In a recent post I asked,” Who are the Stewards of Healthcare?” The CDC comes to mind. Its roll to protect the public from diseases both new and old make it an important pillar of our public health system. The CDC was certainly trying to fulfill its role last week when it notified us about emerging concerns that this years flu vaccine might have reduced efficacy due to antigenic drift. Despite this news, the vaccine may still have some efficacy and likely remains a useful tool in the prevention of influenza and its complications.
This CDC update unfortunately also came with a marketing plug that couldn’t have made the makers of Tamiflu more ecstatic:
Because of the detection of these drifted influenza A (H3N2) viruses, this CDC Health Advisory is being issued to re-emphasize the importance of the use of neuraminidase inhibitor antiviral medications when indicated for treatment and prevention of influenza, — CDC advisory 12/4/14
Apparently, the CDC felt this was a wonderful opportunity to throw its weight behind a dubious class of drugs, and does not feel obliged to protect the public or precious healthcare dollars from unscrupulous drug companies. If you go to the CDC website it seems that despite all evidence to the contrary, antivirals to treat flu should be taken early and often by almost everyone.
“Can flu be treated” they ask? The answer is YES. Who should take it? If your young, your old, your really sick or you just want to feel better, then take it. Of course the page is careful worded, to avoid criticism, but the implication is clear: if your a doctor prescribe this drug; if your a patient ask for it. If you don’t you’re not following standard of care. Many doctors who read this, will hear “give it to your patients, come on what’s the harm, and if you don’t, then won’t you feel terrible when you realize it’s your fault Mrs Smith’s grandmother died because she didn’t get the Tamiflu?” This type of powerful marketing is what continues to make Tamiflu a multimillion dollar bonanza for its manufacturer.
Yet this flies in the face of everything we know about the drug. Current evidence shows it is not preventing disease, or saving lives, or even preventing complications of the disease. In fact some of the evidence is still being hidden by the drug company who makes Tamiflu, and unpublished negative studies that the company hid for years had be forced into the open.
You expect drug companies to aggressively market their wares, but the CDC is entrusted to hold the public interest above all things. Given the recent FDA furor over Zohydro and its approval of this potentially harmful drug (against the advice of even of its own independent advisory panel) it makes you wonder if now the CDC can also be trusted when it comes to its drug approval process.
Endorsing drugs like Tamiflu with no strong evidence of benefit, drains the system of critical resources and fills doctor’s offices and ERs with patients who have an expectation of getting ‘the Tamiflu prescription” –while they inadvertently spread the virus around to others — it undermines public trust in an important institution, and reenforces the idea that marketing and corporate influence come before public health and safety.
What can we do? Hospitals and doctors should be taking the lead on upholding the public trust if the CDC won’t. Talk to your peers, review the evidence, and define a department or hospital policy. Give doctors support to do what they think is the right thing based on the evidence, not on CDC recommendations. Most importantly talk to your patients so that they can make informed decisions.
The Cochrane Collaboration
- Reduced mortality: NO
- Prevents hospitalizations: NO
- Makes people feel better faster: maybe slightly, but trade of off is about an equal number of bad side-effects (fewer days with fever and mylagias more with nausea and vomiting)
- Helps high risk or sicker people: NO
- Industry sponsored research: YES
- Negative research results were hidden or suppressed: YES
- Drug has been aggressively marketed for everything from the flu to bioterrorism preparedness, wasting millions of healthcare dollars with no proven benefit: YES