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FEBRUARY 16, 2009 10:41PM

The Most Useless Drug Ever?

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Flu season seems to be heating up, with spikes in the number of cases throughout the whole country, and very high activity in 16 states

If you're curious about where you live, check out Google's Flu Tracker

The thing that seems to have health officials worried and scratching their heads this time around isn't the spike in influenza activity--that usually happens sometime during February.  The problem this year is that the drug most commonly used to ward off influenza if you get it --called Tamiflu--is ineffective.  The CDC reported in January that influenza A (as opposed to influenza B, which isn't as severe as the A strain) wasn't responding to Tamiflu,  but the most recent news is that Flu A is about 100% resistant to the drug.

The most useless drug ever?

In my pediatric practice, I almost never prescribe Tamiflu, for the following reasons:

1) For it be effective, you have to take it within 48 hours of being of developing symptoms.  Many times, that's impractical because many kids don't show up in the office for fevers until 2 to 3 days out.  Also, I prefer to test my patients to see if they have influenza--that result doesn't come back for about a day where I work.  So the window of opportunity for Tamiflu to make a difference is pretty small. 

2) Even when it's used effectively, Tamiflu only seems to reduce the symptoms of the flu by about 1 to 2 days at best.  To me, that's not a lot of bang for the buck--which leads me to reason #3

3)  Tamiflu is $$$$-it runs about a $100 for a course, a lot of money for parents who may have high deductible insurance plans for at best 24-48 hours of return. 

4) most of my patients are vaccinated against the flu, which gives me great reassurance that when they show up with fevers, it won't be influenza causing it (although, again, some strains of the virus aren't responsive to the vaccine--but that's par for the course since it happens just about every year)

It turns out the biggest buyer of Tamiflu is Uncle Sam--the Government has been stockpiling it for years in anticipation that we may all need some if there's a flu pandemic:  Basically, we all get caught flatfooted because the virus mutates into a very dangerous strain that the vaccine can't prevent.  There have been several pandemics over the past century, but the most notorious was in 1918--50 million people died worldwide as a result of the "Spanish Flu."  Some literally got sick in the morning and were dead by the time the sunset, bleeding out of every orifice in their body.   Here's an interesting picture from that era with a scary caption:

Back to 2009, we've got crates of Tamiflu that, frankly, may be completely useless should Flu A mutate into something virulent.  At the time that the stockpiling began, some experts suggested that we stockpile another flu drug, Relenza, as well.  While some Relenza was purchased, the vast majority of our stockpile is Tamiflu.  Not a wise use of our tax dollars.

Regardless, for now Tamiflu still seems to work for that nasty Avian flu we heard about for the first time in 2005, though we haven't seen much of that in North America. 

Raise you hand if you need a flu shot:  Ok, for those of you who did, go back to the Google Flu Tracker link, where you'll find a "flu shot locator" by zip code.  Good stuff. 

 

www.rahulkparikh.com
Twitter: docrkp

 __________________________________________

ADDENDUM: teendoc sent me a link reporting the death of 2 kids from influenza--very sad:

http://www.momlogic.com/2009/02/when_the_flu_turns_deadly.php

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Padraig,
thanks--there are too many to keep track of....
I can almost always trace my flu or cold to the cashier at a checkout counter. I just avoid shopping as much as possible until March...
Stellaa,
I've never tried Zicam but you're not the first person I know to swear by it
Cartouche,
that's also a great way to save money? Who do you send to buy groceries?
Interesting. My grandmother once told me what it was like in 1918, during the flu epidemic where she lived in Philadelphia. They ran out of coffins and dogs were eating the bodies in the streets.

Good post.
Ablonde,
Here's a link to NY Times' Reporter Gina Kolata's book about it:
http://tinyurl.com/dxrmex
Yes, Dr. Parikh, good to hear people should get flu shots, and the CDC recommends tamiflu + rimantadine for this flu season. If I remember correctly, there was some supply issue with relenza initially, and relenza is an inhaler; it is hard / impossible/ to administer to intubated patients. I believe these were the main reasons that the CDC did not purchase a large quantity for the Strategic National Stockpile program.
Zicam, for me, taken at the very start of a cold, will kill that sucker flat. Mostly, now, colds, which always certainly meant a bronchial infection, pass me by. Zicam appears, although I can't really say for certain, to shorten other viruses as well. That is, my parents just don't use it, despite my begging them to try it, and if we catch the same virus, it knocks them flat for weeks, and I'm up and around in about 5 days.

But it doesn't eliminate them, I'm sad to say.

I kind of don't think the flu shot fully worked this year. My child had one of her shots and then got the flu because, unfortunately, she had a reaction to the first shot. We couldn't get her the second one.

The flu virus was very very mild in her. Passed by her in a matter of days. In fact, I didn't know it was the flu until I caught it. Sadly, I passed it right to my parents. I hadn't gotten my flu shot yet, but my parents are religious about that stuff. They were sick for quite awhile.

Obviously, it would be good if an antiviral could be invented for this. I know you don't like the herbal stuff, but I have found that elderberry makes some difference. Perhaps some sort of synthetic version of this herb? I'd suggest the herb itself, but er, I know where that would go.
I didn't get a chance to get a flu shot this year. I've lucked out so far.

I agree with the good doctor here. The thing that makes Tamiflu so "useless" is the need to take it within 48 hours of symptoms developing. A lot of flu symptoms aren't something that scream "flu" so people like me ignore them until they get bad enough for us to be laid up.

By then, it's too late.
Thanks doc :) What is the shelf life of Tamiflu? Could it not only be ineffective in a mutated-variety pandemic, but also expired? ...our government at work ... superb!

This was very informative. Thanks for putting your time to it!
Zicam is great. I've got my teenagers using it now as well.
My dear Docteur Parikh ~ Do all viral drugs require this immediate awareness and dosage to work? Is it because of some viral quality that differs from bacterial action? Also, what is your opinion of Neti Pot? I've found that a good nostril rinse after exposure to crowds seems to keep colds at bag.
One other thought about flu drugs: elderberry (sambuca nigra) is actually a pretty good neuraminidase inhibitor. This is the same mechanism of action as Tamiflu, and in fact it works well to shorten the course of influenza if given early enough. And, like other herbs with the same mechanism of action as pharmaceutical drugs, the side effect profile of elderberry is considerably safer than Tamiflu for a comparable level of efficacy.
Dear Doctor,
For just a second, if you could suspend the consensus within your profession supporting flu vaccines to consider my question: Might there be any benefit to passing on the flu vaccine as a younger person, acquiring the flu as a younger person, and naturally overcoming the flu as a younger person...in order to build an immunity to the flu should a strain pass through your body as an older person?
Dr. Rahul - so how well did they do in guessing the correct flu strains for the vaccine this year? I'm not being sarcastic, I just hadn't heard yet. Thanks!
How does the "flu tracker" get its data?

For example, my husband probably had the flu. Called the doctor early, they said "can't fit you in today, so it doesn't really matter." Maybe the red zones are just places where doctors have time/willingness to see patients for symptoms of this sort and so they are reported.
>> most of my patients are vaccinated against the flu, which gives me great reassurance that when they show up with fevers, it won't be influenza causing it

Come on. Great reassurance? Aren't flu shots at most 10% effective? Do modern doctors simply worship drugs and the drug industry?
Rahul,

I have become a consistent user of Zicam as well. My use of goes back to some of the first published test results of, I sing opera and an extended cold can lay waste to weeks of prep for a show. Exactly as you have noted with Tamiflu, at the first sign of, is the best use. It is a simple zinc or zinc oxide ointment, liquid, spray, I prefer the original ointment.

Purchase some now, it must be in your cabinet at hand when you begin sniffling, sneezing, etc. Apply at the suspected out break an per the research, an average 6 day cold, becomes an average two day cold, and often misses the following stages of lung congestion and/or opportunistic bacterial infections.

And,,, the slight drying action of nasal passages does help with getting your sleep, functioning during the day, or singing Puccini that evening. Other viruses being affected I have no knowledge of, however, the hand to eye or nose transmission route is common to each is it not?.

Dean
No flu shot for me, nor ever for my kids. I don't even understand what it is--a cold vaccine?

I figure, as long as we're healthy, our own immune systems ought to be able to fight off your basic flu. And am I insane, or isn't it good to let your immune system build up natural resistance?

Totally understand bolstering resistance for young children and the elderly, but what is the benefit of a flu shot for healthy adults?
I don't take pharmaceuticals, nor do my adult children or ex-husband, and we're four of the healthiest people I know, probably for exactly this reason! You couldn't pay me to take flu shot, and when I hear such shots should be given to babies, children, and pregnant women, I absolutely cringe!!

I'll take my chances, thanks! Besides, I have my own remedies....ones without side effects such as death, cancer, strokes, heart attacks, blood clots, swelling of the throat and tongue, stomach problems, diarrhea, insomnia, dry mouth, breathing difficulties, kidney problems, fainting, light-headedness, and all the thousands of other side effects of pharmaceuticals.

Some day, assuming the human race survives global warming (which is just getting started!), pharmaceuticals will be labeled what they really are: a fraudulent, expensive, appallingly stupid joke!!!
Useless? It makes its corporation money! It's perfect!!!
Pucci,
your points are correct about the reason uncle sam didn't stock relenza. I think we may regret it in the future, though
Odette,
do you have any information on elderberry you can link me to?
Stellaa,
about your question--health care is not immune to the downturn. Here's my article in Salon last month, touching on the subject:

http://tinyurl.com/d9bzst

Here's one from Slate:
http://www.slate.com/id/2208221/
I think my next post will have to be a review of Zicam's effectiveness and safety for y'all. I'll look into it asap,
M. Chariot,
I could try to have an opinion of Neti Pot if I had any idea what it is...

regarding the window of opportunity to use antivirals like tamiflu--it's different for each medicine, but my memory tells me that most are 24-48h after symptoms start
William,
good question--short and dirty answer: the flu mutates yearly, which is why we suggest people get a yearly flu shot. if you get sick from one strain of the flu, you will have immunity against it, but next season, you and your immune system reset....
Leigh,
good questions--a lot of parents ask them. Basically, the very young and the very old fall into the "relatively immunocompromised" category where they are more likely to have serious complications from the flu. Every year, we hear of young kids dying from just those complications--not a lot, but it's tragic that a simple vaccine could have prevented it,
bluesurly
I don't know the exact match, but reports that I've looked at suggest it's better than last year's flu vaccine
David Gilmour-
Every morning, I get up and prey to a huge picture of Louis Pasteur, surrounded by picture and candles of all the Pharma CEOs. How did you know? It probably looks like your shrine to Pink Floyd at home
Oh god, not the Neti pot! I can't even watch someone use it.

Basically, it looks like a tiny teapot. You fill it with something--salt water, magic herbs, whatever, then you raise the spout to one nostril, pour and inhale, causing the fluid to slosh around in your sinus cavity.

It's barbaric. And seriously unattractive.
Wait a minute! You got the David Gilmour reference but didn't know what a neti pot is? I'm sorry, I didn't mean to start out all confrontational there but I was honestly surprised! Perhaps you know it by some more complicated medical term. I'm like that when people use common names of plants. Give me the Latin and I'm good.

I have always been curious about this flu vaccine. I have never had any sort of vaccine or shot to prevent the flu. And I can't remember the last time I had anything worse than a cold even though I spend much of the season around crowds of the "filthy subway masses". Yeah, so this is not exactly empirical evidence but in my memory, the flu has always just been the flu. It is like a cold but worse. You get it, it sucks, you get over it. I had never even heard of a vaccine until a few years ago and two of the people I know who got vaccinated went on to get terribly sick right afterward. I know western medicine has it's place and I am thankful for the antibiotics that put my Lyme disease into remission, but what ever happened to letting the flu run it's course rather than aiding in the mutation of the strain.
I had read that the reason the Gummint stocked up so much on Tamiflu was that Dick Cheney was a shareholder or corporate director of the company that holds the licensing rights.

Elderberry does so have side effects. In fact some of the worst hangovers I have ever suffered have come from elderberry wine.
Ok Doc, first of all many thanks for this post. Truly one of the best perspectives on the topic I have encountered thus far in mainstream or blogs. I am sending it around liberally to friends and family.

That said....I also got a truly massive and unexpected laugh out loud moment in front of my laptop when I read this comment you posted -
"Every morning, I get up and prey to a huge picture of Louis Pasteur, surrounded by picture and candles of all the Pharma CEOs. How did you know? It probably looks like your shrine to Pink Floyd at home."
Sure.

I have to admit, I haven't done enough groundwork on this one. Here's an article which references a study done in 2003.

http://www.webmd.com/cold-and-flu/news/20031222/elderberry-fights-flu-symptoms

I believe another was done in 2004. It seemed to work against Influenza B, but that doesn't mean it works against influenza A.

There's an article in pubmed, which I can't get to, but you probably can about the active part of the herb.

http://www.ncbi.nlm.nih.gov/pubmed/11399518

The real problem with the herb is, as you must already know I'm sure, it's hard to get a reliable company to make the herb. Nature's Way is probably the best bet.
My doctors make me get a flu shot every year. I haven't had the flu in 10 years.

But...I'm also paranoid about such things as door handles, cleaning shopping cart handles, and washing my hands as soon as I get home. I wash my hands as soon as I can after handling just about anything that someone else has had their hands on. I make the little ones wash their hands as soon as they show up.

I learned not to touch my nose or rub my eyes, too...not easy when allergies make everything itchy.

So, I can't really tell if it's the flu shot, or following all of the flu-avoidance tips that have come out over the years that has prevented me from catching anything.

What gets me is the stuff that I caught when I was going to a so-called "deluxe" racket club and using the treadmills, showers, exercise balls, etc.
That might have been a bit off topic. With a pandemic from a mutated flu of such virulent proportions as the Spanish Flu, is any prevention possible?

Maybe with the new administration, there will be closer examination before the taxpayers enrich the well-connected pharma firms.
I know that this is merely the opinion of a layman. Won't a pandemic influenza be such due to its' virulence and the inability of the healthcare system to effectively treat it?
On the subject of vaccination I have to say that I have had two and have not gotten the flu even when my spouse had it (no flu shot).
Let's not forget to mention which high official in the GWB regime made a cool $20mill on the gov't buy of Tamiflu....one Mr. Rumsfeld. Sometimes I wish I could wag my tail left on budget items I don't want to pay taxes on, and wag it right for those I agree with. And hey, the direction my tail points has nothing to do with my political allegiance. On the whole, my tail averages out dead on center.
Alright, I have a question. I have always been a little skeptical about flu shots. I know some may have weaker defense systems due to health problems, but what about the rest of us? Are we diminishing our own immunities or defenses by avoiding illness altogether? Aren't we born of a breed of survivors? Is this creating a larger realm of intangible virus's? Okay, this is more than one question, I apologize.
Thank you Dr. Parikh, for your honesty on this subject. It's really wonderful that you have this venue, and you take the time to educate the rest of us.
Really appreciate this post, Rahul. Almost hate to admit this but since it's true, I'll say that I have never had a flu shot in my life. I rarely get the flu (knock on wood, tho that is not scientifically proven to be affective). My GP told me not to start taking flu shots if I have never taken them to date. I'm over a couple of hills and a grandmother. I have been blessed with exceptional good health and never take it for granted.

Ditto, Padraig - Care to elaborate on any other useless drugs?
Useless, except of course to Roche, who no doubt enjoys the usual rape of symptomatic people through the usual absurd pharmaceutical pricing. The pharmaceutical industry is full of rapists.

Rated for truth and practicality
bobbot,
I think the main reason for stocking up on so much tamiflu was to help us treat a pandemic--it looks like it may have been less wise a decision than we initially thought
freedom,
thanks for sharing and for laughing!
rosietherioter,
thanks for reading-
lot of questions I don't exactly have the answer to--but I agree that we're are a breed of survivors.
JustCathy,
thank you and thanks for reading
Poignant and communicative. I received another e-mail this morning from a friend who suggests we do something or other to oppose being forced into a public option. This time (and from now on), I didn't let it pass. I wrote back, made demands, asked for proof, corrected errors, and hit "reply all." This article reminds me why I have to Lose Baby Weight.
Basically, it looks like a tiny teapot. You fill it with something--salt water, magic herbs, whatever, then you raise the spout to one nostril, pour and inhale, Silly Bandz Rock Bandz causing the fluid to slosh around in your sinus cavity.
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I've read negative reviews about this tramiflu and I think that won't be good for the body. http://www.freelancemd.com