You are using an outdated browser. Please upgrade your browser to improve your experience.
Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
Earn MOC points
The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
Prepare for the Certification and Maintenance of Certification (MOC)
Exam with an ACP review course.
Board Certification Review Courses
MOC Exam Prep Courses
Treating a patient? Researching a topic? Get answers now.
Visit AnnalsLearn More
Visit MKSAP 18Learn More
Visit DynaMed Plus
Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration.
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
© Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572
Toll Free: (800) 523.1546 · Local: (215) 351.2400
Philadelphia, January 27, 2012 - Scientists have engineered a
new strain of H5N1 (commonly known as bird flu) to be readily
transmitted between humans. Two perspectives being published early
online in Annals of Internal Medicine, the flagship
journal of the American College of Physicians, raise concerns about
if and how this research should be continued, and how the data
should be shared for the benefit of public health.
The currently circulating H5N1 virus has an extremely high
case-fatality rate, killing about 60 percent of the over 500
confirmed human cases. However, unlike seasonal flu, to date H5N1
has not easily spread between humans. Recently, two scientific
teams (not associated with the Annals perspectives
authors) engineered the H5N1 virus to make it readily transmissible
between ferrets. This means that it may be able to make it easily
transmissible between humans as well. Controversy has emerged about
the safety and appropriateness of this research.
The National Science Advisory Board for Biosecurity (NSABB) has
recommended that the H5N1 research be published, but with
significant redactions. Specifically, journals should publish the
work without detailed methodology, to reduce the risk of
replication and purposeful misuse. This recommendation has divided
the scientific community into those who are for censorship, and
those who oppose it.
In the first Annals perspective, Thomas V. Inglesby,
MD, CEO and Director of the Center for Biosecurity of University of
Pittsburgh Medical Center, writes that the potential consequences
of an engineered human transmissible H5N1 strain are stunning. If
the newly engineered strain were to escape the laboratory and
spread as widely as seasonal flu, it could endanger the lives of
hundreds of millions of persons.
Whether the virus escapes the lab by accident or on purpose, the
highly contagious and deadly nature of the mutant strain could
result in catastrophe. The work was done to increase scientific
knowledge of H5N1. But there is no scientific evidence that a
strain like the one developed in the laboratory will ever occur
naturally. Dr. Inglesby suggests that the harms of the research
therefore outweigh the benefits.
"If we are asking society to take the substantial and
unprecedented risks associated with a human-transmissible H5N1
strain with a nearly 60 percent case-fatality rate, we had better
have a compelling, concrete, and realistic public health
justification for it," Dr. Inglesby writes. If experimentation must
continue, he recommends very restricted use, like the approach that
has been taken with smallpox.
Andrew T. Pavia, MD, Chief of the Division of Pediatric
Infectious Diseases at the University of Utah Health Sciences
Center and Primary Children's Hospital, authored the second
Annals perspective on the topic.
Dr. Pavia, argues that the H5N1 virus may not be as easy to
transmit between humans as some speculate. With regard for the use
of H5N1 as a bioweapon, Dr. Pavia suggests that the scenario may be
unlikely. To manipulate H5N1 as a weapon, the terrorist would need
substantial scientific skill and knowledge of precise methods used
in the studies.
He writes that with proper safeguards, these and future studies
should proceed and can increase critical scientific understanding
of influenza. Currently, there is not a transparent and thoughtful
mechanism to ensure the provision of details only to those with a
legitimate need for the data and to decide who those people are.
Dr. Pavia thus generally agrees with the approach taken by the
NSABB and argues creating more dangerous pathogens in a laboratory
has its purpose. According to Dr. Pavia, "We must have a careful
and balanced approach that is neither too timid in permitting the
performance and sharing of critical research nor too naive in
confronting the biosecurity issues posed by that research."
Meanwhile the investigators themselves have announced a 60 day
self-mortorium on their research while debate continues.
Dr. Inglesby's and Dr. Pavia's articles are available free to
the public at www.annals.org.
Annals of Internal Medicine is one of the five most
widely cited peer-reviewed medical journals in the world, with a
current impact factor of 16.7. The journal has been published for
85 years. It accepts only 7 percent of the original research
studies submitted for publication. Follow Annals on
Twitter and Facebook.