
The Truth About Tamiflu: Has the US wasted $1.5 billion on an ineffective drug? - gojomo
http://www.theatlantic.com/doc/200912u/tamiflu
======
JunkDNA
When I read this article to my wife (a physician) she was not the least bit
surprised. She asked me why it was even news. She has spent the last several
months trying to convince patients that Tamiflu isn't indicated for people who
are otherwise healthy because the benefit vs. risk is not really favorable.
Many become very irate when presented with this information and demand the
medicine anyway, on the grounds that "other doctors" are giving it out to
everyone.

~~~
pragmatic
So did she prescribe the drug anyway?

Doctors are pressured by patients to prescribe pain killers, anit-biotics,
etc. But isn't it up to the doctor to say yes or no?

~~~
anamax
If it does no harm and the patient is paying for it, why not say yes?

Note the "if the patient is paying" clause. MDs shouldn't be doing cost-
benefit tradeoffs - patients should.

Politicians shouldn't be doing cost-benefit tradeoffs either. (That's a
statement against interest - my demographic group has way more say than other
groups, so we'll be subsidized by politicians. And no, it won't be different
this time.)

~~~
stavrianos
You're thinking of a pharmacist.

MDs and politicians should _absolutely_ be doing cost-benefit tradeoffs. I'd
go so far as to say that's basically their job. I go to a doctor because they
have skills and knowledge I don't possess.

That doctors (being experts) so often don't apply their judgment, and
politicians (often being charismatic amateurs) so often do is lamentable.
Politicians should be required to be experts. Doctors should be (aren't they?)
required to exhibit judgment on behalf of their patients.

Expecting everyone to be able to exhibit the judgment of a professional in
every field is so wildly implausible that I've obviously mistaken your
meaning.

~~~
abstractbill
In my experience there's a difference between European and American doctors. I
guess it has something to do with how much American doctors get sued, or how
much American patients expect to be "in charge", or something like that.

My wife and I are both from Europe originally, and going to the doctor in the
US is sometimes really frustrating for us. We go with the idea that we're
consulting an expert for their advice, but sometimes find them quite unwilling
to make any kind of judgment call. Sometimes they just offer a bunch of
options and say "pick one". When pressed for an opinion, they'll sometimes
just _hint_ in one direction or another. Compared to a British doctor, who
will almost always confidently tell you exactly what he or she thinks should
be done, it can be quite an unnerving experience.

~~~
travisp
Doctors are taught in American medical schools that they are supposed to
provide all options to their patients and explain to them the cost benefits
and not try to make or even bias their decision.

I'm not sure if it's simply for fear of lawsuits or if it's coded in the law
itself (although I think I read that it's the latter somewhere).

~~~
carbocation
It is coded in the ethical principle of autonomy, which some would say is more
important than either the fear of lawsuits or the laws of any particular
country.

------
Hoff
As-yet unseen endings of the "someone is wrong on the Internet"
<http://xkcd.com/386/> ...

\- commercial interests. \- advertising. \- religious beliefs. \- political
party affiliations. \- market transparency. \- peer pressure \- etc.

That there are marginal drugs has long been an issue; how many of us read the
available studies? In some cases, you'll find a commercially-successful drug
is little better than placebo, or little better than a generic.

The most reliable approach toward truth and knowledge in a capitalism-based
society? Follow the revenues. Find and then follow what the folks involved
value. Often monetary profit or status within the group.

------
aaronsw
This is pretty much par for the course for new drugs and goes a long way
toward explaining why we're such an overmedicalized society:

<http://www.nybooks.com/articles/17244>

~~~
pragmatic
Again, the DOCTOR prescribe the medicine not the patient. Why would the doctor
prescribe unneeded/unnecessary medicine?

I understand the social pressure etc. However, when I go to a doctor I expect
him/her to prescribe something that is necessary not just write a script to
get me out of the office.

Can much of health care problems be pinned directly on the doctors? I know its
unpopular to criticize doctors, but I'm beginning to think that we can only
address the health issue by directly confronting the MD's.

~~~
fnid
Also consider that doctors get kickbacks from the pharmas for prescribing
certain medicines, in addition to lots of perks like swag, vacations, etc
piled on them by marketing reps.

------
CWuestefeld
_A 2006 Cochrane review of Tamiflu came to similar conclusions -- based
largely on a paper that looked at ten studies, all of them funded by the
company [Roche]._

This kind of reporting annoys me. It's a logical fallacy that having a stake
in the outcome makes your research invalid. And who else is going to fund a
study? Nobody without a stake is going to foot the bill.

 _If the drug is going to be used to prevent death, it seems reasonable to ask
whether or not its potentially deadly side effects are outweighed_

Quite the opposite. If the patient is likely to die anyway, then side effects
be damned. It's time for a "Hail Mary" play. Get the patients past the
immediate danger, and sort the rest out later.

 _The answer may lie in the politics of disease._

Sorry to be political here, but this is exactly what you'll be getting more of
when the government starts to dictate how much will be spent on what kind of
healthcare. When lobbyists or constituents are pushing for something to be
covered, even though they're ignorant or are just interested in profits, the
politicians will tilt the rules toward the squeaky wheel rather than rational
science.

------
GiraffeNecktie
A more nuanced view is available on the Effect Measure blog
([http://scienceblogs.com/effectmeasure/2009/12/the_tamiflu_do...](http://scienceblogs.com/effectmeasure/2009/12/the_tamiflu_doesnt_work_non-
st.php#c2138915)).

~~~
gojomo
That's a useful perspective, but I often get the sense from 'revere' (at
Effect Measure) that he's shading his analysis to promote "the message" he
thinks the public needs to hear.

For example, in the link you provided he impugns the motives of the publishers
of this latest analysis, and says about the their acceptance of the paper: "I
don't think it served the public purpose or the public health."

A couple places, he emphasizes "during a pandemic, no less" or "here we are in
the middle of a pandemic" as factors that should weigh against raising doubts
about Tamiflu's effectiveness at this time.

That kind of political calculation applied to scientific or medical results
creeps me out -- and often backfires on the officials who try it.

~~~
duncanj
Yet, it is a pandemic. That fact does change the calculus of whether to
recommend treatment. Do you say, "I don't have enough evidence yet to
recommend it?" Or do you say, "Based on the evidence we have, it is a good
idea?" There is no right answer until post-pandemic studies.

~~~
billswift
No it is not a pandemic:

# epidemic over a wide geographical area; "a pandemic outbreak of malaria"

# an epidemic that is geographically widespread; occurring throughout a region
or even throughout the world

# existing everywhere; "pandemic fear of nuclear war"

wordnetweb.princeton.edu/perl/webwn

the first hit searching define"pandemic on Google

~~~
duncanj
Um, your first two definitions describe H1N1, the third is irrelevant.
Besides, it's a settled question if the WHO calls it a pandemic.
<http://www.who.int/csr/disease/swineflu/en/>

------
jacoblyles
Hypothesis: Democratic governments make bad decisions in the face of popular
panic. Hypothesis 2: Interested actors often try to stoke popular panic to get
governments to make rash decisions that benefit themselves.

------
patrickgzill
Shocking ... and yet not so shocking, when you consider the other marketing
activities pharma companies get into.

Viagra is probably the best example for heavy marketing of a drug (at least in
the US): TV ads, NASCAR sponsorship, etc.

~~~
tdoggette
Yes, but Pfizer isn't engaging in large-scale deception that costs billions of
dollars and risks millions of lives when they show a car smashing through a
billboard that says "Erectile Dysfunction" on it.

------
dubcomesaveme
[http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo...](http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect)

------
ssn
FYI: Tamiflu is not related to the H1N1 vaccines.

------
drhowarddrfine
I've known this for a year or so and thought everyone else did, too. Only
recently did I see stories about this again and was quite surprised.

------
Alex3917
And once again I ask, how are you supposed to make an informed decision about
health issues when there's a good chance the CDC is lying about the data:

<http://news.ycombinator.com/item?id=894903>

~~~
tokenadult
The only lies about autism and vaccines are coming from the people who fear
vaccines. Autism is definitely not something for which risk increases if
people are vaccinated. That is about as replicated a finding as medical
science has.

<http://www.sciencebasedmedicine.org/?p=2962>

~~~
Alex3917
Who said anything about autism?

~~~
tokenadult
The link

<http://news.ycombinator.com/item?id=894903>

you submitted earlier and just linked back to above.

~~~
Alex3917
Right, I don't believe nor have I ever believed that vaccines cause autism.
What I do believe is that the systemic design of the CDC makes it impossible
to trust what they say for various reasons.

~~~
scott_s
While gesturing at an article that claims childhood vaccines cause autism. I
have difficulty accepting someone's analysis of a federal organization when
they also clearly do not understand how science works.

