This story was about a study comparing a Chinese herbal mixture to Tamiflu for the treatment of H1N1 flu (also called swine flu). Although it communicated the basics of the study well enough, it didn’t provide important information on costs or quantify the benefits with sufficient precision. It also lacked crucial context that a truly independent observer might have provided — specifically, that the patients included in the study (healthy adults with very mild cases) are not the kind of people for whom Tamiflu makes a big difference, as these patients typically get better quickly on their own without treatment. What’s truly needed is an alternative treatment for patients with severe cases who don’t have access to antiviral drugs. This study gets us a step closer to determining whether this herb mixture might be effective for those patients, but it doesn’t address the question directly.
In the recent worldwide flu pandemic, many patients in poor countries did not have access to antiviral drugs such as Tamiflu. It is important to know whether locally available alternatives, such as this Chinese herbal remedy, are useful for treating the disease.
Consumers in the developed world also want to know if popular herbal medicines are worth taking. Stories that report on these kinds of alternative remedies should focus on efficacy and risks, so that consumers can weigh these against the cost and outcome of seeing a physician for a prescription medication.
The story says the herb mixture is much less expensive than Tamiflu. But how much does Tamiflu (and the related physician visit) cost? Providing an actual price tag would have dispelled any uncertainty.
Not enough information here. The story says that Tamiflu, the herb mixture, and the combination of the two “helped to resolve fever sooner than no intervention whatsoever.” But the story never tells us how much sooner the fevers resolved. As it turns out, the fastest resolution was seen in the combination group (about 15 hours from onset), whereas the control group fevers typically resolved after about 26 hours. There was also no discussion of the fact that other symptoms (cough, sore throat, etc) were not affected by any of the treatments.
The story mentions adverse effects that have been associated with ephedra, one of the constituents of the herbal treatment being tested. It also says that minimal side effects were seen in all treatment groups of this study. The story could have commented on other possible side effects of herbals, such as potential interactions with other medications.
We would have liked to see more qualifiers, specifically regarding the fact that these were patients with very mild disease. We don’t know how effective the herb mixture would be for patients with more severe cases of H1N1 flu, which is where Tamiflu has a more pronounced effect. The story does, however, quote an expert who counsels readers not to self-medicate and to see a doctor. That advice, together with a generally adequate description of the study, allows this story to squeak by with a satisfactory.
Although the writer didn’t hype the problem of influenza (which does result in a large number of deaths every year), the majority of those with the flu do not require treatment. So the story edges into disease-mongering territory when it suggests that Tamiflu was the “treatment of choice” for most cases of H1N1. In fact, antiviral drugs were unconditionally recommended by WHO guidelines only for certain groups, such as those with severe illness or who were at risk of developing a severe illness. Patients like those in this study who had “very mild” cases of the flu were not necessarily candidates for treatment with antivirals because their illnesses were typically short and self-limited and would not be substantially affected by taking Tamiflu. In addition, overuse of antivirals encourages the development of drug resistant virus strains. By failing to draw this distinction, the story leads readers to believe that every case of H1N1, even very mild ones, should be treated with Tamiflu, which is not accurate.
The story provides commentary from one of the study authors and a representative of the dietary supplement industry. Neither of these sources could be called truly independent. A primary care physician or public health person could have provided perspective about who is a candidate for treatment with antiviral drugs.
The story never mentions vaccines, which of course can prevent the H1N1 flu from developing in the first place. Also, existing medications such as acetaminophen and ibuprofen can ease fever and other flu symptoms.
The description of the herb mixture’s availability is good enough for a satisfactory. The story says that “finding the medicine in the United States is difficult, if not impossible, given that it contains the stimulant ephedra.” The story could have noted that ephedra’s use remains legal in traditional Chinese medicine (the application being discussed in this story), but patients may only obtain the medicine through a Chinese medicine practitioner.
The story notes that herbal remedies like the one tested in this study have been used for thousands of years in China.
This story was not based on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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