
Tamiflu: Millions wasted on flu drug, claims major report - nairteashop
http://www.bbc.com/news/health-26954482
======
lvevjo
Cochrane is very good at what they do. This kind of systematic review is the
highest standard of evidence when it comes to medical research. It's worth
checking out some of their other reviews:

[http://www.cochrane.org/cochrane-
reviews/top](http://www.cochrane.org/cochrane-reviews/top)

Note that these are abstracts of the full reviews (which they charge for
access).

On a side note, meta-research deserves more funding!

[http://blog.givewell.org/2013/06/06/meta-research-
update/](http://blog.givewell.org/2013/06/06/meta-research-update/)

edit: I linked to the wrong review before (not the one under discussion), so I
edited that out. As gwern mentions in another comment, the link is broken in
the BBC article. nairteashop found a different news release which seems to be
the right link:

[http://www.cochrane.org/features/tamiflu-relenza-how-
effecti...](http://www.cochrane.org/features/tamiflu-relenza-how-effective-
are-they)

~~~
sithu
I agree with most of what you've said, except that I think the recent
enthusiasm for doing systematic reviews + meta-analysis is way overblown. What
really needs funding is novel high-risk/high-reward research that isn't
necessarily supported by precedent data.

------
ekianjo
During the H1N1 craze in 2009 (I remember it very well), governments from all
countries around the world were fighting to get enough stock of Tamiflu in
case of a global Pandemic. Even at that time I thought this was ridiculous,
not just because the risk of Pandemic was overblown (and the media played a
huge part in it), but also because there had been no clinical trial suggesting
that Tamiflu would be working against that particular strain of H1N1. Pure
waste of taxpayers money by uninformed politicians reacting to panic.

~~~
j2d3
Tamiflu is made by Gilead. Donald Rumsfeld was on the board. Mexico (among
other countries) borrowed millions from the world bank to buy Tamiflu during
the H1N1 craze.

[http://www.nybooks.com/articles/archives/2011/dec/22/world-b...](http://www.nybooks.com/articles/archives/2011/dec/22/world-
bank-and-money-flu/)

I say all this to suggest that it's not a waste of taxpayer money by
uninformed politicians... no - the politicians are _very well informed._

~~~
ekianjo
That's why it would be appropriate to have all politicians disclose their
conflicts of interests.

~~~
tommu
I would rather that they simply were not allowed conflicts of interest during
and after office. No joining companies lobbying for the industry you were
supposedly regulating when in office. ETC.

~~~
ekianjo
Not allowing conflicts of interests is almost impossible for most politicians:
they all have friends in different industries because they need financial
support (or popular support anyway). The least you can ask for is transparency
and disclosure of ties/relationships/friendships.

~~~
tommu
Right now they have no chance of being elected unless they spend obscene sums.
Remove that need through campaign finance regulations and you will remove an
enormous source of leverage. I would be happy to see a 50% mix of public money
and 50% individual capped donations making up a cursory figure. Legally
require large networks to give free and equal airtime to each candidate with
enough support to justify inclusion. It simply cannot be impossible to remove
the biggest sources un-democratic influence.

------
ceejayoz
"Paracetamol" is acetaminophen (Tylenol) in the US, if anyone's wondering.

~~~
rdl
Tangentially (since this article is boring, I don't think it's unreasonable):
acetaminophen is one of the commonly-used drugs which I think is most
dangerous.

Aside from liver-damage-suicide-through-overdose, and accidental overdose,
there are a common conditions where you'd want headache relief (hangover,
dehydration, ...) where the liver-damage risk for a _normal_ dose is
substantial (and people commonly take 2-3x the normal dose if they have "a bad
headache, as more is obviously better...).

Another huge sin of the US drug war is mixing likely-to-be-abused painkillers
like codeine with acetaminophen to lower their "abuse potential" \-- but, with
junkies not being rational, it leads to abusers destroying their livers.

~~~
ekianjo
Indeed. For symptomatic relief, Aspirin is usually a better option at low
doses (as long as your stomach does not suffer too much from it, since it
causes stomach bleeding).

~~~
balls187
Perhaps this goes without saying but, I want to warn against taking medical
opinion/advice that is found on the internet, especially from a forum that
mostly revolves to Software, Tech, and Startups.

> Aspirin is usually a better option at low doses (as long as your stomach
> does not suffer too much from it, since it causes stomach bleeding).

[http://en.wikipedia.org/wiki/Reye_syndrome](http://en.wikipedia.org/wiki/Reye_syndrome)

~~~
ekianjo
Come on. You are linking to something that was not even formally demonstrated.

> Epidemiological studies have demonstrated an association between aspirin
> taken for viral illnesses and the development of Reye’s syndrome.[8] But no
> animal model of Reye’s syndrome has been developed in which aspirin causes
> the condition.[9]

It's tiring to repeat it, but correlation and causation are two very different
things.

~~~
balls187
<strike>So, you're saying it's okay to give aspirin to children?</strike>

My point wasn't to say Aspirin is or isn't better than Tylenol.

My point is to say taking medical advice on internet forums, isn't a good
idea.

~~~
ekianjo
> <strike>So, you're saying it's okay to give aspirin to children?</strike>

Actually, in most cases, it seems many developed countries outside of the US
think so, see my other post:
[https://news.ycombinator.com/item?id=7564311](https://news.ycombinator.com/item?id=7564311)

------
tptacek
I thought it was pretty well-known that Tamiflu wasn't particularly effective,
and that the UK NHS had already been criticized for stockpiling it.

~~~
crazytony
this is the lingering problem: it's terribly ineffective if you go to the
doctor with flu symptoms. Seriously. Tamiflu blocks the channels used to
multiply the influenza virus. By the time you recognise you have the flu
Tamiflu looks to be completely and utterly ineffective.

I haven't seen a societal study to say it's better or worse as a group of
individuals. I would be really interested in that.

------
motbob
The article does a bad job of explaining what the Cochrane report finds to be
flawed about the clinical trials.

~~~
gwern
It's hard to tell because the latest version of "Neuraminidase inhibitors for
preventing and treating influenza in healthy adults and children" doesn't seem
to be out (just the 2012) version, and the OP's citation breaks on the wiley
site! Even Cochrane's own materials aren't very clear. The best seems to be
[http://www.cochrane.org/features/neuraminidase-inhibitors-
pr...](http://www.cochrane.org/features/neuraminidase-inhibitors-preventing-
and-treating-influenza-healthy-adults-and-children)

"Questions about the accuracy of these claims and the efficacy of both
preparations prompted an international team of researchers, led by Dr Tom
Jefferson, a Cochrane Review author and independent epidemiologist based in
Rome, Italy, to examine newly available evidence and amalgamate two previously
published Cochrane Reviews focusing on the efficacy of these interventions
into one comprehensive, updated review, published in the January 2012 issue of
The Cochrane Library.

In carrying out this research, the Cochrane team was reluctant to focus their
efforts on published trial reports available in scientific journals, because
while many trials have been conducted around the world, only a few have been
published.

“We identified that a large number of studies, including data from 60% of the
people who have been involved in randomised, placebo-controlled phase III
treatment trials of oseltamivir, have never been published. This includes the
biggest treatment trial ever undertaken on oseltamivir that on its own
included just over 1,400 people of all ages,” noted Jefferson. "We are
concerned that these data remain unavailable for scrutiny by the scientific
community."

Following a public pledge by the manufacturer of oseltamivir, Roche, to make
full study reports available to scientific investigators, the Cochrane team
decided to focus instead on manufacturers’ clinical study reports (typically
submitted to regulators) and regulators’ comments. They called reports and
comments “regulatory information”. Availability of documents generated by
national and regional regulatory bodies during licensing processes in the UK,
USA, continental Europe and Japan, along with partial trial reports from the
manufacturer of oseltamivir, Roche, and from the European regulator European
Medicines Agency (EMA), enabled the researchers to verify information from the
trials.

When the team compared published data with the more complete unpublished trial
records, they found apparent inaccuracies in the published record of the
trials. For example, while unpublished trial reports mentioned serious adverse
events (some even classified as possibly related to oseltamivir), one of the
two most cited publications makes no mention of such effects, and the other
states “... there were no drug-related serious adverse events”.

Having pieced together information from more than 16,000 pages of clinical
trial data and documents used in the process of licensing oseltamivir, the
Cochrane team raises critical questions about how well the drug works, as well
as about its reported safety profile. While the drug did reduce the time to
first alleviation of symptoms by an average of 21 hours, it did not reduce the
number of people who went on to need hospital treatment. Results from the
reanalysis of data also raise questions about how the drug works as an
influenza virus inhibitor."

------
turnip1979
I was prescribed Tamiflu once a few years ago and wow .. what a weird drug. My
memory might be off but I think it is supposed to reduce the length of the flu
by just 2-3 days. And it has to be taken within a short period of getting the
flu. Didn't feel it was worth it.

~~~
eco
It was always my understanding that Tamiflu was more for people for whom
contracting influenza was life threatening. Not for regular people to
experience a shorter flu.

This report is pretty damning, regardless.

~~~
karmajunkie
I've taken it in the past when my son tested positive for flu, but before I've
shown symptoms. I've yet to come down with it under those circumstances. Of
course, its impossible to say for sure whether I'd have gotten the flu
otherwise, but anecdotally I believe it was successful prophylaxis.

------
tokenadult
The follow-up article on this report[1] from _Science-Based Medicine_ provides
more details and good perspective on the difficulty in general of studying the
safety and effectiveness of new treatments of any kind for any condition.

[1] [http://www.sciencebasedmedicine.org/new-evidence-same-
conclu...](http://www.sciencebasedmedicine.org/new-evidence-same-conclusion-
tamiflu-only-modestly-useful-for-influenza/)

------
microjesus
This is like Vitamin C. No one believes me that it's been debunked. My god,
the things that marketing can sell which are of no use.

~~~
smtddr
I dunno about that. Those Emergen-C 1000mg Vitamin C powder packs work wonders
for me. If it's been debunked then I got some kinda crazy placebo effect going
on.

~~~
js2
_8.1. Cold and Flu

According to meta-analyses on the topic assessing doses of 200mg vitamin C or
more, vitamin C has failed to reduce the frequency of colds in the normal
population but was successful in reducing the duration of colds (on average
8-14%);[149][145] when looking at studies investigating extreme physical
stress (marathoners and skiiers), the risk of getting a cold was halved (which
has been noted in past meta-analyses[144])_

[http://examine.com/supplements/Vitamin+C/#summary8-0](http://examine.com/supplements/Vitamin+C/#summary8-0)

~~~
smtddr
That's actually in line with how I use it.

Definitely not a marathoner/skiier but I work out about an hour a day and I
never expect Vitamin-C to prevent colds. I only take it after 2 to 3 day of
sensing an incoming cold.

~~~
vixen99
I remember a recent study found that vitamin C had no effect on the period or
severity of a cold but zinc did. Seems to be confirmed by this :-
[https://www.ncbi.nlm.nih.gov/pubmed/15496046](https://www.ncbi.nlm.nih.gov/pubmed/15496046)

------
bananas
I got given some of this in the UK when I had the sniffles during the panic. I
didn't actually go to the doctors for that problem. Ultimately I didn't take
them and I suspect that most people didn't or they were disposed off after the
discard date. Some people walked off with a fucking huge pile of cash after
that one...

------
robmcm
It's a bit like saying we wasted millions of preparing for heavy snow in the
UK this year as we got none.

If H1N1 or derivatives caused a serious pandemic I would much rather have some
Tamiflu than not, even if it's effectiveness varied for patient to patient.

It's easy to say money was wasted with hindsight.

~~~
kitd
I don't think your analysis is correct.

They're not saying that the money is wasted because we haven't had a flu
outbreak. They are saying that, if there was one, Tamiflu would be as useful
as paracetamol. It would be like (in your analogy) someone claiming that the
snow clearing equipment bought was known to be faulty or not work in cold
conditions. In that case, saying the money was wasted would be justifiable.

I don't have an answer, other than the observation that there are too many
cases these days where public health and commerce don't work well together.

~~~
robmcm
> I would much rather have some Tamiflu than not, even if it's effectiveness
> varied for patient to patient.

At the time Tamiflu was believed to work well, and must have had studies that
backed this up (otherwise it wouldn't have got past NICE).

If it is in fact no better than paracetamol then with hindsight you could
argue it was a mistake to stockpile, however I was reassured that my
government had prepared, which in itself could have avoided some additional
panic and bad press.

------
gwern
Fulltext:
[http://www.bmj.com/content/348/bmj.g2545](http://www.bmj.com/content/348/bmj.g2545)

------
Elepsis
Worth pointing out to American readers that paracetamol is known in the U.S.
as acetaminophen, the active ingredient in (most notably) Tylenol.

------
bencollier49
Is this another casualty of the "selective publication" of results performed
by pharma companies?

------
willvarfar
In Sweden, almost everyone was vaccinated with Pandemrix
[http://en.wikipedia.org/wiki/Pandemrix](http://en.wikipedia.org/wiki/Pandemrix)

I think this is not the same exact drug as Tamiflu, but the parallels - mass
vaccination etc - are worth drawing.

The scary thing about Pandemrix is that some people - mostly children and
young adults - immediately got narcolepsy
[http://en.wikipedia.org/wiki/Narcolepsy](http://en.wikipedia.org/wiki/Narcolepsy)

Now the various investigations have all said they can find no link between
narcolepsy and Pandemrix, and yet they don't really explain the suddenness of
it all. Seems a hell of a coincidence.

Narcolepsy is not some silly little "sleep disorder". This was really brought
home to me - literally - by knowing someone who's child got it hours after
their Pandemrix jab =(

The micro-problem here is the Swedish state trying to avoid paying for care
(its untreatable, as I understand it) and all that wrangling about taking
responsibility. I think most parents of suffers are really out to share around
the burden of responsibility, rather than caring so much about the costs of
care.

The macro-problem is convincing people that the next time we are told to go
get a jab, we should :(

Here's Penn & Teller talking about Vaccines:
[https://www.youtube.com/watch?v=RfdZTZQvuCo](https://www.youtube.com/watch?v=RfdZTZQvuCo)

Science isn't going to win over my wife as easily as all that. And I am very
divided myself, however rational I try and be.

~~~
beedogs
Tamiflu isn't a vaccine; it's an antiviral. You take it when you already have
flu symptoms.

~~~
willvarfar
The parallel was not the drug, it was the government program and the money.

