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What We All Must Understand:

  • “Any community that fails to prepare, with the expectation that the federal government or, for that matter, even the state government will come to their rescue at the final moment will be tragically wrong,” Michael Leavitt, Secretary of Health and Human Services

For Consideration

July 2008

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4 entries categorized "Miscellanea"

June 29, 2008

Credibility and Cognitive Biases

Significant news on the PanFlu and H5N1 front has been rather slow, mostly just more of the same. More plans coming out, more plans to plan, more chickens and ducks dying, more statements of "we've made progress but there's much left to do", and Indonesia's Health Minister Supari is still being most frustratingly obstinate.

Most of the news of note has been about everything but PanFlu or H5N1. Floods, soaring fuel costs, scarcity of food, politics, the US Supreme Court's ruling on the Second Amendment, the findings coming in from the Mars lander Phoenix, an ice-free Arctic this summer. On and on.

The world is a busy, busy place with many important things, some crucially so, intruding upon our limited time and attention spans.

My own life has once again taken an unexpected turn. This past Monday I assumed the Accounting Manager's position as it again became vacant. It has taken a bit of "extra attention" this week as the department undergoes some rather significant reorganization. Since we do not have to hunt a replacement, nor suffer as we train them, this transition, the third this year, is going quite smooth and already showing very positive results – even if I say so myself.

Just as I seemed to be unable to escape taking on a role that I did not want, nor seek, I have been unable to escape a recurring theme of late:

Credibility.

The credibility of our public officials. How the public perceives the credibility of those who advocate on the PanFlu issue. The credibility of the message itself. Who has credibility to parlay into results. Who lacks credibility. Who risks their credibility by speaking up in ways counter to the officially sanctioned public message.

What struck me very recently – no, what knocked me square in the solar plexus, was the realization that those who professed concern for credibility didn't express the same, or for that matter – any – concern for truth or intellectual rigor.

When I made the choice to become actively involved in the pandemic issue I chose to view the public as capable of accepting that a range of potentials existed. Ambiguity, a dearth of hard facts, and evolving knowledge notwithstanding, I believed, and still do, that what we do know deserves to be openly discussed and dissected, and doubly so for what we don't know.

[…]In some cases, people can exert direct personal control over the risks they face (e.g., through diet or driving habits). In other cases, they can only act indirectly, by influencing social processes (e.g., the allocation of law enforcement funds, the enactment of environmental legislation, the siting of hazard facilities). In all cases, they need a diverse set of cognitive, social, and emotional skills in order to understand the information that they receive, interpret its relevance for their lives and communities, and articulate their views to others. They can acquire those skills through formal education, self-study, and personal experience. However, as diligent as they might be, individuals are helpless without trustworthy, comprehensible information about specific risks.

[…]Effective risk communications require authoritative and trustworthy sources. If communicators are perceived as having a vested interest, then recipients may not know what to believe. They may accept the message at face value or reinterpret it in ways that attempt to undo perceived biases. As a result, the impact of communications will be blurred, and the communication process further complicated. Not knowing whom or what to believe can make risk decisions seem intractable (Fischhoff, 1992). Such confusion and suspicion can erode relations between experts and the public, as well as open the door to less credible sources. Such failures of communication can be deliberate, as when communicators attempt to manipulate the public or simply fail to take their duty to inform seriously. However, they can also be inadvertent, as when communicators fail to realize the complexity of their task or the opportunities for failure.

[all emphasis added]

Risk Communication: A Mental Models Approach Morgan, Fischhoff, Bostrom and Atman

 

We all understand that credibility is crucial, whether we are the recipients or the deliverers of an important (potentially life effecting message), but how do we measure it? Do we trust those whose job it is to inform us? Do we trust those with letters trailing their names? Do we trust what a famous celebrity tells us? Do we trust a snarky ex-cop-cum-accountant?

I've chosen whom I view as credible and knowledgeable, and yet even with the information they provide I always – always—run it through my own logic filters. Most times that serves me quite well. On occasion, however, my logic filters don't perform as well as I would like or assume, since like other human beings I have cognitive biases. And, yes, the last I checked I really was a human being.

As I have journeyed I have recently had to come to grips with the cognitive biases I am prone to, even if only in hindsight. Since I have become hyper-aware of how my own shape and inform me, I have also become watchful for them in others.

Being alert to the things that underpin words, I have become aware of a disturbing tendency:

When people begin to spout off about their credibility or the perceived credibility of the PanFlu threat that consistently translates: "I've watered the message down so I'm not judged a scaremonger, my credibility is more important than the truth. Besides, the public is too stupid to effectively handle it so why should I risk my own credibility?"

I don't view the public as stupid, incapable of understanding the myriad facets of all a severe influenza pandemic would likely entail. I have believed most have made conscious choices on the threat of a potential near future severe influenza pandemic. Just as I have made conscious choices on the issue; choices of what and who to believe, what and who to dismiss. But, ya'll out there have cognitive biases as well, so maybe the choices weren't so "conscious" after all, or at least to the degree that I generally go on about (latest here).

This communication thing is far more complicated than I ever knew and I'm learning fascinating things as I feverishly try to address my own naive communication skill-sets. As I've come to understand it I am a "core-dump" person when it comes to information assimilation. That means I want "The facts, all the facts, and nothing but the facts". Which, not surprisingly, shows up in what I have posted over the course of this blog's couple of years of existence.

And that brings me back to credibility: Given my "core-dump" mentality I don't view a "fact" as having credibility – it's a fact after all. And when it's not a "fact", that means it's an assumption, presumption, hypothesis, supposition, extrapolation, or out-and-out guess. Of course, I am assuming the information is promulgated in good faith thus no need to account for lies, falsehoods, half-truths, and anything deliberately misleading.

It's unfortunate that much about what a future influenza pandemic has in store for us resides in the "other than fact" column of the ledger. As a result, the weight we give "other than facts" is highly informed by our perceptions of the credibility of the person making the claims. That is not a bad thing, in fact, that is a very useful and serviceable "logic filter" in and of itself.

I am quite comfortable in "the land of presumption" given my years in law enforcement. In court proceedings things are often presumed factual until proved not: a rebuttable presumption. The most well known example is a defendant's presumption of innocence until proved guilty.

Science has something of an equivalent:

[…] Scientific realists acknowledge (in fact they insist) that scientific knowledge is always provisional, always subject to revision if better evidence is discovered, and most of them have no quarrel with the thought that social factors and extraneous agendas can shape priorities, lines of enquiry, funding, education, and the like.

Why Truth Matters (Benson, Stangroom 2006)

 

I do not find fact and presumption (or hypothesis, logical assumption, inference) untenable dichotomies, even with a "core-dump" mentality, but rather necessary correlates in our search for understanding. Perhaps this also explains why I have no "credibility issues" when I post and discuss what we do know versus what we think we know. To me "being wrong and willing to be proven so" is a wonderful part of the process – it protects us – allowing us (hopefully) to get past the ego to continually search for more perfect understanding, and on those rare occasions to go from postulate to indisputable fact.

But what happens when the person informing us of something so heavily burdened with "other than facts" is also quite consciously guarding their credibility?

We get silence.

Many can't admit, even to themselves, that the watered down message, or outright silence, is self-serving. No, instead, they blame the audience: The public is too stupid to understand, much less channel that understanding into anything other than blind panic.

I'm not certain about anyone else but I tend to be insulted when someone thinks I'm stupid. Even if it's only an ego-protective self-serving cognitive bias on their part.

November 25, 2007

Who Speaks and Holiday Weekend Miscellanea

I have spent a number of days nostril deep in tackling concepts of DNA, and by extension, RNA—influenza's genes are made up of RNA, as well as a more structured understanding of virology. As with much of what I do or know in my life it's "enough to get me in trouble" but not really enough to do me much good. Those of you who may have wondered why I wasn't on the forums that I am known to inhabit with such regularity that is the reason. Enforced "nose to the grindstone".

 

Who Speaks?

I write and participate on the flu forums under the pseudonym SophiaZoe, an iteration of my original pseudonym of ZoeSophia from back when IRC had its heyday, "Life's Wisdom". Since the inception of this blog two other "Sophia Zoes" have shown up with a web presence. That doesn't bother me in and of itself, obviously, I was drawn to the name so they may have been as well, or, it might actually be their name unlike my use of it. But I take a certain pride in "being unique" and I would abhor being mistaken for someone else, not to mention that the other SZs might not appreciate being mistaken for me.

 

Anonymity is an ongoing concern, both in general on the internet, and in the Cyber Flu Community specifically. Some have chosen to drop the comfort and security that anonymity affords and step into the public's view. Not many, but some. I gave up my anonymity back in the spring and haven't regretted the decision. What I have regretted is that I have a certain "web presence" under my pseudonym so even though I would like to switch to my real name I feel it is important to maintain SophiaZoe for the sake of continuity.

I will, however, content myself with "introducing" myself to all of you, as the next best thing.

Debi Brandon

48 years of age

Wife, mother, grandmother

 

The picture was taken with the crappy camera that comes with the Iphone. Honestly, it is so crappy that I don't understand why they even bothered to include it. Oh, and for the record: While I do have gray hair, which I wear with pride, it's not as gray as it appears in the photo, strange lighting and crappy Iphone camera. However, I thought it added a certain "air of distinction" and rather liked the effect so this is the picture I chose to share.

 

As it says in my "About" page on this blog I was a police officer back in my "younger days", I married a cop, I am the daughter, sister, and mother to others, past and present. I have seen heroic goodness, heart-rending tragedy, and frightful depravity; often the family conversations would curl the toes of most people. I exist in an insular and "unique world", and unavoidably, sometimes that "uniqueness" shines through.

My formal education was in Computer Science, but that was so long ago that technology has left me in the dust. Now when something goes wrong with one of my computers I turn to the Geek Squad—or buy a new one. Speaking of which: my "work-horse" laptop went to visit The Geek Squad and I am working on my "travel laptop", a Vista based machine. Vista—what a crappy OS—I spend more time re-booting than I do accomplishing anything.

While I will continue to post under the pseudonym of SophiaZoe, I did what to introduce myself, as I no longer feel that anonymity is necessary or especially helpful to the furtherance of PanFlu information exchange.

 

Debi (aka: SZ)

November 22, 2007

Thanksgiving in America

Today is the day we celebrate Thanksgiving in America. A day when most families gather around a table strained with weight of a feast lain before them. A day to offer thanks for our blessings.

 

To all of my readers in America: Happy Thanksgiving. I hope this day finds you surrounded by the love and laughter of friends and family.

To my Fellow Flubies: Aside from my own family, you are the greatest blessing that I count.

 

Please remember, as you gather in celebration, the firefighters, paramedics, police, doctors, nurses, deployed and TAD military personnel, who are away from their family and friends protecting and safeguarding ours.

 

SZ

November 15, 2007

Adenoviridae

Today's news has been heavy with the internet publication of information on yet another emerging human pathogen, a variant of Ad14.

Ad14 is an adenovirus, of which there are somewhere between 40 and 50 human serotypes, depending on which resource one reads. There are also adenoviruses that infect other mammals, birds, and even amphibians.

From today's CDC MMWR:

Acute Respiratory Disease Associated with Adenovirus Serotype 14 --- Four States, 2006--2007

Adenovirus serotype 14 (Ad14) is a rarely reported but emerging serotype of adenovirus that can cause severe and sometimes fatal respiratory illness in patients of all ages, including healthy young adults. In May 2006, an infant in New York aged 12 days died from respiratory illness caused by Ad14. During March--June 2007, a total of 140 additional cases of confirmed Ad14 respiratory illness were identified in clusters of patients in Oregon, Washington, and Texas. Fifty-three (38%) of these patients were hospitalized, including 24 (17%) who were admitted to intensive care units (ICUs); nine (5%) patients died. Ad14 isolates from all four states were identical by sequence data from the full hexon and fiber genes. However, the isolates were distinct from the Ad14 reference strain from 1955, suggesting the emergence and spread of a new Ad14 variant in the United States. No epidemiologic evidence of direct transmission linking the New York case or any of the clusters was identified. This report summarizes the investigation of these Ad14 cases by state and city health authorities, the U.S. Air Force, and CDC. State and local public health departments should be alert to the possibility of outbreaks caused by Ad14.

 

As with most infectious diseases, it is difficult to know the true extent and severity of a pathogen based solely on the cases that result in medical consultations and/or hospitalizations. There is no way of knowing how many cases occurred, and probably continue to occur, that were not severe enough to require medical treatment. Were we to have access to that data the alarming statistics in all likelihood wouldn't be so alarming, but without the full data set we are left with what we the data we do have. And that data is rather alarming.

This from MSNBC:

New cold bug kills 10, scores sickened

Scores sickened as mutated virus becoming more common, CDC says

The Associated Press

updated 1:55 p.m. ET, Thurs., Nov. 15, 2007

ATLANTA - A mutated version of a common cold virus has caused 10 deaths in the last 18 months, U.S. health officials said Thursday.

Adenoviruses usually cause respiratory infections that aren't considered lethal. But a new variant has caused at least 140 illnesses in New York, Oregon, Washington and Texas, according to a report issued Thursday by the U.S. Centers for Disease Control and Prevention.

That is incorrect based on the MMRW report:

[snip]

Cases reported postinvestigation. Since the investigation, new cases of febrile respiratory illness have continued to occur at LAFB, but the weekly incidence has declined from a peak of 74 cases with onset during the week of May 27--June 2, to 55 cases with onset during the week of September 23--29 (the most recent period for which data were available). In addition, during March--September 2007, three other military bases in Texas that received trainees from LAFB reported a total of 220 cases of Ad14 illness (Air Force Institute for Operational Health, personal communication, 2007). However, whether Ad14 spread from LAFB to these three bases has not been determined. Ad14 also was detected in April in an eye culture from an outpatient in the surrounding community who had respiratory symptoms and conjunctivitis. No link between this case and the LAFB cases was identified.

 

The Associated Press article from MSNBC closes with this paragraph:

More common
It's not clear how the changes made it more lethal, said Linda Gooding, an Emory University researcher who specializes in adenoviruses.

Earlier this year, hundreds of trainees at Lackland became ill with respiratory infections. Tests showed a variety of adenoviruses in the trainees, but at least 106 — and probably more — had the mutated form of Ad14, including five who ended up in an intensive care unit.

 

So while the reporting is alarming, the story that they attempt to report on is not clearly delineated, nor can it be; we just don't possess all of the facts on all of the (likely) cases.

We do, however, know that adenovirus is long-lived outside a host. Door handles/knobs, counter surfaces, toilet and bathroom sink handles, shopping cart handles, and the myriad other surfaces we touch on a regular basis throughout our normal day. Washing our hands regularly and keeping our hands away from our face will go a long way in helping to guard against infection. In today's "viral jungle" we must learn to adapt our behaviors as rapidly and efficiently as the pathogens we face.