Joe Collier on swine flu and ministries of fear

Professor Joe Collier One thing about the current swine flu pandemic is that it has brought with it a universal sense of fear. As with all fears, individuals respond differently, but we know what they are feeling because the sensation of fear, which varies from a mild anxiety to incapacitating panic, is so much part of our constitution that some see it as a normal component of the human condition. The odd thing is that the fear, as an emotion, seems to offer no survival advantage, rather it just causes trouble. That being so, such a response must be seen as irrational and unhelpful.

Where, for example is the advantage of fear to those with new (and worrying) symptoms, who, for fear of being diagnosed with a serious condition are struck by inertia and don’t dare consult their doctor? Or the advantage to those in whom the fear of a ‘positive’ test result, causes endless sleepless nights and anxious days? Or the advantage to those who are prevented from going out at night for fear of being attacked by a stranger? Or the advantage to those in whom the fear of having the wrong body shape causes them to embark on perverse dietary and lifestyle manoeuvres that can end in premature death (cf anorexia nervosa)? Finally, and to some extent extreme, the advantage to those with agoraphobia or claustrophobia whose all-consuming panic attacks make life unbearable?

Back to swine flu – we need to ask why there is a sense of fear (albeit unhelpful) and whether it is justified. The position amongst the population at large is far from straightforward but last weekend Libération, a serious daily in France (England and France are affected by flu similarly) made a strong case that the current flu fear factor is actually the product of French government manipulation.

Traditionally fear is used as a control mechanism by dictatorships. But now, democratic governments are also turning to fear (for example see the use of threats of terrorist strikes, bird flu, missiles from Iraq, computer millennium meltdown etc), as a tool to control populations. Moreover, they have a ready ally in the media who love a bit of drama. In general one might expect governments to calm their populations, but now it seems that calming is not the priority.

Interestingly, Libération also says that the people are wising up to this strategy and that some are rebelling so that in France, as in the UK, there are countless doctors and patients rejecting the offers of vaccination (is it safe? is it effective? are we being used by industry?).

But something else might also be going on. Could it be that health departments themselves are the victims of fear? Recognising that panic and irrational behaviour are key features of fear, could these explain the almost manic activities at the centre as letters and recommendations aplenty are sent out (6 letters in 5 weeks telling managers of the importance of vaccination)? Or the bizarre decision in the UK to make the antiviral oseltamivir (Tamiflu) essentially available over- the-counter despite its unproven value when used in this way, despite the risk of unwanted effects, despite the inevitable risk of inducing virus resistance, and with apparent disregard of the expense to the NHS.

The current flu pandemic is clearly of great relevance with regards to health, but in passing it might also reveal something about our current relationship with governments, and the latter is not a trivial issue.

Joe Collier is emeritus professor of medicines policy at St George’s, University of London