While the H12N1 Swine Flu continues to spread in the UK the government continues floundering in it’s response. There appears to be complete confusion on the issue of Tamiflu, the antiviral drug used to “treat the flu.” Chief Medical Officer Sir Liam Donaldson appears ready to distribute vouchers to anyone off the Internet or otherwise, just days after giving doctors permission to not prescribe Tamiflu if their phone rings too much.
Because patients must be treated with 48 hours after the onset of symptoms there is limited usefulness for the drug. It also does not cure the flu, it only shortens the duration by 1-2 days. While some projections are that widespread distribution of Tamiflu to the general population would save millions of lives, the reality is no one knows if Tamiflu would be effective at all with this type of distribution. It is more likely to create widespread resistance and render Tamiflu a useless drug. Tamiflu is a tremendous asset for a pandemic but it should be reserved for susceptible populations and specific situations and remain under the control of doctors, not the government. Isolation and preventative measures are our front line defense against the pandemic, not handing out Tamiflu to everyone.
A case in point is the Air Force Academy outbreak of Swine Flu. It is early and Tamiflu could be administered to the entire population since they live in close quarters and could be sequestered short term in the contained environment of the Academy. Or they could be more conservative and administer Tamiflu to anyone with a history of respiratory or immune problems making them a higher risk for serious complications, and restrict the campus short term. Letting everyone in Colorado Springs have a free voucher for Tamiflu would be irresponsible.
Tamiflu is not a panacea and using it as one will probably render it useless for the people who need it most. Lets hope the UK does not create a resitant strain of flu via massive distribution of vouchers.
UK new Health Secretary Andy Burnham predicted the H1N1 swine flu could be infecting 100,000 people daily by August with 40 deaths per day. With about 7000 cases currently and reportedly doubling daily, one has to wonder where these projections come from. With the current mortality rate and experience in the U.S. these projections seem inflated to say the least.
More troubling is Mr. Burnham’s statement that Doctors will be given the authority to not prescribe Tamiflu if they are overwhelmed with calls. Mr Burnham is engaging in the act of practicing medicine at this point. It should not be under his purvey to make such a declaration. That is a decision that should be left to the doctors and makes no sense, given that the UK reportedly has ample supplies of Tamiflu. Just because the phone is ringing has no bearing on evidence based medicine decision making.
Hopefully, health care reform in the U.S. when not lead to government meddling in patient care decision making of this nature. If your family doctor can’t decide whether your symptoms and history indicate the need for an antiviral drug they should take up another line of work. If they are not allowed freedom in prescribing we may as well stay home and order whatever sounds good off the Internet. This is also someone who is very proud of the 18 week wait cycle. Eighteen weeks waiting for referrals for testing and treatment is not a model to emulate. Health care reform can do better than this.
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