had been fined $2.3 billion in the US for promoting off-label use of four drugs, while Merck, the sponsor the year before, had been responsible for the deaths of thousands due to deceptive information about its arthritis drug.
Gøtzsche's latest book, entitled Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare' (Radcliffe Publishing Ltd) pulls even fewer punches. The book essentially makes the point that the drugs industry uses virtually every tactic used by the mob to sell its products.
He even quotes a former vice-president of Pfizer as saying, `It is scary how many similarities there are between his industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the sides effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry.'
This is only the latest canary from among Establishment medicine to blow the whistle on Big Pharma. Marcia Ancell, the editor for two decades at the new England Journal of Medicine, recently published her own book: The Truth About the Drug Companies: How They Deceive Us and What to Do About It.
All of the major medical journals, from the BMJ and the Lancet, to the Journal of the American Medical Association and the New Eng Journal, have revealed the scale of the problem - that correctly prescribed drugs are the fourth leading cause of death, that drug companies massage and make up data.
The exposure of an unprecedented crime against humanity. I applaud you Peter.
ByKiwion January 14, 2015
This book by Gotzsche will shake you to wake you out of a false sense of trust in those people society holds up as academic giants people we entrust our health our lives and minds to, people who have proclaimed to first do no harm! It will stir the emotions within that cries out for justice and fairness and transparency when it comes to something as precious as our health. It exposes the shameful disgraceful behavior that has led to the prescribing of poisons under a wrapper of lies, fraud and deceit. Behavior that the trusting, humble man in the street is completely unable to conceive of. Its well referenced documentation silences all critics. [snip]
One quote will stick with me Gotzsche when asked to comment on the ethical standards in drug companies replied......'I am unable to comment on something that does not exist.' A must read for all people who wish to be informed of this unprecedented crime against humanity.
Heart Breakingly Accurate. The corruption is far worse than I ever thought possible.
BySimple Citizenon February 23, 2015
Mind Blown! I mean it. I've been skeptical of the pharmaceutical industry for many years, but I don't know of anything as impressive as this book.
This book is not written by some anti-drug hack. Dr. Peter Gotzsche co-founded the Cochrane Collaboration in 1993 and established The Nordic Cochrane Centre the same year.
I first heard about the Cochrane Collaboration in my high school debate class when my teacher was discussing the greatest collection and analyses of medical knowledge in the world.
Yeah - the author of this book helped found it and he has worked in medical research and meta-analysis of data for most of his life. He became Professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen.
Basically - this guy knows what he is talking about. He is a physician who has prescribed medications, he has been a "drug rep" and helped sell medications, and he has since analyzed more studies than any researcher I've read.
The only reason this book doesn't get an A+ is because it is so amazingly heavy on research and medical terminology that it is unlikely to be read by the general public.
This book meticulously and methodically shows how deeply entrenched the pharmaceutical industry is in EVERY level of medicine.
I knew they offered free lunches, free drug samples, and they paid for speakers at medical conferences. I knew they used to give out free pens and paper, and toys, and clocks. I even knew they had some pull at the FDA. I had no idea about all the rest.
This was the part that scared me the most.
The BMJ (British Medical Journal)'s former editor said "medical journals are an extension of the marketing arm of the pharmaceutical companies." - p. 64
WHAT?! Medical journals are where I get my trustworthy information. It's where I can find double blind randomized control trials that have been peer-reviewed. They are the gold standard for research!
Journals are where I proudly hang my hat. I don't need to listen to drug reps - I read the New England Journal of Medicine. The best in the world!
It turns out journal editors can be bought off - just like everyone else. Even the best medical journals in the world - New England Journal of Medicine, Lancet, BMJ, Annals of Internal Medicine and JAMA - have all accepted drug money to publish misleading information or bad studies.
The New England Journal of Medicine (likely the most respected medical journal in the world) is as guilty as the rest. 32% of all trials published in their journal were solely funded by drug companies.
NEJM even changed their policy in 2002 to allow authors to write about products in which they had a financial interest.
Journals make HUGE money from advertisements and reprints. If they publish a study beneficial to a drug company - that company promises to buy reprints in order to show them to physicians.
The Lancet made over £1.5 million on orders for a reprint of just one of their editions.
The Annals of Internal Medicine lost over $1 million in advertising revenue after it published a study that was critical of industry advertisements.
Journals have a financial interest in making their article abstracts sound beneficial for new drugs. Reprints will be ordered. The more they allow a study to minimize or hide side effects - the more money they'll make.
Journal corruption is just one small chapter in this book. Gotzsche also details corruption in clinical trials, seeding trials, TV ads, the FDA, patents, professional organizations, and even CME, Continuing Medical Education.
Doctors have to stay current. To keep their board certification we have to log hours of continuing education.
60% of all CME is paid for and provided by drug companies - so guess what most of us are learning? Exactly what they want us to.
Drug companies are not changing. They get caught in their fraud. They either say it was "one bad apple" or "mea culpa: we've now changed our ways."
It's all lies.
If you look at the 3 years span from 2010-2012 you'll find these cases:
2012: Abbott paid $1.5 Billion for Medicaid fraud
2012: Johnson and Johnson fined $1.1 Billion for hiding side effects
2011: GlaxoSmithKline paid $3 Billion for illegal marketing of off-label drugs.
2010: AstraZeneca paid $520 Million for fraud
2010: Novartis paid $423 Million for illegal marketing
the list goes on...
They aren't changing. Drug companies know how to make money - and these lawsuits are already factored in to the profit predictions. They know that these fines are worth it. The fraud makes them more money than they will ever be fined.
This book made me look at my life. I'll graduate from fellowship in four months and begin my career as a Child and Adolescent Psychiatrist.
I know there are good medications. There are caring doctors. There are honest people working as drug reps. There are intelligent and ethical researchers at the FDA and at pharmaceutical companies. There are honest, discerning journal editors who want to publish the truth.
I simply don't trust drug companies to give any of these people accurate information.
Foreword by Richard Smith (former editor of the British Medical Journal)
There must be plenty of people who shudder when they hear that Peter Gøtzsche will be
speaking at a meeting or see his name on the contents list of a journal. He is like the
young boy who not only could see that the emperor had no clothes but also said so. Most
of us either cannot see that the emperor is naked or will not announce it when we see
his nakedness, which is why we badly need people like Peter. He is not a compromiser
or a dissembler, and he has a taste for strong, blunt language and colourful metaphors.
Some, perhaps many, people might be put off reading this book by Peter’s insistence on
comparing the pharmaceutical industry to the mob, but those who turn away from the
book will miss an important opportunity to understand something important about the
world – and to be shocked.
Peter ends his book with a story of how the Danish Society for Rheumatology asked
him to speak on the theme Collaboration with the drug industry. Is it THAT harmful? The
original title was Collaboration with the drug industry. Is it harmful? but the society thought
that too strong. Peter started his talk by enumerating the ‘crimes’ of the meeting’s
sponsors. Roche had grown by selling heroin illegally. Abbot blocked Peter’s access to
drug regulators’ unpublished trials that eventually showed that a slimming pill was
dangerous. UCB too concealed trial data, while Pfizer had lied to the Food and Drug
Administration and been fined $2.3 billion in the United States for promoting off label
use of four drugs. Merck, the last sponsor, had, said Peter, caused the deaths of
thousands of patients with its deceptive behaviour around a drug for arthritis. After this
beginning to his talk he launched into his condemnation of the industry.
You can imagine being at the meeting, with the sponsors spluttering with rage and
the organisers acutely embarrassed. Peter quotes a colleague as saying that he felt ‘my
direct approach might have pushed some people away who were undetermined.’ But
most of the audience were engaged and saw legitimacy in Peter’s points.
The many people who have enthusiastically supported routine mammography to
prevent breast cancer deaths might empathise with the sponsors – because Peter has
been critical of them and published a book on his experiences around mammography.
The important point for me is that Peter was one of few people criticising routine
mammography when he began his investigations but – despite intense attacks on him –
has been proved largely right.
He did not have any particular view on mammography when he was asked by the
Danish authorities to look at the evidence, but he quickly concluded that much of the
evidence was of poor quality. His general conclusion was that routine mammography
might save some lives, although far fewer than enthusiasts said was the case, but at the
cost of many false positives, women undergoing invasive and anxiety-creating
procedures for no benefit, and of overdiagnosis of harmless cancers. The subsequent
arguments around routine mammography have been bitter and hostile, but Peter’s view
might now be called the orthodox view. His book on the subject shows in a detailed way
how scientists have distorted evidence in order to support their beliefs.
I have long recognised that science is carried out by human beings not objective
robots and will therefore be prone to the many human failings, but I was shocked by the
stories in Peter’s book on mammography.
Much of this book is also shocking and in a similar way: it shows how science can be
corrupted in order to advance particular arguments and how money, profits, jobs and
reputations are the most potent corrupters.
Peter does acknowledge that some drugs have brought great benefits. He does so in
one sentence: ‘My book is not about the well-known benefits of drugs such as our great
successes with treating infections, heart diseases, some cancers, and hormone
deficiencies like type 1 diabetes.’ Some readers may think this insufficient, but Peter is
very clear that this is a book about the failures of the whole system of discovering,
producing, marketing and regulating drugs. It is not a book about their benefits.
Many of those who read this book will ask if Peter has over-reached himself in
suggesting that the activities of the drug industry amount to organised crime. The
characteristics of organised crime, racketeering, is defined in US law as the act of
engaging repeatedly in certain types of offence, including extortion, fraud, federal drug
offenses, bribery, embezzlement, obstruction of justice, obstruction of law enforcement,
tampering with witnesses and political corruption. Peter produces evidence, most of it
detailed, to support his case that pharmaceutical companies are guilty of most of these
And he is not the first to compare the industry with the Mafia or mob. He quotes a
former vice-president of Pfizer, who has said:
It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry…
The industry has certainly fallen foul of the US Department of Justice many times in
cases where companies have been fined billions. Peter describes the top 10 companies in
detail, but there are many more. It’s also true that they have offended repeatedly,
calculating perhaps that there are large profits to be made by flouting the law and
paying the fines. The fines can be thought of as ‘the cost of doing business’ like having
to pay for heat, light and rent.
Many people are killed by the industry, many more than are killed by the mob.
Indeed, hundreds of thousands are killed every year by prescription drugs. Many will
see this as almost inevitable because the drugs are being used to treat diseases that
themselves kill. But a counter-argument is that the benefits of drugs are exaggerated,
often because of serious distortions of the evidence behind the drugs, a ‘crime’ that can
be attributed confidently to the industry.
The great doctor William Osler famously said that it would be good for humankind
and bad for the fishes if all the drugs were thrown into the sea. He was speaking before
the therapeutic revolution in the middle of the 20th century that led to penicillin, other
antibiotics, and many other effective drugs, but Peter comes close to agreeing with him
and does speculate that we would be better off without most psychoactive drugs, where
the benefits are small, the harms considerable, and the level of prescribing massive.
Most of Peter’s book is devoted to building up the case that the drug industry has
systematically corrupted science to play up the benefits and play down the harms of
their drugs. As an epidemiologist with very high numerical literacy and a passion for
detail, so that he is a world leader in critiquing clinical studies, Peter is here on very
solid ground. He joins many others, including former editors of the New England Journal
of Medicine, in showing this corruption. He shows too how the industry has bought
doctors, academics, journals, professional and patient organisations, university
departments, journalists, regulators, and politicians. These are the methods of the mob.
The book doesn’t let doctors and academics avoid blame. Indeed, it might be argued
that drug companies are doing what is expected of them in maximising financial returns
for shareholders, but doctors and academics are supposed to have a higher calling. Laws
that are requiring companies to declare payments to doctors are showing that very high
proportions of doctors are beholden to the drug industry and that many are being paid
six figure sums for advising companies or giving talks on their behalf. It’s hard to escape
the conclusion that these ‘key opinion leaders’ are being bought. They are the ‘hired
guns’ of the industry.
And, as with the mob, woe be to anybody who whistleblows or gives evidence against
the industry. Peter tells several stories of whistleblowers being hounded, and John le
Carré’s novel describing drug company ruthlessness became a bestseller and a successful Hollywood film.
So it’s not entirely fanciful to compare the drug industry to the mob, and the public,
despite its enthusiasm for taking drugs, is sceptical about the drug industry. In a poll in
Denmark the public ranked the drug industry second bottom of those in which they had
confidence, and a US poll ranked the industry bottom with tobacco and oil companies.
The doctor and author, Ben Goldacre, in his book Bad Pharma raises the interesting
thought that doctors have come to see as ‘normal’ a relationship with the drug industry
that the public will see as wholly unacceptable when they fully understand it. In Britain
doctors might follow journalists, members of Parliament, and bankers into disgrace for
failing to see how corrupt their ways have become. At the moment the public tends to
trust doctors and distrust drug companies, but the trust could be rapidly lost.
Peter’s book is not all about problems. He proposes solutions, some of which are more
likely than others to happen. It seems most unlikely that drug companies will be
nationalised, but it is likely that all the data used to license drugs will be made
available. The independence of regulators should be enhanced. Some countries might be
tempted to encourage more evaluation of drugs by public sector organisations, and
enthusiasm is spreading for exposing the financial links between drug companies and
doctors, professional and patient bodies, and journals. Certainly the management of
conflicts of interest needs to be improved. Marketing may be further constrained, and
resistance to direct consumer advertising is stiffening.
Critics of the drug industry have been increasing in number, respectability, and
vehemence, and Peter has surpassed them all in comparing the industry with organised
crime. I hope that nobody will be put off reading this book by the boldness of his
comparison, and perhaps the bluntness of the message will lead to valuable reform.
Richard Smith, MD
REP. Bill Posey Calling for an Investigation of the CDC's MMR reasearch fraud C-SPAN 29 Jul 2015
Mandatory vaccination in California: follow the biggest money
by Jon Rappoport
August 2, 2015
“When people say, ‘Follow the money,’ they forget that modern culture itself is about dollars, and where the big money goes tells you a great deal about the culture and its legalized crimes against the population. This isn’t hard to understand. It’s like saying, ‘The vampires who sell war do it for profit.’ And lo and behold, war and violence are a centerpiece of our culture. If you don’t understand that, just go to the movies.” (The Underground, Jon Rappoport)
The recent California law (#SB277) ordering all public and private schoolchildren to receive the full schedule of vaccines has a context.
A money context.
I’m not just talking about corporate donations to legislators. I’m talking about the state of California itself and the businesses that operate here.
For example, the University of California system of colleges is a vast sprawling kingdom. Biomedical $$ grants pour in, and a significant portion of the money funds vaccine-related research.
I began searching for and itemizing such grants. They’re easy to find. But then, something overtook me: California companies that do biomed and biotech research and sell related products.
I plunged, in other words, into California culture. I say that because the number of these companies is staggering. They form a background context in which a mandatory vaccination law is easy to understand—just as a farm bill would be easy to understand in Iowa, or a bill about ranching would be easy to understand in various Western states.
California is biomed biotech “pasture and ranchland.”
At a site called labrat.com, I found a list of California “biotech, pharmaceutical, medical device, and chemical company jobs.”
I scrolled down the list and counted. It took a long time. I arrived at a total of 517 companies. I was somewhat taken aback. That’s a large number.
But then I found a site called biopharmguy.com. It featured its own list of “Biotech companies in San Diego and Southern California.” In just that part of the state, I counted an astonishing 660 biotech companies.
Now we’re talking context and culture. Big-time.
Money, money, money.
Along with war-making defense dollars, agriculture dollars, Silicon Valley and Hollywood dollars, California floats on biotech biomed money.
And in that context, a mandatory vaccine law is simply par for the course.
Individual rights re vaccination? The freedom to choose? Vaccine dangers? Never heard of it.
Yes, the natural health dollar is also significant in California, but it has yet to become a major political force. Proponents of a 2012 GMO ballot initiative to label GMO food couldn’t get their measure passed. And owing to a 2014 California law regulating agriculture, there will apparently be no more bans against growing or selling GMO food. Prior to the law, four California counties had banned GMOs.
Biotech, biomed, GMO, medical drugs, pesticides—all these areas overlap. The companies who do business in these sectors form a strong money culture. And state politicians, including Governor Jerry Brown, are aware of that fact.
Illustrating Brown’s position, here is a quote from James Fallows’ 2013 profile in The Atlantic:
“Brown’s reduced and balanced budget includes more spending for what he considers the big challenges of the future: clean-energy initiatives, an expensive (and controversial) north-to-south high-speed-rail project, new canals and aqueducts, even California-based medical-research projects beyond those sponsored by the National Institutes of Health.” (emphasis added)
Even with a reduced state budget, and even though there is already a flood of $$ for medical research, Brown saw fit to inject more.
Turning back, rejecting, stepping on the mandatory vaccination bill would have sent the wrong signal to biomed businessmen. It was never going to happen.
One of the largest natural health companies in California, Whole Foods, is no help, to say the least. Now that the US Congress is on the verge of denying any state the right to pass a mandatory GMO labeling law, Whole Foods is poised on the edge of a new upswing in sales. Why? Because it uses a private company to verify that many of its products are GMO-free. So it has a leg up. It produces its own food labels. Under the guise of stating “we don’t endorse political positions,” Whole Foods makes more money as the culture becomes more repressive. And the company knows that.
What about the business of doctors in California? A 2014 report titled, “California Physicians: Surplus or Scarcity?” from the California Healthcare Foundation Almanac, presents a mixed bag of very interesting figures:
From 1993 to 2011, the number of doctors in California has grown by 39%, double the rate of population growth. Patient demand for medical care will continue to expand.
However, nearly one-third of the doctors in California are moving close to retirement age. On top of that, 20% of the doctors in the state work less than 20 hours a week caring for patients.
And finally, nearly 20% of medical care in California is delivered by non-physicians (i.e., nurse practitioners and physicians’ assistants).
What do all these statistics imply? Increasingly, to serve (toxify) the population, medical care in California will become “automatic,” one-size-fits-all, quick in and out.
That’s a perfect climate for mass vaccinations, which will cover all the disease labels drug companies can exploit.
Again, context/culture is everything.
When searching for reasons governments pass laws, the money trails need to be followed—especially the trails that are not so obvious.
It turns out that California isn’t really the “health nut” state. It’s the biomed biotech state now. On every front. That’s where the dollars are, and where they are going.
The power players are on board.
Mandatory vaccination was a slam-dunk from the start. It took a while to make it happen, but when the ducks were assembled in a row, the movers moved.
The last thing they care about or think about is the highly toxic effects of the vaccines.
As I’ve pointed out for the past 25 years, the medical cartel is intent on enrolling every person in a cradle-to-grave system of treatment. Trudging along a half-light somber path, the patient receives 40 or 50 diagnoses of diseases and disorders during his life, is drugged, and sliced and diced, into a debilitated state that ends in the graveyard.
Vaccines are a central feature of this plan. Aside from their toxic effects, the ongoing schedule of shots and boosters trains the patient in the vital item called compliance—which sets up the rest of the medical program through the years and decades.
Which is why the freedom to reject medical treatment is vital.
Which is why mandating vaccines is viewed by the cartel as phase one. Compulsory vaccines today, compulsory drugs tomorrow.
This is the covert op behind all national health insurance programs, including Obamacare.
ATLANTA — Last fall, when Martin Meltzer calculated that 1.4 million people might contract Ebola in West Africa, the world paid attention.
This was, he said, a worst-case scenario. But Meltzer is the most famous disease modeler for the nation's pre-eminent public health agency, the Centers for Disease Control and Prevention. His estimate was promoted at high-level international meetings. It rallied nations to step up their efforts to fight the disease.
But the estimate proved to be off.
Way, way off.
Like, 65 times worse than what ended up happening.
Some were not surprised. Meltzer has a lot of critics who say he and his CDC colleagues have a habit of willfully ignoring the complexities of disease outbreaks, resulting in estimates that over-dramatize how bad an outbreak could get — estimates that may be skewed by politics. They say Meltzer and company also overestimate how much vaccine is needed and how beneficial it has been.
Overblown estimates can result in unnecessary government spending, they say, and may further erode trust in an agency that recently has seen its sterling reputation decline.
"Once we cry wolf, and our dire predictions turn out not to be the case, people lose confidence in public health," said Aaron King, a University of Michigan researcher who in a recent journal article took Meltzer and others to task for making what he called avoidable mistakes.
Meltzer, 56, is unbowed. "I am not sorry," he said.
He dismisses his peers' more complicated calculations as out of touch with political necessities, telling a story about President Lyndon Johnson in the 1960s. Johnson was listening to an economist talk about the uncertainty in his forecast and the reason a range of estimates made more sense than one specific figure. Johnson was unconvinced.
"Ranges are for cattle," Johnson said, according to legend. "Give me a number."
Meltzer does not shy away from providing a number.
What Meltzer does is not particularly glamorous. He and others use mathematical calculations to try to provide a more precise picture of a certain situation, or to predict how the situation will change. They write equations on chalkboards, have small meetings to debate which data to use, and sit at computers. Meltzer spends a lot of time with Excel spreadsheets.
But modelers have become critical in the world of infectious diseases.
Epidemics often have a "fog of war" aspect to them, in which it's not clear exactly what just happened or what's about to happen next. That's true both of common infections and rare ones.
Take flu, for example.
Each winter, flu is so common that it's impossible to test and confirm every illness. It's also difficult to determine every flu-related death — it's often not clear flu was responsible for the demise of everyone who had flu-like symptoms when they died. So when the CDC cites an average of 24,000 flu-related deaths in the U.S. each year, that comes from modeling, not an actual count.
Ebola is another example. CDC leaders came to Meltzer early last August, when the epidemic was spiraling out of control and international health officials were quickly trying to build a response. Meltzer was asked to project how bad things could get if nothing was done, as well as to estimate how stepped-up aid could bend the curve of the epidemic.
Meltzer and his colleagues created a spreadsheet tool that projected uninterrupted exponential growth in two countries, Liberia and Sierra Leone.
His prediction — published last September — warned that West Africa could be on track to see 500,000 to 1.4 million Ebola cases within a few months if the world sat on its hands and let the epidemic blaze.
About 21,000 cases materialized by mid-January — a terrible toll, to be sure, but also just a tiny fraction of the caseload Meltzer and his CDC colleagues warned about. Today, the epidemic is considered to be on its last legs.
No modeler claims to be 100 percent correct. Indeed, modelers have a saying: "All models are wrong, but some are useful."
They mean that a model's mathematics can be correct, but the resulting predictions can still prove to be terrible if the wrong kinds of data are used or key assumptions are off. Unexpected intangibles, like a change in the weather, can also mess things up. (Of course the math can also be wrong — as in a ballyhooed 2004 CDC estimate of how many Americans die annually from obesity. It later proved to be over-inflated, with officials blaming a computational error.)
During last year's Ebola crisis, the World Health Organization made its own set of projections for the epidemic's course, released at about the same time as the CDC's. But the WHO chose to project cases only as far out as early November, saying 21,000 people could be infected in Guinea, Liberia and Sierra Leone by then.
Also, the WHO decided not to make a key assumption Meltzer did — that Ebola cases were being under-reported by a factor of 2.5.
Did Meltzer blow it? Many say no. He and his colleagues clearly stated they were providing a worst-case scenario of how bad things could get. They also predicted a far lower number of cases if more help was sent — which already was happening when the model estimates were released.
But the worst-case figures got the most attention. The media focused on them in headlines. Health officials highlighted them in their push to get more money and manpower devoted to the epidemic. And interestingly, those are the numbers health officials describe as the most successful part of Meltzer's prediction paper.
"I think it galvanized countries — and people — to put in more effort" into fighting the epidemic, said Dr. Keiji Fukuda, formerly a colleague of Meltzer's at CDC who is now assistant director-general of the World Health Organization.
Dr. Tom Frieden, the CDC's director, said the estimates were helpful in those difficult days of pushing for more action. But he disagrees with contentions that the agency was crying wolf. The agency was clear that the estimates were a worst-case scenario and probably wouldn't come true, he said. But "I don't think it's possible to have exaggerated the risk the world faced in the fall."
Columbia University's Jeffrey Shaman, a modeling leader, echoed the perception that existed when Meltzer was given his assignment. As far as Ebola epidemics go, "we'd never seen anything like this before. This thing looked like AIDS on steroids," he said.
Meltzer was born in 1958 in Southern Rhodesia, a British colony in Africa — a white, Jewish boy growing up in a privileged enclave in a country that was 99 percent black. Drafted into the military at 18, he went on reconnaissance missions in the Zambezi valley during the later stages of a civil war that led to 1980 elections that brought independence and created the nation of Zimbabwe.
His early scientific interest was in the health of animals, not humans. He earned a degree in agricultural economics in Zimbabwe, then wrote a doctoral dissertation at Cornell University on control of tick-borne diseases in African livestock. He was working on animal diseases at the University of Florida when some work on rabies brought him to the attention of CDC, which was recruiting economists to develop numbers for policy discussions. He joined the agency in 1995, when disease modelers were still a tiny group on the margins of public health.
"At the time I came on, hardly anyone at CDC did modeling," said Anne Haddix, who joined the agency in 1992 and became Meltzer's mentor.
Three factors were prodding more infectious disease modeling in the United States:
—Advances in computers and mathematics enabled modelers to do increasingly sophisticated work.
—British scientists successfully used models to guide government decision making. Most notably, modelers influenced how the United Kingdom handled a devastating 2001 epidemic of foot-and-mouth disease in animals. The epidemic was tamed by the end of that summer, after the slaughter of millions of animals.
—In the aftermath of 9/11, government officials pushed for greater preparations against bioterrorism and disease disasters, and needed to know how much money they needed to budget.
Haddix and Meltzer helped establish a corps of dozens of economists at the CDC who performed such tasks as assessing the effect and cost of prevention programs. Their work became crucial when agency officials went to Congress for funding. The economists also were the ones who ended up doing the bulk of the agency's disease modeling work.
Some of Meltzer's peers build sophisticated models that have been likened to jet aircraft, sometimes requiring a large team of experts to create them and keep them running. Those are known as stochastic models that focus on the effects of chance and other potential factors, and emphasize the range of possibilities. Most stochastic modeling work is done at universities.
Meltzer's models are more like a bicycle; much more easily understood and modified. Deterministic, they're called. They more simply describe what might happen in a population given general trends. Meltzer says he uses these models because that's what plays well with policy makers — they are easy to explain, can be quickly altered to respond to a new question, and can spit out simple answers quickly.
Within CDC, he's been lauded for his work. One Meltzer project was creation of free software — called FluAid — that gave local health officials an idea how pandemic flu might affect different geographic areas. He's also been praised for co-creating a model that helped CDC officials make the case for dropping a long-standing federal restriction that prevented HIV-infected foreigners from staying and working in the United States. The restriction was dropped in 2010.
In 2011, Meltzer discovered an error in CDC estimates of how many illnesses, hospitalizations and deaths were prevented during the 2009 flu pandemic through use of vaccines and medications. He initiated a published correction.
But some of his work has drawn ridicule. In 2001, shortly after the nation endured a series of anthrax attacks, Meltzer co-authored a paper that forecast a global smallpox epidemic could reach 77 trillion cases within a year if there were no intervention and an unlimited supply of smallpox-susceptible people. He included the number, he said, to give people an idea just how dramatically cases could escalate if unchecked by public health measures.
Some viewed that number as nonsensical, given that the Earth had only about 6 billion inhabitants.
"Every now and again, Dr. Meltzer loses control of his computer," said Dr. Donald A. Henderson, a revered public health expert who led a global smallpox eradication effort in the 1970s.
There is no doubt some envy among modelers for the influence Meltzer holds. Modeling-produced numbers become valuable currency in debates about what public health measures to take and what programs to fund; they can drive policy decisions.
Many modelers go into the field because "it has real implications you can see in your lifetime," said Irene Eckstrand, who until last year was scientific director of a government-funded modelers network called MIDAS — Models of Infectious Disease Agent Study.
CDC is supposed to prepare the America for the worst, so it makes sense for CDC modelers to explore extreme scenarios. If Meltzer's estimates push policymakers to bolster public health defenses, it's all to the greater good, they say.
"The primary purpose of these models is to say why we need to take action," said Glen Nowak, a former CDC director of media relations who now heads the University of Georgia's Center for Health and Risk Communication.
But there are those who feel that the result corrupts both science and politics.
"Public health officials are well aware that their statistics get used — and misused — to justify an increase in their funding" or to bolster vaccination campaigns and other efforts, said Peter Doshi, an assistant professor at the University of Maryland School of Pharmacy and an associate editor of BMJ, the British medical journal.
Modeling — so poorly understood by the public, the media, and even many people in public health — provides an opportunity to bend numbers to support goals, he argued.
"This is an area again where the CDC is free to produce numbers and nobody can really say they're right or wrong. You can say 'well, they don't seem plausible,'" but then it just looks like some experts are arguing over whose model is better, he said.
Said David Ozonoff, a Boston University environmental health professor who formerly — under the pseudonym Revere — wrote a blog on public health policy and science called "Effect Measure" that was closely read by CDC employees: "The way risk assessment is done in this country is the policy makers shoot the arrow and the risk assessors paint a target around it. There's a flavor of this with modeling, too. If you say the purpose (of a modeling estimate) is motivational, that's another way of saying it's not scientific."
Some say more of a separation between CDC administrators and the modelers might engender more trust in the numbers the agency uses. Perhaps an outside agency — an NIH institute on public health, if one were ever created — could do the modeling and report their findings to CDC, said Lone Simonsen, a research professor at George Washington University who formerly worked at the CDC and at the National Institutes of Health.
More immediately, CDC could increase its collaboration with top academic modelers, she added.
But some experts noted that's not always possible, especially in fast-moving and sensitive situations like Ebola, when the agency might receive information about epidemics from countries or organizations that don't want the data shared with the academic community or others.
Meltzer is wary of proposals for greater collaboration or reliance on non-agency modelers. And more sophisticated models do not interest him.
"Accuracy for the sake of accuracy is merely interesting," he said. "And interesting is not good enough."
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