Saturday, January 18, 2014

Tamiflu: Guest blogger Dr. Mark Helm

Those of you who have spoken with me about Tamiflu or who have read my blog, To Tamiflu or Not To Tamiflu, know where I stand on Tamiflu. My online friend, Dr. Mark Helm, has written about Tamiflu in a very say-it-like-it-is way. Take the time to read and share!

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Tamiflu is probably not going to help you.

Like all prescription medicines, Tamiflu (oseltamivir) can cause many complications. A large number of people who take oseltamivir have side effects which actually feel a lot like the flu (belly problems, headache, etc.). These side effects can be so bad that some people decide they want to stop taking the medicine and take their chances with the flu! Using oseltamivir in kids is very challenging. Children often can not understand or report that the medicine is making them feel bad or altering their thoughts or behaviors.

Almost all of what we know about the safety of this medicine comes from the company which makes and sells it. Doctors know only what that company has revealed. When objective researchers have tried to discover if it actually helps, they have generally found that oseltamivir does very little, if anything, to treat the flu. Even the company concedes that the drug MAY shorten symptoms of the flu by one to one and a half days. Oseltamivir has not been proven to change the outcomes (death, hospitalization, loss of time from work,) of having the flu. It also has not been well-studied in people with significant chronic diseases - who are exactly the people we most worry about when it comes to flu infections. If the medicine is started very early (less than 24-40 hours after symptoms begin), then it may shorten the length of time a person is sick by an average of about 31 hours. Again, this medicine does not seem to affect the need for hospitalization or risk of death that comes from being infected by the flu virus.

Oseltamivir is expensive. It may or may not be covered by your health plan's pharmacy benefit. If it is covered you may only have to pay a co-payment, but your employer or insurance company will have a much larger bill to pay. They will pass those costs on to you next year with premium increases (or cuts in benefits).

A helpful and well-reasoned pamphlet regarding the flu and Tamiflu (oseltamivir) is here. Here's more good stuff on Tamiflu (oseltamivir), including a helpful tab outlining side effects and their frequency.

The challenge for physicians and other prescribers on deciding when oseltamivir may be helpful is balancing the relatively low risk of any individual developing the flu (maybe 1 in 20) against the facts that more like 1 in 10 people taking the drug will have significant side effects, and that there is not likely to be any difference in outcomes for the patient.

So, if you can’t count on Tamiflu, what should you know and what can you do?

Flu will hit you like a ton of bricks, and make you feel horrible. It generally will flatten anyone for about 5-7 days. It is particularly dangerous for "high-risk" people - that is people who have other chronic illnesses, the very young or the very old. However, for health professionals, the more scary illness is the “second sickness” that may follow the flu. If a person with the flu starts to get a little better but then starts feeling worse, they should be seen by a doctor as soon as possible. Additionally if a person with the flu starts to gets worse after 2-3 days of the start of symptoms this is also very concerning.

Flu is a very serious disease every year. 2014 is no exception. The flu strain that is most common this year is the same variety that caused the global epidemic in 2009.

Fortunately, flu is largely preventable with immunization - this is why we try to immunize everyone we can. Despite what some say, the flu vaccine - particularly the injectable vaccine can not give you the flu. The flu shot contains no live virus - only proteins made by the virus. The small dose of these proteins in a flu shot are enough to train our immune system to recognize and fight off the flu. The nasal vaccine does contain a live virus, but it is altered so that it can only reproduce and spread at temperatures lower than in the human nose. Both vaccines teach the immune system to recognize and kill the flu virus.

The vaccine is adjusted each year to match the strains which are believed to be most likely to circulate in the coming season. The vaccine for the 2013-2014 season contains proteins which match the “H1N1” strain that is causing 90% of the disease. People who received the flu vaccine this season have a much lower risk of catching the flu than those who did not get vaccinated - but even for vaccinated people, the risk for flu is not zero. It generally takes at least two weeks after a flu vaccination for the body to develop a good, fighting response. So plan ahead for your vaccine next year… Anytime between Halloween and Thanksgiving is a good time to get vaccinated for the flu.

If you have not had your flu shot this season, and you are worried about the flu, ask to be vaccinated. Assuming that there is still some vaccine supply left, vaccination, avoiding prolonged close contact with people with the flu, and washing your hands are your best defenses against the flu. If you already had your flu shot this year, you should not be worried - you have already taken your best chance to avoid the flu.

About Dr. Helm:

Mark E. Helm, MD, MBA, FAAP is a general pediatrician in Oregon at Childhood Health Associates of Salem. He is active with the state and national American Academy of Pediatrics, involved with the Section on Clinical Pharmacy and Therapeutics, and the Section on Administration and Practice Management. He is currently a member of the Committee on Child Health Financing. Prior to becoming a pediatrician, Mark was a pharmaceutical industry “insider” working in market research. After training at Arkansas Children’s Hospital, Dr. Helm worked with the Arkansas Medicaid program to develop an evidence based “preferred drug list” and to establish policies which promoted safe and responsible use of medications, including psychotropic medication for children. Dr. Helm gets his flu shot every year.

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