Mad Cows and the Maddening Decade of Public Health
SCOTT C. RATZAN
Nearly 10 years ago, on March 20, 1996, the term ‘‘mad cow
disease ’’went global. The U.K. government issued a report
suggesting that bovine spongiform encephalopathy (BSE), the technical
term for mad cow disease, could be transmissible to humans, who could
then develop CJD —Creutzfeldt –Jacob disease.
While this may have the complexity of twentieth-century science fiction, it
was
simplified for the public that eating beef can cause a mad-cow-like
disease in
humans. The fears quickly spread beyond the United Kingdom to Europe
and the
rest of the world. Today, the ramifications are still felt, with bans of
beef in force
in Japan.
The initial announcement by the UK government a decade ago sparked
concern
that 16 cases affected young people under 40 were the tip of the iceberg. Mad
cow
was heralded publicly as an AIDS-like crisis in Britain. Scientists argued
over how
the infectious agent got into cows, though no one has yet proved the
link of BSE
to CJD, from cows to humans from eating beef.
The key question stemmed from the theoretical exposure to the believed
infectious agent, the misfolded protein called a prion that is thought
to cause the disease in cows, and how many victims would be fated to
emerge in the years to come as CJD ’s (unknown) latency runs its
course. Even the U. S. Centers for Disease Control and Prevention, assuaging
public fear in the United States, issued a statement in the New York
Times linking causality: ‘‘There is no evidence that anyone
in the United States has died of the mad cow disease that has killed
eight people in Britain, the Centers for Disease Control and Prevention
said today.’’
In actuality, the facts today point to a diminishing incidence of variant
CJD, with 153 cases reported over the past decade, and only 5 cases
in 2005. There are other facts to consider: First, there is no direct
evidence that CJD comes from the ingestion of contaminated beef, as
the mad cow prion has never been found in solid muscle meat like the
roasts, steaks, and other cuts commonly consumed. There also are still
a number of scientists who believe the prion is not the carrier of the
disease.
The question a decade later is not whether we can prove science right
that CJD was spread from eating beef. What is at stake today goes well
beyond infected beef: It involves questions of how we should respond
to other future outbreaks. As few people publicly challenge the veracity
of the claims or the quality of evidence with a scientifically plausible
argument, the policy response to potential, theoretical health threats
such as SARS, avian flu, and the next food scare is at stake. History
is not the best guide in these cases. Most decisions on banning imports
or changing feedstocks in the British scare were made not by scientists
but by politicians and business people concerned with political and
economic considerations rather than with actual risk to human health.
Competing messages by news organizations, poli- ticians, watchdog groups,
and medical officials continue to make the public uneasy. In the recent
case of avian flu, the top World Health Organization (WHO)official coordinating
the response suggested that the Avian flu could kill 150 million people
IF it mutated for human-to-human transmission. But the probability of
the jump from bird to human has yet to be established. This was further
extrapolated to an economic catastrophe estimated by the World Bank
for the first year to be more than $1.1 trillion, warranting a significant
response to mitigate risk. There has yet to be adequate funding for
multiple stakeholders who appropriately assess probability in concert
with preparation for the ideal global response. The recent loss to the
Asian poultry sector is already around $18 billion, in line with the
loss to British farmers in the initial crisis phase.
At a recent pledging conference in Beijing, Margaret Chan, WHO assistant
director challenged the 800 representatives of 100 countries:‘‘Whatever
resources you put in place —compared to the potential pandemic
cost —it is peanuts. It is nothing. ’’Such a feeling
of hopelessness is in line with the response developed during the years
when mad cow disease was thought to be confined only to cows. Creating
a robust public health system to address infectious disease in countries
where limited systems are in place is not just a simple economic task;
it requires deployment and expertise.
Regardless of the perceived threat, the immediate focus must be to
save lives and prevent any deaths from occurring. But as a former public
health researcher (I am now a vice president in governmental affairs
in Europe for Johnson & Johnson, work that has no relation to the
mad cow issue), I think we should also look at each new potential outbreak
as an opportunity to enhance public health. For example, the potential
deadly avian flu epidemic may in the end improve public hygiene if we
can stress the need for environmental precaution, personal protective
measures such as hand washing, and explanations to the public about
the infectious nature of disease, all while reinforcing the value of
epidemiologic measures including reduction of exposure to potential
infectious agents.
Perhaps the last decade with mad cows and mutated viruses will advance
better policy decisions based on sound science and evidence. But for
now, as scientific certainty does not exist, today’s marketplace
of business, media, science, and politics requires integrity, trust,
and patience. ‘‘They say that beef can kill you ’’has
become a reality to many. Some already believe that ‘‘They
say that the bird flu will (or already has)spread from human to human
(and hence I am at risk), ’’despite no real evidence. We should
work so that the next ‘‘They say ’’in health should
advance public health with trust and integrity. Stakeholders and others
involved in all health sec- tors must work together with the government
to advance prudent policy and with the media to communicate to the public
what we really know. After all, mass hysteria over imagined fears is
its own form of madness.
_____
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also is Vice
President, Government Affairs, Europe for Johnson & Johnson with
academic appointments at George Washington University School of Public
Health, Tufts University School of Medicine, Yale University School
of Medicine, The College of Europe, and University of Cambridge.
