Stories about tragic flu deaths wrongly portray Tamiflu as a panacea

Mary Chris Jaklevic has freelanced for HealthNewsReview.org since 2016 and recently joined the staff as a full-time health care journalist. She tweets as @mcjaklevic.

A number of news stories on Monday linked the flu-related death of a Texas schoolteacher to her reluctance to fill a prescription for a generic version of antiviral drug Tamiflu.

They were misleading because there’s no evidence that antiviral medications can prevent an otherwise healthy person from dying of the flu.

They’re also emblematic of fear-mongering coverage that suggests otherwise healthy people are dropping dead in this year’s severe flu season.

Amid a steady stream of hair-raising statistics about local and national death tolls, the story of Heather Holland, a 38-year-old mother of two who died within days of feeling her first symptom, served to put a human face on the epidemic. It’s not at all clear, however, that her case is representative of people who have died from the flu.

After appearing last week in the Wall Street Journal and the Weatherford (Texas) Democrat, Holland’s story was picked up by several news organizations that focused on her decision not to fill a prescription for the antiviral:

Newsweek: Texas women dies from flu after rejecting expensive Tamiflu medication.

Antiviral medications such as Tamiflu should not be portrayed as a life-saving flu treatment.

CBS: Texas teacher dies from flu after deeming antiviral drug too costly

BBC News:  U.S. teacher dies after opting out of costing flu medicine

Atlanta Journal-Constitution: Texas teacher dies from flu after spurning medication that cost $116

Misplaced emphasis on antivirals

The coverage seems to imply that if Holland had received the medication she might have lived. But in fact, the FDA has concluded that Tamiflu is not proven to saves lives, as medical journalist Jeanne Lenzer wrote in 2015 in the BMJ.

The Food and Drug Administration told The BMJ that data submitted to it for review do not support the claim that the neuraminidase inhibitor oseltamivir (marketed by Genentech and Roche as Tamiflu) ‘saves lives.’ The FDA said that oseltamivir ‘has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.’

None of the stories made that point.

ABC’s Good Morning America featured the story of a different 38-year-old mother from New Hampshire, Amanda Franks, who chose not to take the Tamiflu prescribed by her doctor because of worries about side effects. “Two days later she got sicker and died on the way to the hospital,” the report tells us, adding that the drug is “proven to be effective.”

Other stories have fed potential concerns about the availability of antiviral medications due to heightened demand. They include GoodRx’s Tamiflu prescriptions reveal shocking flu trend  and the Rochester, Minn. Post-Bulletin’s You need Tamiflu, but can you get it?

But HealthNewsReview.org contributor Preeti Malani, MD, a professor of medicine at the University of Michigan, cautioned there’s no way to tell whether taking a prescription antiviral would have saved the life of the Texas woman, or anyone else. Some patients take an antiviral promptly after getting their first flu symptoms and die anyway, she said.

“I don’t think people should be panicked if they don’t get their Tamiflu,” she said. “It is not this amazing panacea, the way an antibiotic might be in fighting an infection.”

Only a modest benefit

While the CDC maintains there’s a role for antivirals in stemming the symptoms and spread of flu if taken within two days of the onset of symptoms, there’s only modest evidence of a benefit.

A 2014 Cochrane review based on a review of data of trials in more than 24,000 people challenged the assumption that antivirals Tamiflu (oseltamivir) and Relenza (zanamivir) are effective at fighting the flu.

The Cochrane review confirmed “small benefits on symptom relief, namely shortening duration of symptoms by half a day on average,” but said there’s little evidence that drugs reduce hospital admissions, lower the risk of developing pneumonia, or prevent the spread of the flu.

Another recent Lancet analysis found that Tamiflu can help prevent hospitalizations from the flu. But as Vox reporter Julia Belluz pointed out, this finding applies only to people who are at high risk of complications from the flu (for example due to an existing chronic illness); otherwise healthy people saw no reduction in the rate of hospitalizations.

The hyped stories about Holland’s death didn’t mention the weak evidence about the effectiveness of antivirals or address the potential harms, which according to Cochrane includes heightened risk of nausea, vomiting, psychiatric effects and stomach pain in adults and vomiting in children.

ABC’s coverage mentioned those risks, but implied that Franks’ decision not to take the drug was foolish and tragic in hindsight because the medication could have saved her. ABC didn’t cover the substantial evidence that supports Franks’ choice to forego treatment.

‘Seemingly healthy adults’ at risk

Along with overstating the case for antivirals, coverage has fixated on the notion that even healthy people are vulnerable.

The Journal’s piece, headlined “The Deadly Flu No One Saw Coming: Thousands of people have been treated at hospitals, including seemingly healthy adults, marking the worst season in a decade,” focused on Holland and one other 30-something mother who died of complications from the flu.

In both cases, the women reportedly died within a week of their initial symptoms. The Journal portrayed them as exemplifying thousands of people who “have been treated this season at hospitals for pneumonia and other complications, including seemingly healthy adults with no underlying medical problems.”

However, the story doesn’t offer data on how many “seemingly healthy adults” are actually dying of the flu.

Deaths of healthy people are rare

Similarly, the USA Today Network declared that “reports of otherwise healthy or young people dying from the infection are flying around,” without providing data.

A Washington Post story reported that “officials are seeing unusually high levels of hospitalizations in non-elderly adults, with the rates for 50-to-64-year-olds significantly higher than what they were at the same period in the severe 2014-2015 season with the same predominant flu strain.” Its coverage included an anecdote about a 58-year-old woman who died of the flu, but again, with no data to back up the idea that the flu is killing scores of people in their prime.

The Post story also mentioned Holland’s death, writing that “the cost of prescription antivirals has led some patients to hesitate using them, with tragic consequences.”

Cases of seemingly healthy people dying of the flu are really an anomaly, Malani said, and news organizations need to point that out along with the fact that patients who die often have an underlying risk factor that isn’t always evident, such as such as pregnancy, heart disease, or obesity.

The CDC has estimated U.S. flu deaths this season could be close to their peak in recent years of 56,000, and most deaths occur in the elderly.

‘Over the top’ coverage

Harold DeMonaco, MS, a visiting scientist at the MIT Sloan School of Management and one of our expert reviewers, said via email that some of the coverage this flu season has been “a bit over the top.”

“I think that the message of getting a flu shot even now is being missed in most of the coverage,” he said. “The flu is not a benign infection so the stories of the unfortunate deaths are probably helping emphasize that point. The old adage ‘an ounce of prevention is worth a pound of cure’ comes to mind.”

That singular message about the importance of the flu vaccine is emphasized by the FDA.

Meanwhile, scary new reports appear to be contributing to record emergency room volumes at the University of Michigan Health System, Malani said.

“All these news stories about this person who was fine and hours later they died, they put people into a panic,” Malani said. “They need to be balanced with the actual numbers.”

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Comments (6)

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Joby Elliott

February 13, 2018 at 2:47 pm

Don’t be an apologist for big pharma. Tamiflu sells wholesale for under $5/day in other parts of the country, but the cost to patients averages $138/day in the United States. That’s upwards of a 3,000% profit margin. Don’t you think that’s maybe a little excessive, for a cheap to manufacture drug listed by the WHO as a complementary essential medicine? Especially in light of the fact that one of the primary reasons it was downgraded from “core” to “complementary” was because it’s so expensive?

    Kevin Lomangino

    February 13, 2018 at 3:46 pm

    Joby,

    I’m totally stumped as to how anyone could read this post and view the author as “an apologist for big pharma.”

    The entire premise of the post is that there’s very little evidence that the drug works. Is that somehow big pharma propoganda?

    I’m sure the drug is overpriced, too, compared with other countries — but that’s not what the post was about.

    Kevin Lomangino
    Managing Editor

Anna Marx

February 14, 2018 at 1:17 pm

The author repeatedly mentions a lack of data in the reporting on flu related deaths. However, I see little data provided here. The author also reports 56,000 expected deaths this season, mostly elderly and children. However, the CDC does not expect over 200 children’s deaths this flu season. Including children in the 56,000 expected deaths figures plays into the fear feeding frenzy. I appreciate what the article attempts here. I only wish more hard data was provided.

    Mary Chris Jaklevic

    February 14, 2018 at 4:00 pm

    Thank you for your comments, Anna. The story has been edited to reflect that, according to the CDC, most flu deaths occur in the elderly.

Joe Farrell

February 19, 2018 at 10:21 am

I don’t think you’re living up to your own standards here. The Lenzer BMJ piece (to which you linked) stressed that the FDA and the CDC seemed to be offering different messages. Lenzer quoted FDA spokeswoman Yao pointing out that the CDC may have reviewed additional evidence that wasn’t “submitted to” FDA; the CDC director mentioned a specific meta-analysis as providing “consistent support for the proposition” that T can save lives, the proposition for which you seem to say there is no good evidence. So as Lenzer herself stressed, this seems to be a matter of differing views of the evidence (or different sets of studies being considered) by CDC and FDA. Yet your article (notably the headline in your email today), treats the FDA as authoritative, doesn’t mention that CDC takes a different view, and seems to suggest that views contrary to FDA’s are irresponsible journalism.

    Mary Chris Jaklevic

    February 19, 2018 at 2:22 pm

    Thanks for your feedback, Joe. It’s true that the CDC on its web site states: “For adults hospitalized with flu illness, early antiviral treatment can reduce their risk of death.” To be fair, that might have led some journalists to believe that there is strong evidence that antivirals can save lives.

    However, as Lenzer documented, there are credibility issues with the meta-analysis cited by the CDC in support of antivirals, including commercial funding of the study and three of its four co-authors. She also points out that the CDC took funding from Tamiflu’s maker, Roche, for its flu messaging campaign.

    I would point to this paragraph in Lenzer’s piece:

    “David H Newman, a physician researcher at the Icahn School of Medicine at Mount Sinai in New York City and editor in chief of TheNNT.com, a web publication for healthcare data reviews and summaries, has reviewed some of the numeric and interpretive differences between the Dobson analysis and a 2014 Cochrane review of neuraminidase inhibitors that did not find a benefit in terms of serious complications. He told The BMJ, ‘The CDC’s message sounds more emotional than scientific. We would love to have a treatment for influenza that works, but in reviews by independent groups—and the Dobson group does not appear to fit this description—the oseltamivir data consistently fail to demonstrate benefits.'”