History of influenza virus treatment: Can technology help humans better cope with the flu?

Is the flu virus a minor illness or a lethal killer? For most healthy people, the flu doesn't seem to matter, and sometimes it doesn't need to go to the hospital or even need to take medicine to heal itself. But at the same time, influenza has a higher lethality among people who are weak or have underlying diseases. According to data released by the Centers for Disease Control and Prevention (CDC) in early 2018, 36,000 to 50,000 people in the United States die from influenza every year. The 1918 pandemic was more brutal than the First World War, killing at least 50 million people worldwide.

Recently, the spread of the new crown epidemic has caused anxiety: If the pandemic reappears, can we do better than our predecessors in a hundred years? Dr. Jeremy Brown, the head of the National Institutes of Health's Office of Emergency Nursing Research, reviewed Deadly Flu's 100-year history of human treatment against the flu. He believes that human beings still do not have a perfect solution to the flu, and that our technical methods for dealing with the flu have various defects and many restrictions. The determination to overcome the flu has actually involved humans in a "hundred years arms race."

As a senior emergency doctor, Dr. Brown pointed out in his "Fatal Flu" based on his keen observation and professional experience that advances in medical technology have made humans intoxicated with false sense of security. However, the recurrence of seasonal flu and the flu The threat of technology exposes the falsehood of technological progress. Human beings have high hopes for technology, but they habitually ignore the birth and function of technology in the human world, forgetting that the "most cutting-edge" and "most effective" medical products and methods are the result of social and cultural ideas, capital, and scientific games. Stack your supplies for peace of mind when you are unknown.

01
Why doesn't flu forecasting work like weather forecasting?
"The pandemic influenza is not a theoretical threat; to be precise, it is a recurring threat," the U.S. Department of Health and Human Services wrote in its 2017 updated "Influenza Pandemic Plan." Flu is a common disease. We know it will happen, but we cannot predict its severity in advance. Under the dual faces of "minor illness" and "deadly plague", the flu is mysterious and free to come and go. The public, the government, and even experts are swinging between the extreme tension and ignorance, and repeatedly in the unknown. Frustrated.

However, humans have never given up on the search for flu patterns. Although scientists acknowledge that the dynamics of infectious diseases are non-linear and chaotic, predicting where and when the flu will break out is still the interest of many professionals. Columbia University epidemiologist Jeff Sharman's impressive achievements have caught the attention of the US Centers for Disease Control and Prevention. In 2014, Sharman won the Predicted Flu Season Challenge held by the center. Sauman is encouraged by his successful experience. He hopes that the flu forecast will be broadcast as part of the daily weather forecast, so that the public can obtain flu-related information for a long time.

Sharman believes that in the case of high accuracy of influenza forecast, the hospital can flexibly change the resource allocation mode according to the forecast to avoid confusion during the peak of the immune situation. In theory, flu forecasting can improve the efficiency of hospitals and the government in responding to the outbreak, but Dr. Brown pointed out that in his career, he has never seen a hospital change its supply allocation model due to influenza. It is impractical to expect hospitals to adjust resources in advance. First of all, idle beds will cause a zero income situation, which is not conducive to hospital profit. And before the outbreak of influenza, if you need to deploy staff and beds for the emergence of influenza patients, then which surgery can be cancelled?

Sharman's influenza forecasting is based on public health. It is expected that technical intervention will change the hospital's operation and management model, and business costs will not be considered. This is unacceptable to many hospitals in reality. According to Sharman's idea, a severe flu may trigger a public health crisis, so it can be prioritized as an emergency. However, the executive order requires hospitals to deal mainly with influenza, which will inevitably deprive patients of other diseases of medical resources. In extraordinary times, putting influenza at the top of all diseases actually raises new questions for medical rescue ethics: should we take the severity of the disease's damage to individual lives first, or should it be infectious and threatening to the population? What is the first disease that may cause collective panic?

To accurately predict influenza, you need to focus on quite a few variables. By continuously improving the model and adding data, Sharman proved to people that it is not impossible to improve the accuracy of influenza prediction on a technical level. But when we want to turn technological power into applicable practical means, we find that the unknown to nature is not the only factor that limits the effectiveness of technology, and economic benefits and moral concepts may have an impact on whether technology is useful and how it works.

In other words, endless scientific exploration is far from enough to solve the flu crisis. The use of science and technology by human beings is always within the existing social framework. We are often accustomed to these frameworks, and attribute the unsolved problems to the underdeveloped technology. The impracticality of the flu forecast points to the arbitrariness of this attribution: even if we have more advanced technology, existing social values ​​will not necessarily provide them with room to play.

02
If the vaccine is not working, why is the US government still encouraging it?
Every year, many people who get the flu shot still get the flu. Influenza viruses mutate very quickly, and it is a very challenging task to develop vaccines that match each season's new flu in a timely manner. In the best-performing years, the flu vaccine was only 50% effective. A survey by the Cochrane Collaboration found that the prevalence of influenza vaccination among healthy adults was only 1.4% lower than that of unvaccinated adults. However, the U.S. government still recommends vaccination for citizens over the age of half, and spends a lot of money on it every year.

The effect of influenza vaccination in healthy adult populations is not ideal. Why does the United States still spend a lot of money and manpower every year? It may seem ruthless to talk about money before life threatens, but Dr. Brown points out that rational thinking about cost-effectiveness can indeed prevent reckless medical investment mistakes. With limited funding, the UK recommends vaccines to minors, the elderly and people with basic diseases based on cost-benefit calculations. The remaining funds can be invested in more cost-effective treatment services, such as heart disease drugs, cervical cancer screening Investigation to save more lives.

But cost-effectiveness is not so important in American medical services. "We are ready to take more action and try the latest drugs or surgery because we don't want to take risks," Dr. Brown said.
Dr. Brown believes that the degree of adoption of vaccine technology is not just a question of effectiveness. It is not just a question of being rich and not rich. It projects special medical concepts generated in different socioeconomic and cultural contexts. "The reason we do these things is because we have this ability, otherwise we would be considered abandoning." In his view, the United States is used to sending more patients to the intensive care unit, although these patients are no better than others The country is heavier and more chemotherapy is targeted at patients with advanced cancer, although this does not necessarily improve their quality of life or prolong life. Cost-free medical methods are not based on the comprehensive consideration of treatment effect and patient experience, but follow the medical concept of "don't want to take risks". If more advanced technologies are not adopted (although these advanced technologies cannot guarantee absolute efficacy or may even have little effect), doctors, hospitals, and governments may face allegations of dereliction of duty and "failure".

After the public health system turns the protection of citizens' health into a state function, the government bears great responsibility for the public's physical condition. The outbreak of a major infectious disease is a test of government authority. Whether public health affairs can be effectively organized to deal with the flu, or whether it can show a positive attitude, affects the credibility of the government. Therefore, even if all kinds of scientific evidence show that the flu vaccine is not as effective as imagined, as long as it does not bring about adverse effects, its use in some countries and regions can be described as "indiscriminate". After all, the word "vaccine" is a cure for anxiety for most people, and it is also a government credible injection.

03
Is it a helpless strategy for the family to store drugs strategically?
In November 2005, bird flu reignited panic. The then US President George W. Bush delivered a speech at the National Institutes of Health. He claimed that there was no pandemic in the United States or globally, but based on history, it is necessary to stay alert. "The United States has received a number of alerts about this crisis and has plenty of time to prepare."

Bush Jr. immediately proposed a response plan, asking the government to stock up vaccines and antivirals. A neuraminidase inhibitor drug called "Duffy" is listed here. At the turn of the 20th century and the 21st century, the United States and the European Union have approved Duffy as a national medical strategic reserve resource. But just two months after Bush Jr.'s speech, an analysis of an anti-influenza drug released by the Cochrane Collaboration showed that Tamiflu has no effect on influenza-like illness caused by specific influenza viruses, and there is no evidence that It can fight bird flu.

While reviewing Duffy's growth history, Dr. Brown found that every step of Duffy's entry into the market and the national reserve warehouse is controlled by the Swiss pharmaceutical giant Roche. In 2003, Dr. Laurent Kaiser and his team at Ribewa conducted 10 researches on Duffy under the auspices of Roche, but only two results that proved Duffy's effectiveness were published and became Duffy's strong support for entering the national reserve list. However, since 2009, the medical community has successively requested Roche to disclose eight unpublished studies.

In addition, Dr. Brown believes that commercial medical journals also tend to publish positive results in order to gain public opinion. The WHO, which is seen as a neutral international force, also has no escape from the allegations of economic interests-the British Medical Journal has issued a question that its experts have been paid from Duffy manufacturers, and its The results of the investigation are unreliable.

Duffy by Roche

The secret of capital controlling its right to speak and profiting from public affairs has been continuously revealed by rumors, news, and research. Popular film and television culture has brought these stories to the screen for more people to know. However, after the uproar of business and politics, it was quickly classified into the "imaginable" category. When the flu raged, people still submissively entered the illusion of capital construction.

In 2014, Tom Freeden, director of the US Centers for Disease Control and Prevention, responded to a Reuters reporter's question about the efficacy of Duffy, saying that Duffy is not a "universal drug." He hopes that there are better options. does not exist. According to Dr. Brown, this answer explains why people take Duffy-we have no choice. Before the introduction of more effective drugs, the effectiveness of Duffy was not the focus of attention. The ordinary people have a surprisingly consistent position with the government when facing uncontrollable unknown diseases: they are better off.

The language used to name and describe the disease exacerbates this tendency. Dr. Brown was keenly aware that the nickname "Spanish flu" gave the 1918 flu a "strange, weird" feeling. Similarly, the "swine flu" that caught the media's attention in 2009 sounded "threatening and wild." In his view, Bush Jr. urged people to be vigilant against the pandemic in 2005 in a manner similar to his speech on terrorism. The names of exotic and animals have added many weird and vivid details to unknown diseases. The invasion of unclean things has destroyed the original sense of order in human society. People seek a new balance in joint efforts, even if this is just a kind of False illusion.

Duffy's story is hardly a pure business scam. Instead of the public being the object of deception, it is better to say that they had a helpless conspiracy with the government and capital before the unknown natural forces. Before the real panacea for influenza, pharmaceutical giants, academia, governments, and related organizations played a game and compromised in the blank areas of science and technology and the gray areas of public health affairs, as Dr. Brown said, after the 1918 pandemic For a century, we still did not have a surefire way to fight the flu. To store Duffy, we just sought peace of mind just in case.

A former field commissioner from the US Centers for Disease Control and Prevention had summed up Dr. Brown's dilemma and ability limits in a perfect way to Dr. Brown. "Duffy has no effect, so take Duffy quickly."