
Why the CDC and FDA Are Telling You Two Different Things About Flu Drugs - ryan_j_naughton
http://fivethirtyeight.com/features/why-the-cdc-and-fda-are-telling-you-two-different-things-about-the-flu/
======
carbocation
This is a great article. I say this as a physician and someone just today
returning to work after having been out all week with the flu.

I weigh the evidence similarly to Cochrane/FDA. Though I was aware I had the
flu within ~12-24h, I did not elect to take Tamiflu. This is both because I
currently have no comorbidities, but also because the side effect profile is
quite real. People really do sometimes add nausea and vomiting to their list
of flu symptoms because they take these medications.

In the inpatient setting I offer Tamiflu to anyone sick enough to be
hospitalized, and I am happy to offer it to outpatients with the flu as well
if they understand the potential side effects, but it's definitely not a clear
winner.

------
gojomo
I trust the FDA and Cochrane Review here more than the CDC.

The small durational effect, high dependence on early-administration, and
reliance on observational reports combine to add to my suspicion. Consider
especially:

If patients are motivated to seek anything that might help, and they know that
a prescription is only given in "first 48 hours", they might report their
symptoms as having started later than they really did. Then, when their
symptoms end at the usual time, it "observationally" looks like a shorter flu.
Or maybe, other placebo/choice-supportive-bias effects cause them to rush to
deem their symptoms 'over' – after all they went through the time and cost of
acquiring the drug.

Thus a pronouncement like "works if rapidly administered" could become a self-
fulfilling prophesy through social/psychological biases in reporting.

Similarly, the CDC is under political/social pressure to "do something", and
have active modern recommendations, other than just generic 100-year-old
patience/hygiene tips. This is especially the case when, as this year, their
flu-strain guesses for the vaccine have been wrong.

Temperamentally and institutionally, the CDC needs to believe there's
something else to do, that the stockpiles of antivirals they've bought at
great cost are effective, and that these kinds of drugs (from specific
companies they often rely upon) will help if something much worse than
seasonal flu materializes. So they're going to err in the direction of faith-
in-antivirals.

------
tghw
I got the flu this year and looked into it. I'm not sure the CDC's suggestions
are well founded. On average, antivirals shorten symptoms by half a day over
seven days. Not a huge upside. And the Cochrane Collaboration and the BMJ
found that it's unlikely the antivirals reduce hospital admissions or
complications[1].

On the flip side, there are a number of side effects, including headaches,
nausea, and vomiting, which can't make the flu experience better.

I was at the edge of the 48-hour window, and decided it just wasn't worth it
for me. Maybe if someone I knew who was elderly or had a compromised immune
system got the flu, I would push them to get the antivirals, but for otherwise
healthy adults, it seems like a waste of money.

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

------
molecules
I have worked in the Biotech industry and worked with both the FDA and CDC.

The CDC and FDA have separate missions. The CDC tries to manage diseases once
local authorities become overwhelmed. They maintain the Strategic National
Stockpile. The SNS is a stockpile of different drugs, not enough for everyone,
but enough to hopefully contain an outbreak. Our particular vaccine was FDA
approved, and purchased for the SNS. The CDC also may purchase drugs that have
not yet been FDA approved (depending on the political climate).

The FDA is the regulatory agency that polices, in this article's case, drugs.
They monitor the clinical trials, and manufacturing process of the drugs (gmp-
good manufacturing process). The FDA makes sure that drug companies do not
exaggerate the efficacy of their products.

So it is not really that surprising that an agency that monitors and manages
diseases would recommend drugs, while the agency that monitors and manages
drugs would point to drug efficacy first.

------
con-templative
The BMJ have run a campaign to make more clinical trial data about Tamiflu
public, along with questioning its effectiveness given the large sum of public
money spent on it. It seems to me that their reporting is the main reason this
story has seen the light of day.

There are lots of BMJ articles about it here:
[http://www.bmj.com/tamiflu](http://www.bmj.com/tamiflu)

------
fpgaminer
>The CDC released figures Thursday showing that this season’s influenza
vaccine is only about 23 percent effective

Yikes, is it normally that low? I looked up a quick figure for 2013, and it
was 60% effectiveness.

~~~
DanBC
It's not normally that ineffective. There has been some "drift" which is
expected. It's not as bad as the 2009(?) swine flu outbreak.

~~~
Intermernet
2009 is correct. Thanks for pointing out the concept that the efficacy of
these drugs changes due to the mutations of the virus.

[http://en.wikipedia.org/wiki/Pandemic_H1N1/09_virus#Nomencla...](http://en.wikipedia.org/wiki/Pandemic_H1N1/09_virus#Nomenclature)

[http://en.wikipedia.org/wiki/2009_flu_pandemic](http://en.wikipedia.org/wiki/2009_flu_pandemic)

------
stinos
Isn't this the same old story, as written about by Ben Goldacre for instance,
over and over again?

Pharma sees money ( _everyone_ gets the flu), tries to come up with something,
sort of fails, yet still wants money and somehow manages to push through via
official channels and gets a new drug of which the effects are rather
questionable into the stores, earns money.

~~~
spacecowboy_lon
no this is selfish peopel who didnt get the jab in time wanting somthing after
the fact.

~~~
spacecowboy_lon
Oh dear did I upset little timmy the vaxer - I HAVE to have the job (plus a
load of other ones) for medical resons and its muppets liek you that don't
proactivly care of your health which impacts me diretly and damages heard
imunity.

~~~
TallGuyShort
Given that you're discussing inconsistency in what medical experts are saying
it would benefit everyone if people like both of you just shut up and let
people make their own decisions.

------
wcbeard10
My perception is that the FDA's on the hook if they promote a drug that turns
out not so safe/effective, and CDC's on the hook proportional to how much
damage the flu wreaks. In which case I'd expect the FDA to be extremely
conservative about promoting it, and the CDC to push anything with even a
marginal effect, no matter other costs.

------
snowwrestler
I think one aspect of disease management that the CDC probably (I don't have
direct proof) cares about more than most is logistics. Specifically, the
companies and processes needed to produce and distribute flu vaccines and
drugs in volumes sufficient for national response.

This sort of infrastructure is very expensive and time-consuming to create--
way longer than a flu strain takes to propagate, or an individual vaccine
takes to formulate.

In the back of everyone's mind is the 1918 flu, and the possibility for a
similarly deadly (or more deadly) version to develop today. It's possible and
essentially unpredictable. If it were to happen, we would need to have that
vaccine/drug infrastructure ready to go.

So: get your flu vaccine every year, even though it might not be super
effective. Take Tamiflu even though it might not help much with a typical flu.
Why? To keep those businesses and factories around for another year, in case
we _really_ need them.

------
walkamages
As someone who had one of the products mentioned here, the side effects were
not slight, and to be honest more annoying than the flu itself. We only
received the medication (here in the UK) because at the time there was the
fear of an outbreak of avian or swine flu, and the idea at the time was to
head things off. I think even if they do show any effectiveness in longer term
trials (didn't do much for me personally), I would be wary of seeing them
widely used, as it seems they should be targeted mostly at those individuals
with compromised immune systems, or perhaps in the future, those individuals
identified as having a genetic makeup that could aid and abet a flu related
fatality.

------
2muchcoffeeman
Tamiflu is $130? I was prescribed Tamiflu last year and a course cost me 1/3rd
of that at the first drug store I walked into. I'm in Australia.

Can't say if it really worked or not.

~~~
hvs
Your government is subsidizing a large amount of the cost:

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

------
spacecowboy_lon
Becase to be efective you take the damm thing before flu season starts in
spetember - once you have it its not worth it.

