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Does Tamiflu provide a good defense against avian flu?

Stockpile Driver

A new kind of flu is sweeping the world. It’s called Tamiflu.

Tamiflu Symptoms: Fear and panic over shocking reports about the millions of deaths that a global pandemic of avian flu might cause. This symptom is often followed by a desire to grasp at straws in search of a defense against avian flu.

Treatment: Send your Christmas tree to Canada.

Shiny happy numbers

Tamiflu, of course, is the name of a popular prescription drug designed to reduce the symptoms and severity of influenza. So, 1) you’ve got a medication that’s reputed to stop the flu, and 2) you’ve got a potential pandemic percolating in Asia. Consumers can add. One plus one equals a desire to purchase and hoard Tamiflu.

On the surface, it might seem like a good idea to have some Tamiflu on hand. After all, if the avian flu does turn into a true pandemic you can be certain that supplies of the drug will be scarce and very expensive. Also, Tamiflu is only effective when taken shortly after the onset of a flu. Obviously that won’t be the best time to start looking for something that’s in short supply.

But does Tamiflu actually provide a good defense against avian flu? According to an article that ran in the Washington Post last October; two different research teams recently devised mathematical models that showed how a “widespread use of Tamiflu at the outbreak site” might slow or even stop a strain of the avian flu that could be passed from one human to another.

But those mathematical models are counting on Tamiflu to be effective. Numbers don’t lie, but in this case they might be overly optimistic.

Resisting arrest

Last month the New England Journal of Medicine (NEJM) published an article with details about two Vietnamese patients with avian flu who were treated with Tamiflu shortly after symptoms were identified. Both patients died. But they didn’t die because Tamiflu was ineffective. They died because the virus developed resistance to Tamiflu.

If the drug had only been ineffective, that would have been discouraging. But the fact that resistance developed is far more troubling, indicating a very adaptable virus. Writing in NEJM, Anne Moscona, M.D., a Cornell University medical professor, noted that the misuse of Tamiflu stockpiles may promote resistance, lessening the usefulness of the drug. She concluded that stockpiling should be strongly discouraged.

Sohow do you put a good spin on that one? According to ABC News, a representative of Roche Laboratories, Inc. (the maker of Tamiflu) reacted to the NEJM report with a news briefing about eight avian flu patients who were treated with the drug. Four of the patients showed a drop in viral levels and survived. The other four patients died.

This outcome was offered by the Roche rep as evidence that Tamiflu is effective against the virus. (I guess he’s a glass-half-full type of guy.) He didn’t happen to mention that among the approximately 120 people who have contracted avian flu over the past two years, about half have survived.

Oh, Christmas tree

Meanwhile, back in China, star anise supplies are fading fast.

Star anise is a Chinese fruit from which skikimic acid is extracted to make a synthetic component called oseltamivir, the active ingredient of Tamiflu. So not only is star anise becoming scarce, but some are concerned that Chinese authorities may ban the export of the fruit in order make sure their own oseltamivir supplies don’t dwindle.

But there is another source of skikimic acid: Christmas trees. More specifically, the needles of pine, fir and spruce trees contain enough of the acid to produce about 40 grams of oseltamivir from a kilogram of needles. This has prompted a small drug company in Canada to request various cities (Toronto, Ottawa, Buffalo, etc.) to donate Christmas trees that are collected from curbs. Toronto has already agreed to donate half a million trees, which could produce about 50 million oseltamivir tables.

Which would be very comforting if there were any solid evidence at all that oseltamivir/Tamiflu is genuinely effective in treating avian flu.

Sources:
“Oseltamivir Resistance – Disabling Our Influenza Defenses” Anne Moscona, M.D., The New England Journal of Medicine, Vol. 353, No. 25, 12/22//05, content.nejm.org
“Bird Flu Victims Die After Drug Resistance” Alicia Chang, Associated Press, 12/21/05, ap.org
“The Trouble with Tamiflu” Joy Victory, ABC News Internet Ventures, 12/21/05, abcnews.go.com
“Run on Drug for Avian Flu Has Physicians Worried” David Brown, Washington Post, 10/22/05, washingtonpost.com
“Christmas Trees to the Rescue” Joel Kom, The Gazette (Montreal), CanWest News Service, 12/27/05, canada.com

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