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The Next Pandemic: Bird Flu, or Fear?

Fear and paranoia often take hold when a disease threatens to become an epidemic. Dr. Marc K. Siegel is the author of the new book Bird Flu: Everything You Need to Know About the Next Pandemic.


Other segments from the episode on February 2, 2006

Fresh Air with Terry Gross, February 2, 2006: Interview with John Tayman; Review of Mary-Ann Tirone Smith's book "Girls of tender age;" Interview with Mark Siegel; Review of Edsel Gomez's new album …


DATE February 2, 2006 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A

Interview: John Tayman, author of "The Colony: The Harrowing True
Story of the Exiles of Molokai," discusses his book

This is FRESH AIR. I'm Terry Gross.

We're going to hear the story of an infamous leper colony which my guest, John
Tayman, describes as a long, deadly and misguided experiment in medical
segregation. It was located on a remote and inaccessible peninsula on the
Hawaiian Island of Molokai. For 103 years, beginning in 1866, the Hawaiian
government forced people who were diagnosed with leprosy to live there.

In his new book, "The Colony" John Tayman tells the story of this colony and
considers what it tells us about public health. He points out that at the
time of the colony, leprosy was believed to always be highly contagious, which
we now know is not true. In part to destigmatize the disease, it is now
referred to as Hansen's Disease.

The Hawaiian king signed into law an act to prevent the spread of leprosy
which criminalized, actually criminalized the disease. What did the law say?

Mr. JOHN TAYMAN: The law gave the Hawaiian government the right to arrest,
imprison and exile anybody they thought had the disease.

GROSS: Is this a precedent making law, or are there other laws you know that
criminalized having the disease?

Mr. TAYMAN: No, the law wasn't unique. Other countries had done somewhat similar
things, but the kingdom, or the king, arrived at this idea primarily on the
counsel of his American and European advisers, and they were reacting with
some amount of panic to what they thought was an impending epidemic of

GROSS: Why did they think that an epidemic was imminent?

Mr. TAYMAN: Well, the government was a little sensitive to epidemics of any sort
because they had suffered through a series of them that had essentially halved
the population in the islands from the time of first contact. It was
estimated that about 350,000 Hawaiians lived there before the first white
settlers came and the missionaries, and, by the time they began to see an
increased number of leprosy patients, that population had fallen to 150,000.
And so, in part because the king was terribly concerned that the remainder of
his people were going to be wiped out, he listened to his advisers, and the
advisers said the only was we can do this is to round up everybody who has the
disease, put them in this island prison, and let the disease die itself out.

GROSS: Now you think that this exile was based on several misunderstandings
of leprosy. What were the misunderstandings?

Mr. TAYMAN: Well, at the time that they passed the law, they knew very little
about the disease, and the law remained in effect, not only through the
Hawaiian government, but after America annexed the islands, and indeed, after
it became a state. And some of those misconceptions about the disease,
itself, remained in place. Probably the biggest one was that leprosy was
rampantly contagious. In fact, it's a very, very difficult disease to catch
and 95 percent of the population has a natural immunity. The other thing is
that everybody they sent away they assumed was infectious. And in fact,
again, there are different degrees of leprosy, and, as it turned out, of the
more than 8,000 people they sent away to this island prison to die, more than
half of them probably didn't have to be there. They were either misdiagnosed
or they had the disease in a form that wasn't contagious.

GROSS: Would you describe the disease that's now called Hansen's
Disease--during most of the historical period you're writing about it was
called leprosy--but would you describe the different forms of the disease and
the different stages of it?

Mr. TAYMAN: Sure. It's a chronic infectious disease that's caused by a germ, and
typically what happens is that you inhale that germ like you would a common
cold or tuberculosis. And then once--if you're susceptible to the disease and
once it takes hold, it attacks the skin and the nerves. Now, the germ, the
bacteria itself, reproduces best at cooler temperatures, and so it tends to
move to the far regions of the body, the fingers and hands and the nose and
the eyelids and the cheeks. And when it begins to multiply rapidly, it can
cause disfigurement. Of course, in the 1940s, they did create a cure, and
it's a multidrug therapy that arrests the disease within a day of your taking
it and it stops any further disfigurement. Nonetheless, the disease is still
relatively common in the United States. It is more prevalent than measles
right now, and there's about 7,000 people who either have or have had the
disease in the US.

GROSS: The old stereotype of leprosy is that your fingers fall off and your
toes and, you know, your ear lobes. How much truth is there to that?

Mr. TAYMAN: Not very. What happens is that you lose the sensitivity. You lose
what doctors call the gift of pain in your fingers and toes. And so, where
you and I might touch a hot plate or a sharp piece of glass and immediately
feel the danger of that and yank our hands away, people with the disease
don't--aren't able to react that way, and so they are continually traumatizing
their fingers and toes. I write in the book that, on the average, a typical
person injures themselves 4,000 times in their lifetime and most of that is
everything from paper cuts to small burns and whatnot. Well, with somebody
who doesn't have the feeling in their hands and feet, that number doubles or
triples, and it's the constant trauma, the constant damage that they're doing
to their fingers and toes that causes the blunting. So the myth that they are
dropping fingers and toes and arms and legs in the street is just that--it's a

GROSS: Was there any way of empirically diagnosing the disease?

Mr. TAYMAN: For many years, no. Certainly for the first 50 years or so they had
no clear way of determining whether you had it. Leprosy is caused by a
particular bacteria, and it's relatively straightforward. It attacks the skin
and nerves, and if it's left untreated, it can cause partial paralysis and
insensitivity and blindness and some disfigurement. There's a cure now of
course, but until the early 1920s, they really had no bacteriological method
of determining if you had the disease. When they finally did find one, they
allowed people to be rediagnosed, and of the first 11 people that they
rediagnosed, all 11 turned out not to have the disease. Many of them had been
in exile for 20 years already.

GROSS: Would you describe the peninsula that was chosen for the leper colony?

Mr. TAYMAN: Sure. You know, Robert Louis Stevenson called it a prison fortified
by nature, and that's very much what it was. Molokai is the island between
the islands of Maui and Oahu, and it's a relatively small, underpopulated
island. The northern side of that island boasts the highest sea cliffs in the
world, these 3,000 foot green walls that sort of leap up from the sea. And
about midway along the coast, there's a little triangle of flat land that
emerges about two miles by two miles. And it was relatively barren, and it
had only a few residents on it. And so one of the original members of the
board of health, who knew the island from his time as a traveling doctor in
the islands, suggested that this would be an ideal place to send away these
people. It's impossible to land on it because the seaside borders of the
island are ringed by lava rock, and there's no natural landing or natural
beach. And so the only way in is down this giant cliff or to try and pilot a
little whale boat to an edge of the peninsula and make your way in that way.
It was very treacherous, and many people died.

GROSS: So you're pretty well guaranteed of being kept very remote from the
rest of the world.

Mr. TAYMAN: It was. It was like the government intentionally shipwrecked these

GROSS: So what happened to you if you were diagnosed with leprosy? What
could you expect after that?

Mr. TAYMAN: Well, nothing good, quite frankly. The government sent out tax
collectors, sheriffs, other sorts of government agents, and in a few cases,
doctors, to comb the islands and identify anyone they suspected of having the
disease. There was a master list that was kept, and, based on that list, they
decided whether you were a candidate to be exiled or not. And so essentially,
these were businessmen, parents, and children who were pulled from their homes
and from their offices and classrooms even, and they were marched down to the
waterfront, locked into cattle stalls on livestock supply ships, and then
sailed across the channel and left to die on this prison.

GROSS: OK, so the people who were quarantined to this peninsula, they are
living in a place that is incredibly remote and hard to get to. They are not
farmers or anything. I mean, what do they eat?

Mr. TAYMAN: Well, the government actually thought they were going to be farmers.
They thought the colony would be self-sufficient, and so, on the first day
when the first 12 people were dumped on shore and they straggled to shore,
sort of soaked through with sea water and damp and blinking with shock, the
resident overseer that the government had hired to literally sort of just be a
prison guard handed them a shovel or a hoe and a blanket, and then he marched
them across to this abandoned village and told them to start making it their
home. And they were expected to farm enough and raise enough crops to feed
themselves. And what the government had neglected to realize was not only
were these people not in the best shape to be effective farmers, many of them
were weak and already ill, but the moment they did start getting together some
crops and managing to get enough to sustain themselves, another boatload of
people would show up and immediately things fell into shortage. And so,
literally, for the first decade or two, people were starving. There was
constant daily shortages that were met with riots and rebellions and threats
of murdering the resident superintendent, and it was an awful situation.

GROSS: So, what was the society like that developed in this colony of exiled
sick people?

Mr. TAYMAN: Well, in the early days it was something like something from "Lord of
the Flies" where the strongest and most brutal held sway. And there were
murders and riots and moonshiners and rape and prostitution. But within five
or six or seven years, the population grew to the point where there were more
and more people who realized that if we are going to be a community, we have
to make that community ourselves. They were "civilizers" to use the phrase.
And so, they put in place a rough form of government. They had a sort of
legislature for themselves. They created a small police force to try and keep
the people who didn't want to be lawful in place. And they began to sort of
split into different factions that some farmed, some fished, some tried to
build shelter for the others. The people who were educated could read and
send letters off or, in time, try and file lawsuits to get themselves out. By
the 1900s it was almost like a typical, small American town that just happened
to be filled with people who either had the disease or the government thought
they had the disease.

GROSS: Did people marry and have children within the colony, and are there
people who grew up as the children of the people who were exiled there, who
never knew any other life?

Mr. TAYMAN: There were marriages and childbirths in the peninsula. And at
various times the government would take the newborn away from the family at
one years old and send them up the cliff and then place them in a hospital on
what's known as "Topside Molokai," which is the remainder of the island of
Molokai, and then they were placed in foster homes or in orphanages. They
later found out one of the genetic quirks that enables you to catch the
disease follows along familial lines. So, in some families, it is much easier
to catch the disease, and, in fact, some of the children who either were born
there or had relatives there also came down with the disease. And so some
have spent almost their entire life in exile.

GROSS: You know, I think some people would assume that a place that was a
colony for people who were then diagnosed with leprosy would be a place with
terribly disfigured people, people who look quite grotesque were walking
around. I mean, I think when people think of leprosy, they think of the worst
images they have ever seen. So what percent do you of people who were
sentenced to live on this peninsula were really hideously disfigured?

Mr. TAYMAN: Much smaller than you would imagine. If you walked around the
community, more than half the people would look no different than a normal,
healthy person. Leprosy doesn't manifest itself as disfigurement in every
case, and so you had not only the people who never had the disease but they
were in exile anyway, but you had the ones that had the disease in a mild form
who were not contagious and didn't come into any of the disfigurement.
Nonetheless, it's interesting is that some of the most disfigured patients
took advantage of their appearance to terrorize not only the current
residents, but any newcomer. Often the boats that would spill the patients to
shore would arrive at Kalaupapa in the dark, either late in the evening,or
very early in the morning and the more disfigured patients took advantage of
that fact and would gather on shore with torches and stand in the darkness,
cackling as the boats were heading toward shore and screaming, `In this place,
there is no law.' And as such, they managed to cow anybody who came and
immediately would rob them or take their belongings.

GROSS: My guest is John Tayman, author of "The Colony." We'll talk more after
our break. This is FRESH AIR.


GROSS: My guest is John Tayman, who's new book, "The Colony," is about a
leprosy colony on a remote and inaccessible peninsula on the Hawaiian island
of Molokai. For 103 years, beginning in 1868, Hawaiians diagnosed with the
disease were forced to live there.

As several missionaries were sent to the colony, was this considered a very
difficult assignment for the missionaries?

Mr. TAYMAN: It was. I mean, at the time, what they knew about the disease
implied that anybody who went to serve there was accepting a death sentence,
that they were martyring themselves. That didn't necessarily have to be the
case, but the most famous missionary is a man named Father Damien, a Catholic
priest. The Catholic Mission in the island decided that there were two
hundred or so Catholics, and they needed the presence of a priest to take
confession and see to their needs. And Damien volunteered to go. And so at
age 33, he entered the community, and he was the first full-time priest to

GROSS: He ended up getting leprosy himself.

Mr. TAYMAN: He did. He happened to be part of the 5 percent that lacked a
natural immunity, and he freely intermingled with obviously infectious
patients and passed his pipe around and ate from a communal bowl. He did so,
in part, because he felt to do otherwise wouldn't allow him to be a priest.
They had this thing--it was interesting in reporting the book, I saw from some
from the very early documents, not only in letters from the exiles themselves,
but in the doctor's reports, and I later experienced it myself. They
subjected visitors, newcomers, to something that might be called a handshake
test. And when you entered the colony for the first time, people would come
up and offer their hands, and, depending upon how you reacted, that determined
how they were going to treat you during your stay. If you shied away or if
you pulled on your gloves, as many people did, you were treated with disdain
and a tourist and essentially ignored. But if you did put out your hand and
shake it and knew enough either to know that this was not a danger or that you
were willing to accept that danger in order to do good, then they embraced you
and welcomed you into the community. Damien, of course, sort of did his own
version of that and immediately become a full member of the community. When
he finally did catch the disease, he, of course, began to describe himself as
"we lepers" in his sermons, and that became really part of his legacy.

GROSS: I'd like to ask you, before we go any further, about the word that
we're both using which is leprosy. The disease is usually referred to now as
Hansen's disease, named after the person who discovered the cause of it. Is
it considered inappropriate now to use the word leprosy? I think we're
both--I know you use it in your book because you're using the time-appropriate
language, and I'm using it because you're using it I guess. I'll just blame
it on you. Are we inadvertently...

Mr. Mr. TAYMAN: Well, don't do that.

GROSS: Are we inadvertently offending anybody by using that word? I mean, is
it considered wrong to use the word now?

Mr. Mr. TAYMAN: It should be used with caution. As you mentioned, leprosy is
now known, in part, by an alternate name, and that's Hansen's disease. It is
named for the doctor who discovered the germ that causes the disease, but the
word leper itself is loaded with so much power it's become something like a
racial epitaph, and many victims of the disease feel that way. They're
offended each time they hear it. It's an easy reaction to understand. Here
are a group of people that simply had the misfortune to catch a germ, and, for
the rest of their lives, they are known foremost as lepers. The most powerful
metaphor for otherness there is. And so when I use it in "The Colony," I make
sure to use it either in its direct historical context or within a direct
quotation, and, in fact, the usage of the word begins to disappear as societal
attitudes change. And so by the 1930s and 1940s it appears not at all, and
toward the end of the book, the people I write about are referred to
exclusively as residents of the community of Kalaupapa rather than lepers in a
leper colony.

GROSS: Who lives there now?

Mr. Mr. TAYMAN: Twenty-seven residents remain there, and they're people in
their--the average age is 72. They have been there most of their lives--50,
60, 70 years--and they were sent away as children, and they're there by
choice, in part because it is so magnificently beautiful. It's a quiet,
lovely little town. Their friends are around them, and, over the years,
they've managed to make a loving community out of what had been some of the
most harrowing circumstances imaginable. It's impossible to meet and talk
with these people and not be overwhelmed by their strength and the power of
their faith.

GROSS: You've written about a whole colony of people who were quarantined,
and you've written this at a time when we are hearing about the possibility of
quarantine in America, if there is a bird flu, if there is a terrorist attack
with smallpox. What are some of the lessons that the quarantined community
you wrote about have for us today?

Mr. Mr. TAYMAN: Well, the main lesson is that you can't let public hysteria
drive policy, and that's what led to the creation of this colony, and it's
what lead to 8,000 people having their lives destroyed when most of it was
needless. At the time I started the book, of course, I didn't really have any
idea that there would be a current relevance to it when it came out specific
to avian flu. As I discovered, one of the first instances of instruction for
quarantine and isolation occurs in the Old Testament where they give details
on how to isolate lepers. Now, one of the--again, one of the terrible ironies
is that in the Bible, the people who were described as lepers, actually don't
have the disease leprosy. And so, unfortunately, time and again you see
governments reacting the same way when they are faced with an infectious or
scary disease. It happened recently with SARS. It happened in the early
1980s during the first days of the AIDS crisis when, on a government level,
there was discussion of exiling everybody they thought had AIDS to the colony
and turning it into a national AIDS colony.

GROSS: Well, John Tayman, thank you very much for talking with us.

Mr. Mr. TAYMAN: Thank you for having me on.

GROSS: John Tayman is the author of the new book "The Colony." I'm Terry
Gross, and this is Fresh Air.

(Soundbite of music)


GROSS: Coming up Dr. Marc Siegel tells us why he thinks his patients are
worrying too much about bird flu. He is the author of the new book "Bird
Flu". Maureen Corrigan reviews a memoir which she doesn't doubt is true, and
Kevin Whitehead reviews Cubist music, the new CD by the pianist Edsel Gomez.


* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Maureen Corrigan reviews Mary-Ann Tirone Smith's book
"Girls of Tender Age"

This is FRESH AIR. I'm Terry Gross.

Mary-Ann Tirone Smith has had a long career as a writer of literary fiction
and detective novels. Her new memoir, "Girls of Tender Age," demonstrates for
book critic Maureen Corrigan the truth in the old writing adage that the best
stories are the ones closest to home. Here is Maureen's review.

I read Mary-Ann Tirone Smith's spellbinding new memoir, "Girls of Tender Age,"
smack in the middle of the James Frey expose, yet never once did I wonder if
she was making up any of the events she describes. My lack of critical
weariness doesn't derive from defeatism. I'm not one of those `what is truth,
anyway?' types who think that every memoir is just a variant of fiction. In
fact, I went on the record two and a half years ago on this program saying
that memoirs have a responsibility to try to tell the truth, utopian as that
effort might be. I was commenting on Vivian Gornig's public admission that
she had invented some scenes and conversations in her revered memoir "Fierce
Attachments." In the aftermath of Oprah's recent televised horsewhipping of
Frey, many more people are jumping on the truth-in-autobiography bandwagon,
some of them sanctimoniously and belatedly. Cynics and deconstructionists are
running for cover. Crowds of the earnest and outraged are shouting, `Foul
play!' and taking the field. Someday soon we scholarly types may feel free to
use the word truth in literary discussions again without making those little
quotation mark signs around that word.

I don't doubt the truth of Mary-Ann Tirone Smith's memoir because, aside from
the fact that she's telling me that this is a recollection of her
Italian/French working class Catholic childhood in New Haven, Connecticut, in
the 1950s, she's also writing this book as a kind of sacred and profane
memorial to her classmate Irene, who was murdered at age 11 by a convicted sex
offender prowling Tirone Smith's neighborhood. Irene was snatched by this
monster from the streets one evening in 1953 as she was walking home from the
neighborhood store carrying potatoes that her mother wanted for dinner. Her
body was discovered early the next morning in a yard a couple of fences over
from Tirone Smith's house. That day at school, Tirone Smith recalls, her
teacher announced to the fifth graders that there will be no speaking of
Irene. Then the maintenance men came in and carried Irene's desk out of the
classroom, and all of the kids moved up a space. Class resumed. As Tirone
Smith says, "Irene was killed twice. Murdered by a horrific man and then
erased by the era that was the 50s. All who needed to talk about her
silenced." Tirone Smith wants to use her memoir in traditional fashion to
break that silence by speaking the truth.

But there's a danger inherent in a project like this. The danger is that
Tirone Smith might seem opportunistic, taking advantage of her own proximity
to tragedy to give her life story a sensational gloss. Not to worry. The
first page--no, the very first sentence of "Girls of Tender Age" establishes a
voice and worldview so sure, so complex that Irene's story, awful as it is,
seems of a peace with a simultaneously nostalgic, violent and looney sense of
the 1950s this memoir evokes. Tirone Smith opens her book with this comment
that will resonate with so many readers of a certain age and class. She says,
"Here is how my father describes our socioeconomic level" "working stiffs."
When was the last time you heard that phrase? Tirone Smith goes on to
resurrect other time capsule artifacts of her particular corner of the 1950s,
which included life with her older brother, Tyler, who, as she says is
autistic at a time when no one has heard of autism. Tyler is a World War II
savant who carries on conversations via a Campbell's noodle soup can, his red
phone, with FDR about troop casualties. Tirone Smith's mother emotionally and
physically flees the family, working the housewife shift from 3:30 PM to 10:00
PM at a nearby insurance company and then playing in midnight bowling leagues.
Her father is a sweetheart of a guy who takes up the slack and keeps himself
going day and night with gallons of percolated coffee and the occasional
grappa. Tirone Smith stands as intelligent witness to it all here. She tells
the truth--at least she's got me convinced she does--but she also skillfully
tells it slant, looking back at a remove of some 50 years in longing, avowed
anger and tough-girl humor.

GROSS: Maureen Corrigan teaches literature at Georgetown University and is
the author of the memoir "Leave Me Alone, I'm Reading." She reviewed "Girls of
Tender Age" by Mary-Ann Tirone Smith.

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Interview: Dr. Marc Siegel discusses his book "Bird Flu" and
his concerns about pandemics

In his new book, "Bird Flu," Dr. Marc Siegel says it's good to be prepared
for worst-case scenarios, but, he says, fear itself is its own virus and can
cause far more damage than influenza. In his previous book, "False Alarm,"
Siegel wrote about the epidemic of fear, and how anxieties are often
disproportionate to the actual threats we face. Dr. Siegel is a practicing
internist and an associate professor at the New York University School of

How come you seem to be less worried about the spread of bird flu than a lot
of other health experts are?

Dr. SIEGAL: The answer is that I'm not unafraid of avian influenza in
general. I think it's a bug well worth being concerned about. My issue is
that I'm not making the broad leap to believe that H5N1, which--there's
several steps that have to occur before this bird flu can put multitudes at
risk and millions and millions at risk. First of all it has to mutate to a
form that goes easily goes human to human, which hasn't occurred. Then if it
does go through that mutation, it may, in fact, mutate out of the form where
it's really killing people. We don't know whether those things are going to

GROSS: If the bird flu did spread, are there things that we could do now--I'm
sure there are--that couldn't be done in 1918 during the flu pandemic that
killed millions of people?

Dr. SIEGAL: Absolutely, Terry. You know, in 1918, yes, there were less
people than now. Yes, we have more elderly now. Yes, we have travelers.
We're constantly being reminded we travel around the planet at great rates.
But what we have that we didn't have in 1918--and this is very crucial--we
have antibiotics, and 50 percent of the birth certificates in 1918 said
pneumonia on them. Now, I don't know how many of those were bacterial
pneumonia, but we can assume a vast number were. We have treatments for heart
disease, and heart disease killed a lot of people that had the flu in 1918.
We have steroids to treat people in respiratory failure, which they get from
flu, which they got in 1918. We have public health announcements. You know,
in 1918 people weren't even sure what a virus was, and they huddled together
at draft rallies during World War I, and, of course, the virus was also spread
in trenches, and it was spread among very, very poor people. It is not the
same concern of lack of public information. Not only that, the government in
1918 was suppressing information. The government was telling people this is
nothing to worry about. We have the opposite problem now.

GROSS: What are some of the worries that your patients have spoken to you
about that you think are really unnecessary worries?

Dr. SIEGAL: One of the reasons I got interested in writing about this bird
flu in general is that I was alarmed at how many people are talking about this
and not worrying about the things that I'm actually treating them for. I
mean, people with heart disease and obesity, people that are smoking that I'm
trying to get quit smoking are coming in asking if they are going to get bird
flu, can they have Tamiflu. And I say, `What about the yearly flu?' I mean,
the yearly flu kills over 36,000 people every year, and they're not concerned
about the yearly flu. It took me a long time to actually get some of my
patients to agree to take the flu shot this year because they weren't thinking
about the flu. They were thinking about bird flu. And this fear is way out
of proportion to the risk. And, of course, I tell people not a single bird in
United States has this.

GROSS: There are antivirals like Tamiflu that are being discussed in
connection with dealing with a pandemic if there were to be one. How does
Tamiflu work?

Dr. SIEGAL: Well, Tamiflu is an antiviral drug. It is called a
meuraminidase inhibitor. It blocks the spread of viruses, flu viruses, from
one cell to the next, and it is usually effective against all influenza. In
this particular bird flu, it has not yet been proven to work. Actually, a
review study in one of the major British journals last week pointed out that
it has not been proven to work, but it has been proven to work in animals, in
mice and in ferrets. And there's every reason to believe that it would be
somewhat effective at high doses at this bird flu, but it is not a panacea.
There's also no reason for anybody to be taking it right now if they're not
exposed to this virus. And the only people that have been shown to be exposed
to this virus are bird handlers in countries where the disease is endemic in

GROSS: So, is Tamiflu a cure? Does it stop the progression of the disease
once you've had it? Does it prevent you from getting it in the first place?

Dr. SIEGAL: Tamiflu would work for bird flu presumably the same way it works
for yearly flu. It's mainly used in the first 24 to 48 hours after you come
down with symptoms. After that it doesn't tend to work. It decreases the
length that you would have the disease by about a day or two and probably
decreases the mortality somewhat. It is the only antiviral drug that has
been approved for prevention, but I also think that that's led to tremendous
overuse of the drug in Asia because everybody that thinks they may be near the
flu at all has taken it. Millions and millions of doses of it have been used,
and I'm concerned about resistance occurring as has already occurred with an
older flu drug known as amantadine. So we need to actually keep Tamiflu for
when we would really need it, both in terms of the yearly flu and in terms of
a bird flu pandemic. It's one of the reasons I'm not a fan of personal
stockpiles because I don't know when my patients would take it. I don't like,
in general, the idea of patients stockpiling medications. I prefer the idea
of keeping the physician in the loop, if possible. Government stockpiles of
Tamiflu make some sense, except that, there again, you're sending the message
that something imminent is about to happen. I'm more in favor of long-term

GROSS: We have flu vaccines every year. Some years they're more effective
than others. I know you need advance time to make an effective vaccine, and
you need to know what you're inoculating against, what's the strain of flu.
Since we have some advance warning that there is this new strain of bird flu,
is it possible we would have a vaccine prepared by the time the bird flu
jumped to the human species, if it ever does really jump in a major
threatening way?

Dr. SIEGAL: Well, you know, the problem is that we currently make vaccines
using a chicken egg medium where we inoculate eggs against the virus and, as
you can imagine, that causes a problem because the virus is an avian flu, and
it kills eggs. So we need to use millions of eggs, and it takes six to nine
months. And this process has been around since the 1950s, and it really needs
to be upgraded using cell culture where we use mammalian cells and we inject
them with a genetically engineered virus which we have the ability to use. We
use it for hepatitis B and chicken pox, and we certainly could use it for flu.
Without that, this is too long a lead time. Now, we currently have a bird flu
vaccine, but if H5N1 mutates, it's hard to say how effective that vaccine
would be. We could produce vast quantities of it in several months, but it
may not be that effective. The yearly flu vaccine right now is only usually
about 40 to 60 percent effective against the flu. So we tend to see it as a
panacea, but it is really not. It is a useful tool, not a panacea.

GROSS: The president has called for $2.7 billion to be put toward the
manufacture of vaccines. Would that help in an effective way to transfer to
this new technology you are describing?

Dr. SIEGAL: You know, I think that that's actually a good part of the
president's plan. I think $2.7 billion is a very good start towards going
over to modern technology, using cell-cultured genetic technology, or even the
newer vaccines that are out there, that are in the works that may actually be
able to provide a vaccine against all influenza for a 10 year period. That's
currently in the works. So I think that's great, but it doesn't address the
more fundamental problem, which is we're relying on the vaccine manufactures,
and there's very few of them right now--actually, only three. And the problem
is that they're afraid of lawsuits, and I think the solution is more
government involvement the way we have in Western Europe where the government
actually takes control of vaccine manufacturer and assures a certain amount
per year and distribution. Without that we're kind of in trouble. These are
generic products. They don't have a large profit margin, and we can't really
assure a rapid turnaround of vaccine manufacture, especially in an emergency

GROSS: You're saying you don't think that there's enough of a profit motive
for commercial pharmaceutical companies to invest a lot in the development of
new vaccines?

Dr. SIEGAL: You know, I think that that's been seen by the fact that there
used to be 27 vaccine manufacturers in the 1970s in the United States and now
there's three. It's partly because it's a generic product; they can't make a
lot of profit on it. It's partly because it's very highly regulated, and it's
partly because they have liability concerns.

GROSS: Well, the president has also proposed ending those liability concerns
by making them not liable for any side effects that the vaccine may cause.

Dr. SIEGAL: Well, this may sound counterintuitive, but I'm not really for
that idea. I think somebody's got to be liable. I mean, we don't want to
make the public be liable. So if the government assumes the liability, that's
fine, provided that there's a liability concern. I mean, we can't just say,
you know, we can't promote a panic, overreact, vaccinate millions of people,
and then say, well, no one's liable. That's actually a concern that occurred
during the swine flu fiasco in 1976, where a virus that never actually came
caused such a panic that 40 million people were vaccinated over a month and a
half time, and over 1,000 cases of ascending paralysis appeared as a result.

GROSS: Why is it so difficult, and I'm glad it is difficult, but why is it so
difficult for the flu virus to jump from birds to a form that can infect

Dr. SIEGAL: Let's clarify that because there's thousands of bird flu viruses
out there. And our yearly flu actually is generally a bird virus, at least
all the influenza A viruses are. And that's the current--the current yearly
flu, what we're calling the California flu this year, that's an avian
A--that's an influenza A. That is a bird virus. So it's not that it's so
hard for bird viruses to jump to human. In fact, the pig is a very common
vector for that to occur. Pig mixes both human and bird viruses, and you
sometimes get your yearly flu that way. But it's a misassumption to assume
that you can pick a certain virus and say that's the one that's going to do

Now, flu viruses mutate a lot, they change a lot, which is one of the reasons
it's worth having scientists track this virus. I am concerned about it, but I
would take this point to emphasize that there hasn't been enough distinction
made between birds getting this virus and people. And, you know, we've had
about 160 people but millions of bird. In fact, I focus my book, an entire
chapter, called "Bird's-Eye View," where I look at the veterinarian response.
You know, it might be worth considering that the main experts in the world on
avian influenza are actually vets. And many of them work for the USDA and are
doing big research on this. And I talked to them and interviewed several of
them, and I'm absolutely convinced that the biggest attempt has to be made to
control this in the bird population--more vaccinating of birds, more
international cooperation targeting birds, more killing or culling of birds.
But not all birds. I mean, not, you know, you go out and kill every chicken
in sight, you know. More scientific approaches to that. And that's where the
money really, really should go.

GROSS: You know how you've talked about how some people, you belive, are
hyping the avian flu because you think that they have an agenda of their own.
For instance, that, you know, researchers might hype it because there'll be
more research money if people are more worried about the spread of flu. And
here's what I'm thinking, your thing is that we have an epidemic of fear, that
we're too worried about things, and that we're worried disproportionately. So
like you have a vested in a way of telling us not to worry about bird flu
because your thing is that we worry too much.

Dr. SIEGAL: That's a very fair question, Terry, and maybe one of the best
questions I've ever been asked. But the truth is that I'm not saying we have
nothing to worry about. I'm saying that if we want fear to work properly as a
warning system, we ought to use it against the things that are directly
threatening us. And I think animals know that a lot better than we do. And
we could talk about the things that I think are really threats, like obesity,
like, you know, the automobile, maybe nuclear weapons. I mean, that's
something that can harm us out of proportion to the risk. We need a scale.
We need to say how many people can be affected by that thing and what is the
likelihood of it actually happening? That's a simple scale. With bird flu,
it's worth looking at seriously because a lot of people can be affected. But
the chances of it are small, so you have to factor that in as well. It's not
that my vested interest is in promoting that we don't overreact at all. It's
that we learn to overreact to certain things and not others.

GROSS: Marc Siegal, thank you very much for talking with us.

Dr. SIEGAL: I've greatly enjoyed it. Thank you.

GROSS: Dr. Marc Siegal is the author of "Bird Flu."

Coming up, jazz critic Kevin Whitehead reviews a new CD by the pianist Edsel
Gomez. This is FRESH AIR.


* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Kevin Whitehead reviews jazz record "Cubist Music" by
Edsel Gomez

Pianist Edsel Gomez was born in Puerto Rico and went to music school in Boston
where he began an ongoing association with clarinetist Don Byron. Then Gomez
spent 10 years working in Brazil before moving to New York, where he joined
the band of saxophonist David Sanchez. The week Gomez's CD came out, he was
playing jazzed-up Mozart in Vienna. Jazz critic Kevin Whitehead says Edsel
Gomez's music doesn't sit in one place either.

(Soundbite of Edsel Gomez and band performing)

Mr. KEVIN WHITEHEAD: Edsel Gomez calls his new album Cubist music, by
analogy with Picasso's Cubism with its geometric forms, fragmentation and
multiple perspectives on the same material. Gomez gets into the same spirit
of deconstructive reconstruction. The tune we just heard, "NYC Taxi Ride," is
his Cubist revamp of "Caravan" by Duke Ellington and Juan Teasel.

For Gomez, Cubism involves building tunes and solos out of small blocks, a few
short, distinct and theoretically unrelated motifs which he calls unities.
The idea is to bypass the traditional jazz practice of just improvising over a
tune's chords, though the players take care of that, too.

(Soundbite of Gomez and band performing)

WHITEHEAD: Steve Wilson on alto saxophone with a super good rhythm section of
bassist Drew Gress can play pretty much anything and in tune, and drummer
Bruce Cox, whose cockamamy accents nail that Cubist vibe. But in the end,
it's the music, not the method, that grabs you. Edsel Gomez employs five top
reed players on his new album, usually grouped in twos or threes, including
saxists David Sanchez and Greg Tardy. They all sound fine here, especially
clarinetist Don Byron, who also produced the album.

(Soundbite of Byron and band performing "Ladybug")

WHITEHEAD: Don Byron on Edsel Gomez's "Ladybug." Now, Gomez knows the
improvisers he hires are going to break the rules and go their own way
sometimes, and that's OK. Whatever works. But elsewhere, you can hear how
his unities shape the music in interesting ways. A highlight of the album is
his tribute to the Puerto Rican co-composer of "Caravan" called "Juan Teasel."
It's a vehicle for alto saxophonist Miguel Zenon, also from Puerto Rico.
Gomez's birdcall-like piano figures echo Duke Ellington, who was fond of
mynahs and mockingbirds himself.

(Soundbite of band performing "Juan Teasel")

WHITEHEAD: There is something Ellingtonian in the way Edsel Gomez balances
the needs of the composer and the improviser in his band, and in his command
of recombinant instrumental colors. His album "Cubist Music," on the Zoho
label, is one of the brightest jazz records I've heard in awhile. Rich
textures, catchy tunes, meaty solos--why can't they all be this good?

GROSS: Kevin Whitehead teaches English and American Studies at the University
of Kansas, and he's a jazz columnist for He reviewed "Cubist
Music" by pianist Edsel Gomez on the Zoho label.


GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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