Abstract & Commentary
Movies and Politicians: Which Are Reality-based?
By Stan Deresinski, MD, FACP, FIDSA, Clinical Professor of Medicine, Stanford University, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Editor for Infectious Disease Alert.
Hollywood movies have always created their own reality. Meanwhile, the rest of us slog through the conventional reality of our daily lives. Many of us may have assumed that our politicians live in the same world we do and that they have similar perceptions of it — a view that has definitively and repeatedly been demonstrated to be foolish and naïve. Parallel examinations of a new popular movie and the statements of a candidate for her party's nomination for president have demonstrated a reversal — reality from Hollywood and a startling rejection of reality by a prominent politician.
Steven Soderbergh's movie "Contagion" begins with Gwyneth Paltrow becoming ill, developing seizures, and dying within days of encephalitis. She proves to be "Patient Zero" of a worldwide epidemic caused by a previously unknown infection with an associated mortality rate in excess of 20% that results in the deaths of millions. This extraordinary mortality leads to the necessity of using mass graves and the emergence of progressively escalating social disorder, exacerbated by rumor-mongering and false promises of a cure. Meanwhile, public health workers at the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) struggle to understand the epidemic's origin and means of spread while, at the same time, instituting preventive actions.
CDC scientists set out to determine the etiology of the infection and to develop a protective vaccine. They determine the cause to be a virus that appears to have been modeled upon a known zoonotic cause of encephalitis, the Nipah virus. Epidemiologic investigation eventually finds that uprooting a forest of palm trees to establish a new piggery disrupted a colony of frugivorous bats. An infected bat regurgitates the indigestible portions of a banana that is then eaten by a pig. The pig finds its way to the kitchen of a Macao casino where it is prepared by a chef who ends up shaking his unwashed hands with a character played by Gwyneth Paltrow. Shortly after, Ms. Paltrow's character flies home to Minneapolis to her child and her husband (Matt Damon). Like Ms. Paltrow's character, the child dies, but Matt Damon survives. The epidemic progresses throughout the world as the CDC and WHO struggle to solve the problem. Eventually a vaccine is developed and distributed, but not before millions of deaths, including that of a CDC Epidemiologic Investigation Service Officer (Kate Winslett).
The movie is amazingly realistic in many aspects, including much of its science. The major liberty it takes, clearly for dramatic effect, is time compression. The initial spread of the virus is remarkably fast, probably unrealistically so. In addition, 57 versions of the vaccine are tested in primates before an effective one is developed. The vaccine undergoes unspecified further testing, is manufactured and distributed — all within a few months. This remarkable celerity may prove feasible at some time in the future, but not yet.
The mutated virus causing the epidemic, called MEV-1 (it is unstated, but perhaps standing for "meningoencephalitis virus-1") is clearly modeled on the Nipah virus, which was first identified in Malaysia in 1988-1999 and whose natural host is a flying fox, a type of frugivorous bat. Nipah outbreaks in Asia have been associated with contact with pigs, but also with human-to-human transmission and with eating contaminated fruit and fruit juices, such as raw date palm juice. Clinical illness starts with influenza-like symptoms with, in some cases, progression to pneumonia and to encephalitis, often ushered in by seizures with progression to coma in 24-48 hours. There is no known effective treatment and no vaccine is available.
So much for reflections of reality. A member of the previous presidential administration (said to be Karl Rove, former Deputy Chief of Staff and Senior Advisor to President George W. Bush) was quoted as scoffing at the "reality-based community," indicating that he and his colleagues were creat-ing their own truth. And more recently, while Hollywood was doing its best at being realistic, Representative Michelle Bachman (R-Minn) was joining the attack on the "reality-based community."
The reality: Human papillomavirus (HPV) causes, among other malignancies, most of the more than 200,000 cervical cancers that occur in the world each year, most in developing countries where screening is not routinely performed. In the United States, where Pap screening is the rule, there are, nonetheless, 12,000 cases and 4,000 deaths each year. An effective preventive vaccine has been available for several years and is recommended for administration to girls beginning at age 11 years (and as early as age 9 years) — ideally before sexual debut, since HPV is the most prevalent sexually transmitted infection in the United States and the vaccine does not protect against existing infection. The quadrivalent vaccine also protects against genital warts and recently received approved for use in males as young as 9 years of age. Importantly, the vaccine, which does not contain live virus, has an impressive safety record.1
Despite this safety record, Rep. Bachman, a graduate of the Oral Roberts School of Law, in a recent Republican candidates' debate, called the vaccine "dangerous" and spoke of the "poor innocent little girls" upon whom it was inflicted. The following day she went on to relay an unsubstantiated story about a girl who "became mentally retarded" after receiving the vaccine. Associated statements by her and some of her fellow candidates also contained the implication that any public health mandate constituted an unconstitutional denial of freedom. As an apparently charter member of the seemingly expanding cult of "denialism" — the rejection of science and its methods and of objective reality itself — perhaps these statements should have been expected. They, nonetheless, have the potential to cause enormous damage by causing individuals to reject the vaccine for themselves or their children. Will the denialists take responsibility for the resultant deaths?
- Gee J, et al. Monitoring the safety of quadrivalent human papillomavirus vaccine: Findings from the Vaccine Safety Datalink. Vaccine 2011 Sep 9; Epub ahead of print.