I have been reading a lot about Tamiflu. The problem with it is that if you don't have it on hand when your symptoms start, it's too late to take it by the time you get to the Doctor. If you refrigerate it, I think it will keep a long time. If I was in "flu territory," I think I would get some.
In praise of Tamiflu: Mitigating the viral spiral
austinbay.net
The scratch and ache began around noon yesterday– and was a full-fledged sore-throat by three PM. I popped a Tamiflu about 4 PM. The biggest complication: I was giving a speech at 7:30 PM to the 100 Club of Central Texas, a combination fundraiser for police scholarships and award ceremony police and sheriff department heroes. I made it through the speech, dinner, and awards– but alas, the virus finally slammed me about midnight. I took another Tamiflu about 5 AM – and despite the sore throat and cough felt well enough to get up at 9:30 AM and drive to Houston to pick up my college freshman and bring her back to Austin.
Roche’s Tamiflu doesn’t stop the flu virus completely, but the twice-a-day anti-flu drug does mitigate symptoms. Maybe I’d simply caught a 24 or 48 hour bug, though this didn’t feel like a simple bug. By 6 PM this evening, Thursday, (and after another Tamiflu), the illness was on the downswing. It’s not licked, but it’s not getting worse.
The NY Times ran a short article on Tamiflu in this past Tuesday’s Science Times (April 5, 2005).
It’s a timely article, for many reasons:
As a hedge against a possible worldwide pandemic of bird flu in humans, the governments of at least 17 countries have in recent weeks begun ordering stockpiles of Tamiflu, the potent antiviral drug with a sunny Sandra Dee of a name.
But should the rest of us do the same? Until there’s a vaccine against the virus (and clinical tests of a prototype have only just begun), Tamiflu will probably be our best defense. Why not, just in case, pester our doctors into prescribing a five-day packet of pills?
“Resist that urge,” said Dr. Ben Schwartz, a pediatrician and infectious disease specialist with the National Vaccine Program Office in Washington. Although he rates Tamiflu as a powerful tool in the global medical arsenal, Dr. Schwartz says he has not squirreled away an emergency store for himself or his loved ones.
Just two years ago, the Swiss-based pharmaceutical giant Roche was having trouble getting doctors to prescribe Tamiflu even for patients who were sick. First approved for sale in the United States in 1999, the drug, also known as oseltamivir phosphate, cripples influenza’s ability to spread from cell to cell by blocking a crucial enzyme, neuraminidase.
According to the drug’s label, which took only premarket research into account, Tamiflu can hasten recovery from flu by a day or two. To be effective, it must be started within 48 hours of the first symptoms - abrupt fever, cough, congestion and racking muscle aches in adults, or simply a sudden fever in children.
And that is the issue with the drug. I had a Tamiflu pack on-hand, one I didn’t use but had prescribed when my youngest daughter caught a mild flu bug last January.
The article continues, relating it to preparing stockpiles for a potential flu pandemic:
More recent research has shown that Tamiflu not only shortens a flu bout if taken promptly, but also markedly cuts serious complications including pneumonia and secondary infections that require antibiotics or hospitalization.
Still, what has prompted the global stockpiling isn’t concern about garden variety flu but rather worry about the particularly quick and virulent leap from birds to people that a Type A avian strain known as H5N1 has made in Southeast Asia. Among the 74 people in the last year confirmed to have been infected with H5N1, many were young and previously healthy, and 49 died from their infection.
Nearly all are thought to have caught the virus through contact with infected poultry, not people. No one can say if or when H5N1 will develop the ability to spread easily and efficiently from person to person - the last step required to start a pandemic - or whether the virus will retain its lethal virulence if that happens.
Still, the signs from Asia are ominous enough that nations are scrambling to come up with a vaccine and are placing huge orders for what’s widely expected to be the best of imperfect treatments - Tamiflu - with Roche, the world’s sole supplier. Another drug from the same chemical family, Relenza (or zanamivir) from GlaxoSmithKline, is not being stockpiled to the same degree because its use is more limited, excluding children under 7 and people with asthma or other chronic lung disease.
So far, the United States has just 2.3 million treatment courses of Tamiflu on hand; discussions are under way about how much more might be needed and who would get them first. According to a Roche spokesman, Terence Hurley, among the other countries that have placed firm orders, Britain will buy 14.6 million courses of the drug; France wants 13 million; and Canada, 5.4 million. The orders are to be filled over the next several years.
Is stockpiling wise?
Still, just reading the words “pandemic” and “stockpile” in the same sentence can be enough to kindle acquisitive angst, said Dr. Howard Markel, a medical historian at the University of Michigan. “Historically, whenever there’s a crisis you’ll find stockpiling, hoarding, black marketeering and generally bad behavior,” he said. “It’s been going on since Hippocrates.”
Dr. Schwartz said he thought a hefty national stockpile made sense in ways that a personal stockpile didn’t. For starters, drugs in a national cache are stored under ideal conditions and regularly checked to make sure pills close to their expiration date are still potent, he said. The same drug in the medicine cabinet of a humid bathroom could quickly lose its effectiveness.
Plus, governments typically get a price break, he said. Don’t expect such a discount at your local pharmacy, where a five-day prescription for Tamiflu can run $65 to $100 or more.
The article also addresses the potential for abuse of the drug and over-use by –yes– self-administration. I’d be scheduled for three months to give the award ceremony’s keynote speech and I knew I was in a downward viral spiral. I think I made the right decision, though I can’t disagree when the article warns that “stockpiled Tamiflu” might get used by the stockpiler to treat a common cold – and if that happen too frequently, it may ultimately undermine the drug’s effectiveness.
I think a national stockpile of Tamiflu and other anti-virals is a wise precaution, but then I’m also for smallpox inoculations. Before I deployed to Iraq I had a new small pox inoculation. If we’re going to inoculate the troops, let’s inoculate the citizenry as well. Fine, exempt the infirm and those with immune disorders. A new regimen of small pox inoculations will increase our “herd immunity” (that is the term, for an inoculated mass protecting an uninoculated individual– the"herd” stops the disease’s transmission). I’ve been concerned for sometime about potential pandemics and bio-warfare. Here’s a link to a column from February 2004 on viral terror. While Tamiflu might blunt the effects of avian flu, it won’t blunt a small pox epidemic spawned by a terrorist. |
