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To: CalculatedRisk who wrote (43077)	10/8/2005 3:43:18 PM
From: Elroy Jetson	Respond to of 110194

Is the information in the Los Angeles Times correct? Not really. I'm sure you have found that the more you know about a subject, the more annoying it is to read newspapers with all of the latest misinformation. Their comments have a whiff of truth about them, without much substance. Read the following and you decide. Viruses infect and take over the functions of a cell, forcing it to create new virus. The only "cure" for a virus is to kill all infected cells. The cell is dead anyway. In the process of releasing a crop of new virions, the infected cell is destroyed. Your immune system kills all of your cells which express viral signals on their surface. Unlike other antiviral drugs, Tamiflu and Relenza do not prevent the virus from infecting cells. Instead these drugs prevent infected cells from releasing new virions. By blocking the release of new virions, the exponential increase in new infected cells is halted. *Obviously* it is much better to halt the viral infection when 0.01% of your cells are infected, than waiting a week until 10% of your cells are infected. This is the difference between mild disease symptoms and death. Remember that all infected cells must die. The Bird Flu likes lung tissue. This is why I think its important to have the antiviral drugs "on hand" to be used immediately. This is also why many Bird Flu survivors have lost a large percentage of their lung capacity - the virus infected those lung cells and that lung tissue died. Using drugs like Tamiflu and Relenza halts the infection, giving your immune system the time needed to kill all infected cells. This is the job of NK cells activated LAK cells and cytolitic Neutrophils. Injectable drugs like Interferons and Interleukins can greatly accelerate the correct response by your immune system. This page shows a basic break-down of the immune response. I wish the diagram were larger with better resolution. The immune system: bendermedsystems.com Is it possible that a drug like Tamiflu can stop the virus, leaving you a chronic carrier of the virus like "Typhoid Mary"? Yes, its possible . . . if your immune system does not respond to the virus by killing the infected cells. Supposedly "Typhoid Mary Malone" was a chronic carrier of Typhus, meaning her immune system never eradicated the typhus bacteria. Every family, who employed her as a cook, experienced an outbreak of Typhus. This is very rare and today can usually be corrected using injections of interferon-alpha. Typhoid Mary: pbs.org As for the LA Times comment that a particular drug may not be "approved" for use in children or "people with red hair" or what not. If your child or towheaded friend came down with the Bird Flu, would you let them die or throw bureaucratic caution to the wind and give them the drug in spite of FDA labeling? just because a study in children has not been done, doesn't mean that its not safe. Some Doctors do have a difficult time weighing risk and benefit when they find themselves in a new situation where there is not complete knowledge. You don't want a person like that as your Doctor. .

To: CalculatedRisk who wrote (43077)	10/8/2005 4:38:35 PM
From: Elroy Jetson	Read Replies (2) \| Respond to of 110194

One comment about viral resistance to antiviral drugs. Because of natural selection, the "wild type" virus is almost always "more fit". Because viruses reproduce sloppily, making frequent mistakes, use of an anti-viral drug will eventually give rise to a drug resistant strain, and through natural selection this strain will become more prevalent if the "drug pressure" is maintained through continued use. This drug-resistant virus will usually be less fit and less of a problem. Switch to a different drug and a new viral strain will emerge, resistant to the new drug but often susceptible to the original discontinued drug. This is why multiple drug therapy is more effective than single drug therapy - whether you're treating virus, bacteria, or other pathogens. Its like adding additional tumblers to a lock. But viruses mutate more quickly and easily than do bacteria. Due to widespread unauthorized use in China of Amantadine in poultry feed, Bird Flu is resistant to Amantadine. I understand the Chinese official responsible for this insanity is now in prison. Some strains are resistant to Tamiflu. So why did I buy Tamiflu, if I have not yet bought Relenza? Tamiflu production is subject to a bottleneck which cannot be easily amended. Thus I need Tamiflu today while it is still available. If the situation becomes more serious, I will also obtain Relenza. I might even break down and buy some soon, since my health insurance pays for it - why not? Governments have pressuring Pfizer to package Relenza in an injectible form rather than an inhaler. This would get more drug into your body, more reliably -- especially given that Bird Flu victims can barely breath. If I used it, I would probably break open an inhaler pack and inject it, mixed with sterile water. I already have Memantine, the metabolized form of Amantadine. I also have access to a full line of injectable immune cytokines such as interferons and interleukins. Its also important to realize that the Bird Flu virus, like the 1918 flu virus, is very deadly *precisely because* it is an avian virus, not yet well adapted to humans. As it spreads through humans, natural selection will give rise to a variant which reproduces better in humans, and in the process it will become less lethal -- a virus which does not kill the host can out-compete viruses which quickly kill the host. .