The Standard today has a huge headline across the front page saying: “TAMIFLU ALERT” and reports that overdosing of the drug reduces effectiveness against bird flu.
It has been clear for some time that the Hong Kong medical establishment has either been completely blinded by the weight of Roche’s marketing of Tamiflu, or, perhaps, that they have some other incentive firstly to place huge orders for a Tamiflu stockpile and secondly to keep it in the public eye so that people go and waste their money on it every time some little kid has a runny nose.
Today one Paul Chan, professor of microbiology at the Chinese University is quoted by The Standard as saying “Tamiflu is a very effective flu drug and also the last weapon to fight H5N1 [bird flu]. We cannot afford to jeopardise its efficacy.” Apart from being wrong in all factual aspects, this is quite clever – it makes him look as if he is being responsible whilst, of course, he is fully aware that the local population has no interest in minimizing the emergence drug resistance and so he keeps the name of Tamiflu on the front page of the paper, thereby boosting its sales.
Let’s consider what the Tamiflu Product Information leaflet has to say on the subject of that efficacy.
Efficacy of TAMIFLU in patients who begin treatment after 40 hours of symptoms has not been established.
(lines 250-251 of the leaflet). In other words, it has no effect in this case.
Safety and efficacy of repeated treatment or prophylaxis courses have not been studied.
There is no evidence for efficacy of TAMIFLU in any illness caused by any agents other than influenza agents Types A and B.
(lines 245-246) This excludes the vast majority of “runny nose” illnesses.
So what exactly does it claim to do? There is a lot of data in the leaflet, but in summary Tamiflu is recommended for use in two ways: as a prophylaxis (i.e. take it when a susceptible virus is around in the hope that this will stop it from infecting you), and as a treatment.
As a prophylaxis, the data shows that in groups exposed to a susceptible virus the use of Tamiflu for 42 days during a community outbreak reduced the incidence of adults catching the virus from 4.8% to 1.2%. (Lines 213-216 in the leaflet). However, the data also shows that there is a 4% increase in reported nausea (line 433) – so the total number of people feeling ill was pretty much unchanged even if it is a susceptible type of flu, and is increased if it is a different type.
Amongst children both effects are more marked (although the sample size at around 100 is small): prophylaxis reduces the risk of catching a virus when someone in the same household has it from 17% to 3%, but also increases the risk of nausea or vomiting by 11%. (lines 227-239 & 460). Again, the net number of people feeling ill is not greatly changed in the case that close contacts have a susceptible flu virus, and is significantly increased if they don’t.
When used to treat a susceptible virus the results are, to say the least, modest. The result of a 5 day course of Tamiflu started within 40 hours of symptoms appearing was to reduce the duration of the flu symptoms by an average of 1.3 days for adults and 1.5 days for children.
And what of the possible side effects? The Leaflet has this to say:
There have been postmarketing reports (mostly from Japan) of delirium and abnormal behaviour leading to injury, and in some cases to fatal outcomes, in patients with influenza who were receiving TAMIFLU. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on TAMIFLU usage data. These events were reported primarily amongst paediatric patients and often had an abrupt onset and rapid resolution. The contribution of TAMIFLU to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behaviour. If neuropsychiatric symptoms occur, the risks and benefits of continuing treatment should be evaluated for each patient.
The Japanese and South Korean Ministries of Health specifically warn against giving Tamiflu to 10-19 year olds.
So, in summary:
- Tamiflu has no efficacy against the common cold or other viruses except influenza (so that would be the vast majority of kids with runny noses).
- If used as a prophylaxis it is about equally likely to make you feel ill as to save you from the flu, even if it is one of the susceptible types that you are exposed to.
- If used promptly as treatment it may reduce the duration of symptoms by a day or two, but there’s a chance it will cause you to go psychotic and maybe kill yourself.
- Despite these facts, the Hong Kong medical establishment has stockpiled about 20 million doses of at a cost of HK$277.7 million. (See page 32 of this document examining the Department of Health budget.) This has been driven by the Scientific Committee on Emerging and Zoonotic Diseases (SCEZD) under the chairmanship of Professor Yuen Kwok-Yung of HKU.
This is the same Professor Yuen who at the time of SARS did wonders for the sales of Ribavirin (another antiviral drug) before it too was shown to be largely ineffective. He also admitted in an unguarded moment (reported in the SCMP of 9 May 2003) that the most of the people who died with SARS did so because of the over-medication by the medical establishment, not from the virus itself. (See this post for a contemporaneous analysis of the SARS hysteria.)
In my opinion, if the ICAC hasn’t already started looking for the kick-backs from drug manufacturers to the medical establishment in Hong Kong then they should do so.