Heroes Not Zombies

Last week’s BMJ and Channel 4 News highlighted the highly dubious evidence base for Tamiflu.

In the process of updating their review, Jefferson et al found several important inconsistencies. Prompted by a reader of their previous update, they attempted to reconstruct the evidence from a much cited analysis on which they had based their previous conclusions. The analysis, by Kaiser et al, looked specifically at the effects of oseltamivir on the risk of hospital admission and complications (pneumonia and other lower respiratory tract infections) in people with influenza. Jefferson et al noted that the Kaiser analysis was funded by the drug’s manufacturer Roche and was based entirely on 10 trials funded by Roche, only two of which had been published as articles in peer reviewed journals. All 10 included trials were authored by Roche employees and paid academic consultants. The Cochrane reviewers could find no independently funded trials of oseltamivir in healthy adults.

Independant researchers have

concluded that they have no confidence in claims that oseltamivir reduces the risk of complications and hospital admission in people with influenza.1 In doing so they have reached a similar conclusion to the Food and Drug Administration in the United States and the recent health technology assessment performed for the UK’s National Institute for Health and Clinical Excellence (NICE), which both conclude that there is insufficient evidence on complications

So, why has the UK government given £500 Million (yes, £500 MILLION) pounds to Roche to buy massive supplies of this drug? (In the US, they’ve spend about one and half billion dollars on it)

The issue of what does Tamiflu do if it doesn’t significantly reduce the chances of complications of hospital admissions has been summarised as reducing the duration of flu by about half a day.

The £500 million drug cost isn’t the whole problem. By setting up a flow-chart based telephone prescribing system Tamiflu has been given to hundreds of thousands of people without a proper diagnosis of influenza or swine flu. If you can’t start with the right diagnosis, how do you ever get the patient the right treatment?

So, what’s the explanation for the government’s strategy for managing  the “swine flu pandemic”?

Is this a good example of “evidence based medicine”? Is it a good example of rational practice or cost-effective practice in the NHS? I don’t think so