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To the Editor:In a recent news story, Alex Kaat with Wetlands International (WI) seems awfully sure that wild birds didn't bring avian flu to Nigeria and won't spread it from there to Europe. So, scientifically, why is he so sure it won't spread to Europe via the ducks? Do they not fly from Africa back to Europe? From my understanding, many wild water fowl -- especially ducks -- show few if any signs of avian flu infection and spread the virus via their feces, which can be dropped en route onto non-wetland areas. In fact, in Eurasia, avian flu is spread via wild birds.Are WI or any of their partners testing the Nigeria/African ducks in any numbers to see if the population is harboring the virus? Are they only testing the birds that drop dead (i.e. swans in Italy and Greece) and not living populations of other birds/waterfowl?Alex Avery Director of Research Center for Global Food Issues, Hudson Institute PO Box 202, Churchville, VA 24421 540) 337-6354, or -6387 aavery@cgfi.orgAlex Kaat responds:Alex Avery thinks that I am "awfully sure" about wild birds not being vectors of avian flu, but the language I used is rather cautious. Expressions used include "unlikely", "don't think", "more likely", "we think it is more likely" and "there is a risk". Nobody yet knows the factors responsible for carrying avian influenza to Africa, and Wetlands International aims to make this clear in the information it provides. Too many people seem to be sure about the role of wild birds. I expressed the opinion that it is "unlikely" that migratory birds brought the disease to Nigeria, but I also named the species most likely to be responsible if this were the case, and explained that while the northward migration to Europe begins in late February, it will "most likely" not bring the disease to Europe.Reporting of recent outbreaks of HPAI has often been unbalanced and sensational and there is a strong tendency to blame migrating waterbirds while disregarding the role played by activities related to the poultry farming and transport industries. In intensively farmed poultry, the high density of birds and constant exposure to faeces, saliva and other secretions provide ideal conditions for the replication, mutation, recombination and selection through which highly lethal forms can evolve. The global nature of the poultry industry, and the international movement of live poultry and poultry products also provide a likely mechanism for the spread of the virus between Asia, Africa and Europe, and at a local level within these continents. The view that poultry movements have played a major role in the spread of the disease is supported by an analysis of viral strains recently published in the Proceedings of the National Academy of Sciences.Some of the agencies attempting to monitor and control avian flu, such as the FAO, seem to have been reluctant to draw attention to the role of intensive agriculture, because of the impact on national economies and on access to cheap sources of protein. There are also powerful vested interests in the global poultry industry.It is noteworthy that countries such as Japan and South Korea, which imposed strict controls on the import and movement of domestic poultry after initial outbreaks, have suffered no further infections. If wild birds had been spreading the disease across continents it would be reasonable to expect trails of outbreaks following migration routes, but this hasn't happened. Highly pathogenic avian influenza viruses are very rare in wild birds. Our ongoing work in Africa will help answer Alex Avery's question about whether African populations of waterbirds are harbouring the virus or not. Alex Kaat Wetlands International alex.kaat@wetlands.orgTo the Editor:I'd like to respond to some issues raised in a recent blog about the ongoing fallout from a published study touting the benefits of prayer for in vitro fertilization.The blog says "most scientists would likely think critically about research touting the health benefits of prayer," even without my public questioning of the findings. I certainly hope this is true. However, the scientists who wrote the article and those at the Journal of Reproductive Medicine who accepted it for publication might strongly disagree. Far more importantly, the general public would have little or no reason to think very critically about research touting the health benefits of prayer, if it has already passed peer review and been published in a reputable journal.Alison McCook also writes: "As a reporter, I can't help but be skeptical and question Flamm's motives for pursuing this story so diligently." This comment really made me think. What are my motives? I've devoted countless hours to this effort for no compensation. Some of my friends feel that I should never have opened my mouth about a study involving faith and prayer, and a few no longer talk to me as a result. There's also nothing personal about my actions -- I have absolutely nothing against the authors of the study or anyone at their institutions or the journal. My sole motivation for exposing this scandal was, and still is, a heartfelt belief that bizarre papers claiming mysterious supernatural results do not belong in scientific journals.Finally, McCook asked: "Is the desire to maintain the integrity of the scientific record enough to drive someone to spend years on a campaign questioning one paper?" Although it may be difficult to believe, the answer is yes. This "one paper" is quite different from most papers that have investigated claims of healing by prayer. Most such studies have had either negative results or borderline results that may have been caused by chance alone. In contrast, this study claimed a 100% increase in IVF success rates. These results, if real, would be earthshaking. How could the results of any future research study in any scientific field be trusted if distant prayers could profoundly alter the results? This paper also differs from other studies in that it is almost certainly fraudulent. Mr. Wirth, the author who designed and supposedly set up the prayer groups is now in federal prison. Scientists who are have diligently investigated Wirth's research recently concluded that all of his "healing" studies may be fraudulent and should be removed from the literature.I understand that my persistent efforts to have this study removed from the scientific literature may seem silly or even obsessive to many observers. However, in spite of my efforts, a highly flawed and almost certainly fraudulent study claiming to demonstrate miraculous supernatural phenomena has not been retracted from a supposedly evidence-based medical journal. In my heart I believe that this has been a battle worth fighting and, win or lose, I firmly believe that I'm doing the right thing. Bruce L. Flamm, MD. Partner Physician, Kaiser Permanente Medical Group, Riverside, California Clinical Professor, Department of Obstetrics and Gynecology, University of California, Irvine. bruceflamm@aol.comLinks within this articleS. Pincock, "Fears of Africa flu spread," The Scientist, February 14, 2006. http://www.the-scientist.com/news/display/23120/H. Chen et al, "Establishment of multiple sublineages of H5N1 influenza virus in Asia: Implications for pandemic control," PNAS, February 10, 2006. PM_ID: 16473931A. McCook, "More Korean research problems (blog)," The Scientist, February 16, 2006 http://www.the-scientist.com/blog/display/23128/J. Solfvin et al, "Questions concerning the work of Daniel P. Wirth," Journal of Alternative and Complementary Medicine, December 2005. PM_ID: 16398584

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