An article in the British Medical Journal (online fastrack) by a team at Oxford has looked at the available evidence on using tamiflu to treat flu. It concludes that there is no evidence that it would be worth using even if it was free.
It typically reduces the length of illness from a week to six days. On the other hand, a small percentage of children (5%) suffered an increase in side effects (unpleasant, but not life threatening – nausea, vomiting, diarrhoea).
Of course, for the overwhelming majority of victims, flu is a trivial illness in any case. But a tiny proportion of victims suffer from more serious, life-threatening complications, typically because of existing medical conditions. So the interesting data is to what extent tamiflu and relenza help in these more serious cases. The article says that there is insufficient data to tell.
The researchers were looking at data on normal seasonal flu, not on the much ballyhooed swine flu, expected to reach epidemic proportions in the UK in the late autumn. On the other hand, it is the best guide we have for swine flu, whose clinical effects seem to be similar to the usual seasonal flu.
So to put matters more crisply, there is absolutely no evidence that tamiflu is worth taking. So what is going on?
First, it is just an “antiviral”. These are general purpose medicines aimed at any viral infection. They are well-known to be fairly useless (unlike antibiotics, which are aimed at bacterial infections). [It is called Tamiflu, just because flu is the only thing people are dumb enough to buy it for.]
A more useful treatment is a specific vaccine targeted at the particular virus. But such vaccines take time to develop. The government is paying GlaxoSmithKline and Baxter £155 million to produce 130 million doses of vaccine over the next four years targeted specifically at swine flu, but they will not arrive until later.
In the meantime “Health Protection Agency records, to date, suggest that 99 per cent of confirmed H1N1 [= swine flu] cases are offered Tamiflu …” (Hansard 24 June 2009, bottom col 1019W). According to Gordon Brown at Prime Minister’s Question Time on 29 April “we have recently increased our order to 50 million doses” (Hansard near top col 859).
[one of many warehouses making Roche richer]
The major manufacturer of tamiflu is Roche. Pricing is a “commercial secret”, meaning that neither the government nor Roche wants the public to know how much we are paying for this junk.
Roche appears to have been selling about 50 million doses/year getting around £1 billion/year for them, but business is now booming. It expects to sell almost ten times that amount over the next year or so to scared democracies. That suggests a bulk-pricing of maybe $20/dose. But maybe it is managing to up the price in the current “emergency”. Texas, for example, reports paying $100/dose.
Even if we are managing to keep our costs down to $20/dose, which seems unlikely, that is still £0.6 billion for those 50 million doses, with zero evidence that they are any use at all.
But, of course, no politician wants to seem uncaring. When the public is thoroughly scared for no good reason, it is much safer to start providing useless remedies than to try to calm people down. A government spokesman repeated:
safety first approach, offering anti-virals for everyone, will remain the sensible and responsible way forward
Unfortunately, rich democracies seem to delight in getting scared over trivial risks and wasting money on unhelpful solutions.
[Oh, if you want to read the BMJ article, it is currently hard to find, but free, on the BMJ site. The pukka name for tamiflu is oseltamivir. It is one of a class of drugs called neuraminidase inhibitors.]
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