Tamiflu treatment REDUCES the survival rate of avian flu patients.

[stickdog]

17 of the 22 avian flu patients treated with Tamiflu are now dead and buried. That's avian flu 17, Tamiflu 5. Further proof that when it walks like a neoCON and talks like a neoCON and enriches a neoCON, it's generally just another big CON.

A chart from a NE Journal of Medicine article ( http://content.nejm.org/cgi/content/full/353/13/1374 ) that's been widely distributed and quoted from to "prove" that oseltamivir (Tamiflu) is a clinically effective treatment for humans can be found here:

http://content.nejm.org/cgi/content-nw/full/353/13/1374/T3

The chart suggests that a total of 25 H5N1 patients have been treated with oseltamivir (Tamiflu), but it doesn't give a breakdown of how many of these lived or died. However, all 10 of the patients in the Ho Chi Minh City outbreak were treated with Tamiflu, and these patients had an 80% mortality rate -- which is much higher than the average mortality rate for all clinically documented human cases of avian flu.

Further, when the NE Journal of Medicine article claims that "early {Tamiflu} treatment will provide the greatest clinical benefit," it cites a medical article concerning the Thailand outbreak ( http://www.findarticles.com/p/articles/mi_m0GVK/is_2_11/ai_n11833869 ) in its footnotes. The cited article states:

Seven patients were treated with the neuraminidase inhibitor oseltamivir (Tamiflu) at various stages of illness. Treatment tended to have been started earlier in those who survived (a median of 4.5 days from onset compared with 9 days for those who died), and both survivors who were treated received the complete 5-day course of drug, whereas 2 of 5 patients who died received the complete 5-day course.

In addition, when this prestigious journal mentions that the "early initiation of antiviral agents appears to be beneficial," it references another medical article concerning the Vietnam outbreak ( http://content.nejm.org/cgi/content/full/350/12/1179?ijkey=171d51f775eec28a47c5aabe85eed863238c3984 ). From the cited article:

Oseltamivir {Tamiflu} was administered to five of the patients, four of whom died. Treatment with the drug may have been started too late to be effective, although one of the two surviving patients did not start oseltamivir therapy until the 12th day of illness. ... Our experience suggests that supportive care may be the only option available. Controlled clinical studies are needed to assess the role of antiviral drugs and corticosteroids in the treatment of influenza A (H5N1) virus infections.

****

THE BOTTOM LINE:

8 out of 10 patients treated with Tamiflu in the Ho Chi Minh City outbreak died. 5 out of 7 patients treated with Tamiflu in Thailand died as well. Finally, 4 out of 5 patients treated with Tamiflu in Vietnam died, with only the patient whose treatment was started the latest (in the 12th day) surviving!

For those counting at home, that works out to a whopping 77.3% mortality rate for avian flu patients treated with Tamiflu! To put this in clinical perspective, just 21 of the 37 other avian flu victims died -- resulting in a far less severe mortality rate of 56.8%.

In summary, there is no evidence for the widely repeated claim that Tamiflu is a clinically effective treatment for humans infected with the avian flu virus.

[stevedeshazer]

1. 22 is a mighty small sample

So is 37.

[stickdog]

3. Yes, but the difference in outcomes is still significant.

The reason the sample size is so small is because the transmission of this disease from birds to humans is so difficult.

The bottom line is that these small samples absolutely do NOT support the widely reported claim that Tamiflu is an effective treatment for humans who have somehow contracted avian flu.

[GrumpyGreg]

2. Ignore all studies----you'll sleep better at night.

[CAG]

4. The bottom line is we simply don't know yet. We know it has in vitro

activity, but short of a randomized clinical trial, all data will be subject to scrutiny. In these relatively uncontrolled circumstances cited above, we really don't know that the patients NOT receiving the drug were as SICK at baseline as those that received the drug. These uncontrolled numbers are entirely too small to tease out meaningful conclusions for or against the drug. All this is predicated that the H5N1 strains from year to year and region to region are similar enough to all have similar virulence properties and susceptibilities to the drug.

In almost every acute viral infection that we are able to affect with antiviral therapy, its been shown that in most cases starting the drug >48-72 hours after the start of symptoms is basically useless. Thats why they are stressing this type of approach of beginning the drug as soon as possible.

[stickdog]

5. So we need to stockpile a drug that hasn't been proven effective

against a viral threat (human to human transmissible avian flu) that doesn't currently exist?

[RedOnce]

6. Excellent point!

[CAG]

10. The decision-makers on a policy like this (ie, CDC, HHS, WHO)

are in a very tough spot with this. I sit back and watch people screaming at them that they aren't doing enough about this, and then I sit back and watch people screaming at them that they're doing too much. Its easy for all of us armchair quarterbacks to have very strong opinions on something like this, because at the end of the day, whether or not this becomes a pandemic or not, we won't get blamed for either not doing enough or doing too much.

The flu vaccine is only about 60% effective in the most vulnerable population. That stinks for a vaccine. There were outcries from people early on about whether this warranted recommendations urging such large populations to get the vaccine, but now its pretty much considered to be beneficial and standard of care when additional data was available.

The truth is, I don't know if we should be stockpiling oseltamivir or not. The data available just doesn't answer the question yet. Yes, the fact that a drug company that has 20% profit margins already is about to bleed people dry even more is sickening, but that doesn't have anything to do with whether avian flu is going to be treated adequately with oseltamivir or not.

[stickdog]

19. Does the fact the Rumsfeld used to be the chairman of the board

of the corporation that makes Tamiflu -- and still owns a ton of stock in it -- enter into your ruminations?

[CAG]

23. No. Roche makes Ceftriaxone (Rocephin). This drug has been

found to be effective for numerous infections, from gonorrhea, community-acquired pneumonia, bacterial meningitis, endocarditis, Lyme disease, cellulitis, to urinary tract infections. The drug has made zillions for Roche, and probably zillions for Rummy. Do I withhold this drug from my patients just because Rummy's getting rich from it??

In a lot of hospitals, ceftriaxone has been a workhorse drug. Not in ours because we had more cost-effective options that were just as safe and effective.

Exactly what drug company doesn't have sick greedy repub management/CEO/board members/investors making money off of sick people? When you find one, tell me about it. Until then, it doesn't enter my clinical judgement over whether a drug is the best choice for a given patient.

[pinto]

7. C'mon stickdog. You know that's not causal data. I read the other thread,

thought you and the others all made some good points and posted some good info. 17 of 22 treated with Tamiflu died...that doesn't equate to Tamiflu "reducing" survival rate. Says something about effectiveness, perhaps, even without taking into account how sick each of the 22 were when administered the drug, any other medical complications among the 22, dosage, etc., etc.

In a way, that's like comparing the 1918 pandemic to a possible 21st century pandemic without taking into account the differences in overall health, antiviral/antibiotic availability, health care systems, general nutrition, transmission vectors, government response etc., etc.

If anything, "avian flu" has spurred researchers, epidemiologists and governments to look at a world wide response to the possibility of a flu pandemic.

I don't think an effective response - or a pandemic - will be forthcoming "overnight" in the scheme of things. We'd probably all do well to avoid jumping to conclusions.

Thanks for the data graph...it helps put things in perspective.

:thumbsup:

ed for civility and clarity.

[stickdog]

11. Point taken. However, you must admit that the idea that Tamiflu

is an effective human avian flu treatment is certainly not even remotely supported by our current clinical evidence.

Given the 20% decrease in survival rates among those patients treated with Tamiflu, wouldn't you agree that a measure of skepticism concerning Tamiflu's widely claimed efficacy is in order?

[pinto]

14. Yeah, I agree.

[rooboy]

8. My wife has been prescribed and taken Tamiflu in the past.

The bottom line is this - if you take Tamiflu VERY EARLY after symptoms are discovered, it MIGHT help you fight the illness. Otherwise it's worthless.

It's kind of like saying that mouth-to-mouth didn't work on a bunch of people who drowned 2 hours earlier, therefore it's no good.

[Lex]

13. How do we know is WASN'T taken very early after symptoms

were discovered?

[Coastie for Truth]

9. Yer doina heck of a job Crissie

Crissie Beato is Bush's "Tamiflu" expert--->

<>
Rear Admiral Cristina Beato
Acting Assistant Secretary for Health, Department of Health and Human Services

In June 2004, Cristina Beato admitted to her hometown newspaper that she hadn't paid much attention to the details of her resumé. That's too bad, because those silly little details seem to have stalled her confirmation for assistant secretary for health for over two years now. Beato said she earned a master's of public health in occupational medicine from the University of Wisconsin (but the university doesn't even offer that degree). She claimed to be "one of the principal leaders who revolutionized medical education in American universities by implementing the Problem Based learning curriculum" (but the curriculum was developed while Beato was still a medical student). She listed "medical attaché" to the American Embassy in Turkey as a job she held in 1986 (but that position didn't exist until 1995). She also boasted that she had "established" the University of New Mexico's occupational health clinic (but the clinic existed before she was hired, and there was even another medical director before her). For her part, Beato has offered a simple explanation: English is her third language, after French and her native Spanish, and sometimes the language barrier is just too much to handle. How does one say "pants on fire" in Spanish?

[madrchsod]

12. vaccinate the god dam chickens

geez that`s the simple thing to do. veitnam and china are already doing this is the united states going to? i doubt it.

[pinto]

15. Yeah, that's one obviously effective measure, here and now. Decrease the

viral pool among commercial poultry. Would help to minimize wild bird transmission as well if domestic flocks were vaccinated.

:thumbsup:

[Media_Lies_Daily]

18. Here's the catch...the chickens aren't the major problem....

...wild birds are carrying the virus to every corner of the world.

How are you going to innoculate all of them?

[helderheid]

16. I'm tellin ya... Virgin Coconut Oil...

[upi402]

17. Thank you very much! k/r

[mainer]

20. Flu patients treated with ventilators more likely to die!

than flu patients NOT treated with ventilators! It proves that ventilators are more likely to kill you if you have the flu!

[stickdog]

21. Nice try. Are patients supposed to go on ventilators ASAP just like

antivirals? And since over 60% of the people getting avian flu died, what makes you think that ANY of them weren't treated with ventilators?

While Tamiflu may not have contributed to the higher mortality rate of the patients who were treated with it, my point is that there is no clinical evidence that suggests that Tamiflu is an effective treatment for humans who have somehow contracted avian flu. Do you agree or disagree?

[upi402]

22. i agree, the previous analogy didn't hold for me either

Your take on it is the same as mine. And if a greedy Rethug is gonna profit from fear, then it follows.
-yet another premise which supports the conclusion.

The actuarial study finding that a large % of car accidents occur w/in 5 miles of home is due to the fact that all trips are 5 miles or less, a smaller % are 6 - 10 miles, still fewer 11 - 15 miles, etc.
A large % of those in danger of dying of respiratory failure are put on ventilators -because they're in danger of dying.
Those not in danger don't generally get put in ventilators.
Therefore, a higher % of those dying of flu were put on respirators.

Can't get Flu shots without Themerisol anyway, so I don't expect Tamiflu to be available to 3rd world Americans like us.