Tamiflu: Myth and Misconception

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The people clearly proven to be benefitting from the flu medication are its manufacturers.

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Tamiflu

Flu season is still here, and Hoffman-LaRoche, the manufacturer of the anti-viral drug Tamiflu (oseltamivir) are still running an ad intended to market directly to patients. "Sometimes what we suffer from is bigger than we think. The flu is a big deal, so don't treat it like a little cold. Treat it with Tamiflu." 

If you didn't get the message from these ads, the U.S. Centers for Disease Control and Prevention has also issued public service announcements urging people to get Tamiflu at the first sign of a sniffle or sneeze. 

Between the two, the government recommendations and pharmaceutical ads appear to be having the desired effect, because Americans have been flooding their local emergency rooms and doctor's offices asking for their prescription of Tamiflu.

You have to wonder what the thinking is at the CDC when it decided to recommend Tamiflu as a first line treatment against the flu.

Emergency physicians tell us their beds and hallways are jammed with people complaining of flu-like symptoms. And for those doctors who might be tempted to tell their patients to go home, take two aspirin, and get back into bed, Roche has been targeting the doctors with another set of marketing messages. In its ads to physicians, the company claimed that Tamiflu cuts hospital admissions by 61 percent and reduces complications such as bronchitis, pneumonia, and sinusitis by 67 percent. In at least one press release, the company even claimed that the drug reduces flu deaths.

The drug does none of the above. An FDA committee declined to approve Tamiflu in 1999 after finding that Tamiflu had not been shown to reduce pneumonia or mortality. But FDA administrators overruled the expert advisors and approved the drug. The agency later instructed the company to issue the following statement:

Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.

In 2009, a decade after the drug was approved, an FDA spokesperson told the BMJ (formerly the British Medical Journal) that clinical trials "failed to demonstrate any significant difference in rates of hospitalization, complications, or mortality in patients receiving either Tamiflu or placebo."

Last year, the prestigious Cochrane Collaboration, a group of experts in medical evidence, set about re-analyzing all the data they could lay their hands on about Tamiflu. When they examined seven studies of hospitalizations of flu patients given Tamiflu or placebo, Roche's drug showed "no effect." In other words, go to your doctor, pay your money -- and you're just as likely to end up sick enough to require hospitalization, whether or not you take the drug. The Cochrane study did find that flu symptoms were shortened by 21 hours, which hardly seems worth the risk of Tamiflu's side effects, which include vomiting and diarrhea. The drug has also been linked -- anecdotally -- to psychiatric symptoms.

Why does the CDC recommend Tamiflu as a first line treatment against the flu? (The agency also spends millions of dollars each year stockpiling and promoting flu vaccine, which is also of dubious value, as we wrote in an article for The Atlantic in 2009.) 

When we asked the CDC to show us the data behind the decision, the agency responded, "CDC looks at more than clinical trial or randomized control trial data ... many observational studies ... have consistently found that early oseltamivir treatment of influenza patients reduces the duration of hospitalization and risk of severe outcomes such as intensive care unit admission or death." In other words, they're willing to throw out the scientific evidence in favor of observational studies.

But the most worrisome thing about the ongoing hype around Tamiflu is the emergency room crowding it is causing. Dr. David Newman, an associate professor of emergency medicine at Mount Sinai School of Medicine, in Manhattan, says that one of the biggest dangers of any flu season is the outbreak of panicky patients who flood emergency departments around the country. The vast majority don't even have the flu, they've got some other yucky virus. But of those with the flu, most aren't sick enough to need hospitalization. Even so, says Newman, when patients with even mild flu symptoms show up in the hospital, they spread whatever virus it is they have by sneezing and coughing in rooms that are jammed with other people.

When emergency rooms are crowded, death rates among people who really need immediate care go up. One study found that heart attack patients were more likely to die in crowded emergency departments. That means not only are patients with minor flu-like symptoms exposing themselves to a load of other bugs when they rush to the ER, they're potentially standing between some other patient and lifesaving treatment. We should consider all of this before going to get treated with a drug that does so little for us, and so much for the manufacturer's bottom line.

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Presented by

Shannon Brownlee & Jeanne Lenzer

Shannon Brownlee is the acting director of the health policy program at the New America Foundation and an instructor at the Dartmouth Institute for Health Policy and Clinical Practice. Her writing also appears in The New York Times Magazine and The New Republic. Jeanne Lenzer is an investigative journalist and a frequent contributor to BMJ.

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