HealthNewsReview.org | Independent Expert Reviews of News Stories | Holding Health and Medical Journalism Accountable |
|
|
Tamiflu's Widespread Use, Effectiveness Is Questioned
January 19, 2006
In a study that drew criticism from some health officials and the drug maker Roche Holding AG, a group of researchers has concluded that Tamiflu and similar antiviral drugs shouldn ' t be used widely during the regular flu season because they aren ' t likely to help many patients with flu-like symptoms. The authors also said they found no "credible evidence" that Tamiflu works against avian flu. The study, published today in the London-based medical journal the Lancet, will come as a surprise to consumers and health officials, who in recent months have embraced Tamiflu as the best available defense against regular flu and a potential bird-flu pandemic.
Our Review Summary
This story discusses findings of a meta-analysis, or review of many studies, of anti-viral medications conducted by European researchers and published in the Lancet. According to this review of 51 randomized controlled trials, antiviral drugs such as Tamiflu are only effective in reducing symptoms of influenza type A and B by about 50%, and not as effective in the cases of "flu-like" illnesses. Doctors can and should test patients to determine if they have influenza type A and B viruses before prescribing anti-viral medications such as Tamiflu; the drugs should not be taken for flu-like symptoms and non-life threatening influenza. In fact, Tamiflu is ineffective for other types of flu-like illnesses. The main disadvantage of the misuse of anti-viral medications is the risk of developing a resistance to these drugs, which is mentioned in this article. However, there is no mention of side effects of anti-viral drugs, which can include gastrointestinal problems, nausea, insomnia and hallucinations. The risk ofthese side effects is greater in older people. No quantitative data is provided on either side effects or benefits on any of the anti-viral medications. The message perhaps not conveyed strongly enough by this piece is that there is no need to stockpile Tamiflu. Considering that WHO, CDC and other health organizations continue to recommend stockpiling Tamiflu, the cost of this practice would be interesting to note. No information on the cost of anti-viral drugs is provided. There was also little discussion to counter the statement: "Roche and the WHO agreed there aren't yet large human studies showing that Tamiflu is effective against bird flu. But they said animal studies and anecdotal evidence in humans show the drug is active against the H5N1 avian-flu virus." There is no credible evidence at this time that Tamiflu is effective against avian flu. Anecdotal evidence and animal studies are insufficient, and further controlled clinical trials on humans are needed to determine if these anti-virals aree effective, safe and appropriate for a large population. Tamiflu reduces the symptoms of the flu by only 1-1.5 days and it may not prevent transmission of the virus. While the drug may be appropriate as flu prevention in a household, it would not likely be very effective during a flu epidemic.
Click on Criteria for definitions.
This product is FDA approved to treat Type A and B influenza, but no mention of FDA approval in story. This is relevant to the story if talk of off-label treatment is being evaluated (i.e. other flu strains and avian flu).
No information on the cost of anti-viral drugs for treating non A or B strain viruses. No information on global cost for preventative use.
Addresses over-prescription of antiviral drugs in most cases of flu-like symptoms.
This was a meta-analysis of 50 clinical trials examining treatment efficacy, prophylactic use and side effects of several anti-viral flu drugs. This needs to be clearer: it was a study of studies. There was little discussion of the findings to counter the statement: "Roche and the WHO agreed there aren't yet large human studies showing that Tamiflu is effective against bird flu. But they said animal studies and anecdotal evidence in humans show the drug is active against the H5N1 avian-flu virus." There is no credible evidence that Tamiflu is effective against avian flu. Anecdotal evidence and animal studies are insufficient and further controlled clinical trials on humans are needed to determine if these anti-virals are effective, safe and appropriate for a large population.
No mention of the incidence or severity of side effects of the anti-viral drugs, which include gastrointestinal problems, nausea, insomnia and hallucinations. More prevalent in older patients.
Mentions that this treatment is not as effective as previously thought at reducing symptoms or for controlling transmission of influenza.
No quantitative estimates of benefits provided in this news story, though they are available in the journal article upon which the story is based.
Story says the study was funded by U.K and Italian health depts. in conjunction with Cochrane Collaboration, an independent, non-profit group.
Mentions disadvantages of over-prescribing Tamiflu and Relenza when it not indicated, for example, in the case of flu-like symptoms and non-life threatening influenza. The main disadvantage is developing a resistance to the antiviral drugs.
Total Score: 4 of 9 Satisfactory
The U.S. Preventive Services Task Force is considered the gold standard of preventive health recommendations - including on screening tests. It's a good source for journalists and consumers.
About 70% of the stories reviewed from 2006-9 failed to adequately discuss costs, or to explain how big (or small) are the potential benefits and harms of treatments, tests, products and procedures.
We have documented a disturbing trend of news stories taking an advocacy stance, promoting certain screening tests outside the boundaries of scientific evidence.
Stories on new technologies like Cyberknife, DaVinci robotic surgery systems, and proton beam cancer therapy often fail to scrutinize the evidence and/or to discuss the costs involved.
Rather than suggesting that everyone should be screened for everything, news stories could explain: "All screening tests cause harm; some may do good."
The first 38 network TV network morning health news stories reviewed in 2009 earned an average score of 1.2 stars. 13 of the 38 stories got ZERO stars.
Both TIME magazine and BusinessWeek have published terrific stories explaining the importance of the Number Needed to Treat - or NNT.
Knowing relative risk reduction is like knowing you have a 50% off coupon but not knowing whether it's for a Lexus or a lollipop. Absolute risk reduction tells you what the "coupon" is worth. Read more.
The website NoFreeLunch.org posts "a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information."
To help journalists cover stories responsibly, we post a list of independent experts who state that they do not have financial ties to drug or medical device manufacturers.
We apply the same ten standardized criteria to the review of every story.
We have about 30 story reviewers. Each story is reviewed by 3 different people.
Gary Schwitzer's seven words you shouldn't use in medical news: cure, miracle, breakthrough, promising, dramatic, hope, victim. Read why.
Our reviewers include two former CNN medical reporters and a former editor of the Washington Post health section.