How the demand for Tamiflu and Relenza may kill us all

The current strain of swine flu appears to be sensitive to the anti-virals Tamiflu and Relenza.

That’s causing huge demand for these medications, with many pharmacies rapidly selling out. For instance, a typical pharmacy may fill one prescription of Tamiflu a week, but now, dispenses up to 25 packages per day.

There’s clear stockpiling going on, and the doctors who acquiesce to patient demand share the blame.

Los Angeles pharmacist Christine Amos is outraged, saying, “Clearly these requests are for stockpiling and not for active infections. These drugs sit in the medicine cabinets of the well-heeled who can demand and get a prescription for every single member of the family while these drugs remain in short supply for populations that may need it. People in under-served populations without access to medical care rely on clinics that may not have these antivirals in part due to unnecessary hoarding.”

Indeed.

Additionally, people who inappropriately take these anti-virals only serve to breed resistance. So when the virus appears in its next incarnation, there may be nothing effective to treat it.

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  • Anonymous

    Why shouldn’t success confer a survival advantage? Other wise what is it far? The successful are already forced to subsidize the transfer of the reproductive advantage to the so called “disadvantaged”.

  • cathy

    Amen, Dr. Kevin. All of the pharmacies in our small town are completely out of Tamiflu with new shipments weeks out – and we have not one single confirmed case of swine flu here. Shame on the doctors who are writing prescriptions to people who clearly don’t need them. They’re doing a disservice to us all.

  • Debe

    Right on Dr Kevin and shame on you anonymous for your elitist comment. No, one, life is more important than another. I don’t care how much money you have. The point of the blog was to inform the public what the consequences might be if the anti viral drugs are taken unnecessarily. All of my patients are VIP’s.

  • Rogue Medic

    Is this really that much different from demanding antibiotic prescriptions for every cough, cold, tug at the ear, sinus infection, . . . ?

    The real difference is the panic, which we experienced with the hoarding of Cipro during the anthrax scare several years ago.

    The ignorant are determining the fate of the rest of the country.

    The ignorant, who refuse or delay vaccinations for their children, are also endangering the health of the rest of the country. Those selling books and remedies as alternatives to vaccines are getting rich promoting the deaths of Americans. Deaths that can be safely prevented with vaccines.

    The same is true for alternative medicine. They make a fortune selling their snake oil, while patients are deprived of effective treatment and some die.

    We need to be much more critical of this dangerous and deadly stupidity being spread by fraud and scare tactics.

    These quacks are more lethal than Osama bin Laden, they make fortunes, and are promoted by Oprah, Larry King, the Huffington Post, and other fronts for voodoo medicine.

  • GG Freeman

    Anonymous’ comment reminds me of that line, “The rich stay healthy, the sick stay poor.”

    Sad.

    In this early stage of the POSSIBLE pandemic, family doctors don’t even have the swabs to test for swine flu yet, and we can’t and certainly shouldn’t send every viral URI to the ER.

    Of all the people that came to our office with viral URI Sx last week, we gave exactly ONE Rx for Zanamivir. (I thought CDC said Tamiflu was NOT monotherapy!)

    Why?

    40-ish year old guy with viral URI and fever of 102+ … who was as scared as a rabbit at a greyhound convention.

    That’s who you give the stuff too… not just anyone who WANTS to have medicine hanging around… just “in case”.

  • Anonymous

    Well here’s the problem guys. Let’s say someone comes to you worried that they’ve got the swine flu.

    They’re not sick, but they live with a toddler or elderly family member. They demand Tamiflu. You rightfully decline.

    Next thing you know you’re being served with a lawsuit. Said family member got sick and either died, or was in the hospital and (didn’t die) but generated a ton of medical bills.

    Now of course it’s YOUR FAULT you didn’t Rx the Tamiflu.

    Maybe this wouldn’t win in court, but I know I’d rather write the Rx than get dragged through the legal process (even if I were to win I’d be out $$$ and now I have to report this everytime I apply for a new job).

    Solution? Let the government control distribution. Hell of inefficient, but that way i’m off the hook.

  • Rogue Medic

    anonymous 1:10,

    They’re not sick, but they live with a toddler or elderly family member. They demand Tamiflu. You rightfully decline.Maybe this wouldn’t win in court,Maybe?

    Solution? Let the government control distribution. Hell of inefficient, but that way i’m off the hook.Right! Patient care is a little more complicated than avoiding doing anything that somebody might sue for someday. Or doing everything because somebody might sue because you didn’t do everything. Why should a physician have any say in it? Let the lawyers fight it out.

    Government control of distribution has nothing to do with good patient care. It isn’t even good economics. Perhaps, this is why you present it as tort reform.

  • Anonymous

    Is this viewpoint ignoring the downside of the “doctor’s office” solution? The current method of delivering Tamiflu to patients appears worse than allowing families to keep a package at home. Tamiflu should be taken immediately upon developing a fever, otherwise if the patient waits 3 days for an opening in the doctor’s appointment calendar, Tamiflu becomes useless. When it is ready in the medicine cabinet at home, then it can be used most effectively. Secondly, consider that if the patient must go through the doctor visit procedure to obtain Tamiflu, there is a great chance of spreading the flu to many others – in the doctor’s waiting room, and while waiting in line at the pharmacy. In that case Tamiflu may help one person but the process of getting Tamiflu helps to infect 5 others. I believe the real solution is to prescribe Tamiflu ahead of time for home use – but for the medical community to provide much clearer instructions on when exactly it is to be used, and when not to be used. Perhaps patients can go through some kind of basic instruction at the doctor’s office on how to recognize the true flu symptoms, and after receiving this basic instruction, it would be ok to keep in the medicine cabinet at home for future use.

  • Rogue Medic

    Anonymous 3:11,

    You make an interesting point.

    One of the problems with Tamiflu is that it seems to be most effective at causing resistant strains to develop. This is something that needs to be taken into consideration when prescribing it.

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