MOVIES, YOGURT, AND VACCINE MISINFORMATION

During the past couple of weeks, the attention of the media was chiefly captured by the endless quarrel on compulsory vaccination.  The WHO Regional Office for Europe released data about death for measles in Europe in 2016, which amounts to 35 fatalities,  an outrageous number, considering the vaccine-preventable nature of measles. New legislations enforcing mandatory vaccinations are  in progress in Italy and in France, raising, however, fierce objections not only among anti vax people but also among people merely unhappy with the intrusion of the state into what they consider their private life. Such a point of view seems to be supported by a report issued in early July by the British Medical Association, strongly discouraging compulsory vaccination because it would disrupt the doctor-patient relationship.  In the while, anti vax activists continued their  never-ending polemics  against Big Pharma. Nothing new under the sun; each actor persisted in playing its role in the wider “vaccination comedy”. Yet, playing again and again the same character on the stage is risky. Repetition blinds, prevents seeing novelties. This is well illustrated by three parallel stories, which received far less attention from the media.

The first story is reported by Harriet Hall, “a retired family physician who writes about pseudoscience and questionable medical practices”. Harriet devotes her 11 July comment to What the Health, a successful documentary,  released on March 16, 2017. The documentary claims to provide the evidence that meat and dairy food are responsible for most “modern” deadly diseases, and that all health agencies and scientists know this truth, but they conceal it because they are on the Big Food and Big Pharma’s payroll. The audience of the documentary had a sudden and unexpected spike last June, after it was added to Netflix, as showed by Google trends. After carefully reviewing the movie, Harriet Hall concludes “The “What the Health” movie is not a balanced documentary, but an alarmist, biased polemic. It cherry-picks scientific studies, exaggerates, makes claims that are untrue, relies on testimonials and interviews with questionable “experts,” and fails to put the evidence into perspective. It presents no evidence to support the claim that a vegan diet can prevent and cure all the major diseases. It is simply not a reliable source of health information”. Notwithstanding Harriet’s efforts, it is easy to predict that many people all around the world will continue watching this movie, finding in it the evidence that eating meat and dairy causes cancer and chronic diseases.

The second story is reported by Jonathan A. Eisen, professor at the Genome Center of UC Davis, California. Jonathan wrote a nice post instigated by the echo raised by a paper published  on June 28 on Psychosomatic Medicine, a leading, peer-reviewed,  journal, which has been the official journal of the American Psychosomatic Society​ since 1939. The paper, a bit pompously entitled “Brain structure and response to emotional stimuli as related to gut microbial profiles in healthy women”, claims to demonstrate that there is a causal association between gut bacteria and emotion, which is a misleading statement, because – argues Jonathan – the paper only shows a statistical correlation between some gut microbiome patterns and some behavioral traits.  Not only “behavioral traits” are not emotions (in case, they are just indirect signs of emotions), but turning a correlation into a causal relationship is a fallacy known since Aristotle's time. Eisen comments,  “it could be that people with different thought patterns eat differently.  Or people with different thought patterns exercise differently.  Or just about anything.” Yet, the findings of this paper have been overemphasized by media, e.g., the Huffington Post had the headline “Your Gut Bacteria Really Do Affect Your Emotions”; Science Alert, “Human Emotions Really Are Affected by Gut Bacteria, New Study Suggests”; the Daily Mail, “Gut feelings are real: Some people have stomach bacteria that makes them more anxious and stressed, study shows”; Forbes, “The Fascinating Connections Between Gut Bacteria, Weight and Mood”. The study was promoted by UCLA, the  University of California, Los Angeles, whose annual economic impact totals the equivalent of one percent of the entire California economy. Purposely, Dr. Eisen investigated about recent UCLA press releases, and he discovered that, on June 29, the University Press Office released a statement, claiming that a UCLA team has  “identified gut microbiota that interact with brain regions associated with mood and behavior”. Jonathan concludes that the source of misinformation was that press release. Well done, but he mercifully omits to add that the first author, Dr. Kirsten Tillisch, received funding from Danone Research, the research branch of the famous world food company; also his main co-author, Dr. Emeran Mayer, was on the advisory boards for yogurt product company Dannon and its parent company Danone. Moreover, 3 other persons of the team were employed by Danone Research; while another researcher was employed by Symrise Group, a German multinational  providing “fragrances, flavors, active ingredients (…) for the (…) food, beverage and pet food and baby food industries”. Since 2014, Symrise AG has made massive investments on the probiotic market acquiring two leading companies, the French Dianafood and the Swedish Probi. Finally, the whole study was partly supported by grants from Danone Research. It is difficult to avoid the unpleasant impression that movies such as “What the Health” are not totally groundless. To be sure, they are misleading people about their health, which is a lot worse than covertly advertising probiotic products, which is not that horrible crime. The UCLA team just marketed  its findings and, incidentally, also yogurt consumption. Yet, there are reasons not to be happy with such a way to inform the public, notably in a moment in which we need to strengthen public trust in science.

The third story has received for now less press coverage, although it is by far the most important.  In early July, a group of Canadian virologists from the University of Alberta announced to have recreated an extinct horsepox virus using synthetic DNA strands. Horsepox viruses are not dangerous for humans, but the research demonstrates that in principle all types of pox viruses could be generated in the same way, including the lethal smallpox. The novelty is not in the technical procedure, because since 2002, we know that it is possible to assemble pox viruses  from scratch, rather it is in the demonstration that this could be done by a “small scientific team with little specialized knowledge half a year and cost about $100,000”, purchasing DNA available on the market,  and without asking for (or by-passing) any authorization or security clearance. This dreadful news passed nearly unnoticed, without anyone - either scientists, regulatory authorities, public health agencies, scientific journals, general press, or social media – realizing the enormity of the event. With the laudable exception of HuffPost UK,  and a couple of online scientific magazines, this news was completely ignored. Yet, this is still half story, the second half is that this news was not at all new. Actually, Canadian virologists had already presented their findings in November 2016, at the WHO Advisory Committee on Variola Virus Research meeting in Geneva, and a report from that meeting has been available on WHO's website since May 2017. When researchers tried to draw  WHO's attention on their experiment, “the first response was, ‘Well let's have another committee to review it,’ and then there was another committee, and then there was another committee that reviewed that committee” tells David Evans, the Canadian team leader, who eventually comments "It became a little bit ludicrous”. Almost in the same period, (on March 2, 2017), Tonix, a pharma company which collaborated with the University of Alberta in this study, announced the “successful synthesis of a potential smallpox-preventing vaccine. This vaccine candidate, TNX-801, is a live form of horsepox virus (HPXV)”. Reading their press release, it was evident that the horsepox virus was recreated from scratch in a quite trivial way. Yet, the story still got unnoticed.  Evans also sent the draft paper describing the study to the Canadian Public Health Agency, as well as to the Food Inspection Agency, only getting the staggering, candid, answer that “these things potentially fall under export legislation”.  The whole chronicle was finally reported by the July 6 issue of Science, which was  the sole media, and prominent scientific journal, which gave to this story the relevance that it deserves. Thus a happy end? Almost. Actually, as Caroline Ash, an editor at Science, honestly admits, the paper of the Canadian team was initially submitted also to Science, which rejected it, because it did not offer “a sufficient gain of novel biological knowledge to offset the significant administrative burden the manuscript represents in terms of dual-use research of concern”, an answer which is a terrific example of bureaucratic miscommunication.


These three parallel stories - the fortune of a pseudoscientific documentary; an oversold study, covertly promoting yogurt consumption; an unnoticed research, showing how it could be easy today to recreate a deadly virus -  illustrate quite well the subtleties of today science communication. It's just a shame that most media, including social media, didn't realise it, getting instead trapped into the bubble of the anti vax quarrel. 

FROM DANGER TO RISK

In a research letter published by Nature in the last week of June, Kevin J. Olival and his team at the EcoHealth Alliance, a New York based global environmental health nonprofit organization, have announced the results of their latest study on “Host and viral traits predict zoonotic spillover from mammals”. Researchers investigated whether it is possible to predict human pandemics of viral origin by focusing on “by phylogenetic relatedness to humans, host taxonomy and human population within a species range”. Their findings suggest that “both the total number of viruses that infect a given species and the proportion likely to be zoonotic are predictable”, consequently “providing a novel framework to assess if a newly discovered mammalian virus could infect people”. The study size was remarkable. Researchers investigated 54 mammalian species (in this preliminary study they focused only on mammalians), say 14% all mammalian species, and identified 586 different viruses. Among these viruses, 263 (44,8%) were shared by animals and humans, including 188 zoonotic viruses, which were transmitted from animals to humans in the past; 73 viruses, previously considered “specific” to humans, were instead found in animals, so providing the evidence of “inverted” zoonosis, say, transmissions from humans to animals.  Overall this study demonstrated the ongoing infective cycle between humans and animals, which strongly supports the notion of “one health”.

Surprisingly enough, the results of this study have been immediately reported and amplified by world leading media, including The Economist, Time, Wired, Science Magazine, International Business Times, Wall Street Journal, Spiegel, BBC News, CNN News. It is rare to see such an interest for a news which could seem, at a first glance, of interest only for biologists and epidemiologists.  Why so many media were “thrilled” by this study? The Economist provides a possible answer, “maps”. The research team was as smart as to distillate their results into very catching graphics, “heat maps showing places where the actual and predicted number of zoonotic viruses least resemble one another, and which therefore have the highest risk of springing a nasty surprise on the world”.  Brief, “having maps like these – continues The Economist - is important because they can help researchers choose the most fruitful places to conduct studies into zoonotic transmission and (…) increase the chance that the next SARS or AIDS might be spotted, almost before it has emerged”. This is then the first lesson to be learned, in the information society – like in the illiterate medieval Europe – images are much more effective than words if one aims to reach a wider audience. In the medieval Europe, where most people could not read, the Church, which included most educated people of that epoch, sponsored artists to educate the mass by images. We should then thank illiteracy for the windows of the Chartres Cathedral and Giotto’s paintings. Although one can hardly recognize today Giottos, effective tools for communicating scientific discoveries are welcome.

Yet, there is probably a deeper reason why this news has had such an impact on media, something novel happened recently, deeply changing the nature of epidemics and pandemics. Once, epidemics and pandemics were considered non-insurable risks. The Insuranceopedia  defines non-insurable risk “a risk an insurance company deems too hazardous or financially impractical to take”, which is a right definition but still insufficient. A more precise definition is provided by the Financial Time Lexicon, “A risk for which an insurance company will not provide cover because it cannot calculate the chance of it happening”. More precisely, a non-insurable risk is a risk whose odds of coming to be cannot be calculated, and therefore the insurance company cannot work out a premium that must be paid. Typical non-insurable risks are political, reputational, and regulatory risks, whose odds are unpredictable because they depend too much on human contingency and randomness; also “acts of God”, the legal formula used in the English–speaking countries to indicate natural disasters, are non-insurable. For insurance purposes, acts of God are events that cannot be foreseen, avoided, or anyway prevented.  Today, however, some acts of God are considered insurable (e.g., flood, earthquake, volcanic eruptions, and so) either because they turned out being the consequence of human intervention (e.g. environmental disasters) and consequently preventable, or because their chance of occurrence can be inferred from statistics of similar past events. Epidemics and pandemics have been always considered totally unpredictable and unpreventable, consequently uninsurable. Given that the definition of risk entails that 1) the odds of a negative event can be calculated; and 2) the negative event may be avoided through preemptive action, epidemics and pandemics should  be considered – rigorously speaking -  dangers, threats, but not risks. This holds true till to 2014.

In 2014, the Munich Reinsurance Company (Münchener Rück), a world’s leading reinsurance company, started a strategic partnership with Metabiota, a San Francisco-based global company that “has pioneered the use of near-real-time data collection and comprehensive risk analytics for epidemics”. In 2015, in the midst of MERS epidemics, Munich Re, on the basis of data provided by Metabiota, accepted to reinsure the Korean government, which wanted to offer a full insurance coverage to all international travelers and tourists. This decision contributed to prevent massive travel cancelations and consequent economic loss. In May 2016, the World Bank in collaboration with the World Health Organization initiated the Pandemic Emergency Financing Facility (PEF), a global insurance scheme for epidemics and pandemics risks, offered to 77 low income countries. The PEF covers most zoonotic viruses involved in potential pandemics, including new Orthomyxoviruses (new influenza pandemic virus A), Coronaviruses (SARS, MERS), Filoviruses (Ebola, Marburg) and other zoonotic diseases (Crimean Congo, Rift Valley and Lassa fever). PEF financing is triggered when the infection reaches a certain level of contagion, calculated on the basis of WHO data on the number of deaths, the speed of the disease spread and whether the disease crosses international borders. Munich Re, Swiss Re and GC Securities  accepted to reinsure the World Bank for this program, so making it feasible.  Finally, in 2017, Munich Re made pandemics  and foodborne infectious diseases  strategic priorities.

This is then the second lesson to be learned from the EcoHealth Alliance’s study. Advanced genomics, big data, and predictive analytics are not only changing our scientific and operational approaches to epidemics and pandemics, but they are also deeply changing the very notion of infectious outbreaks, which are now entering, in their own right, the world of predictable and preventable “risks”.  The impact of this event is much wider than one could guess, also implying important communication consequences.