Tamiflu? Get Outta Here!
Doctors could learn a lot from George Costanza
“You see? It’s right here… it’s a little white.” George points to his upper lip.
The doctor leans in, points his light. “Oh yeah. Yeah. Hmm. Never seen this before.”
George grabs the doctor’s arm. “Cancer? Is it cancer?? Do I have cancer???”
The doctor shrugs, nonplussed. “Well I don’t know what it is.”
Tamiflu, generic name oseltamivir, was approved 25 years ago by the FDA. The manufacturers claimed it could reduce symptoms by a day—but only if given within 48 hours of symptoms to people with test-proven influenza. How, then, did it become a blockbuster, averaging more than a billion dollars per year in sales?
One reason is that the US Department of Defense began purchasing and stockpiling the drug in 2006. Which is weird, because as a soldier I don’t recall any of my superiors ever caring a lick about whether I felt sick for one extra day.
But it turns out the manufacturers also claimed, based exclusively on ‘unpublished data’, Tamiflu reduced pneumonias (and presumably deaths) and could prevent infections. The DOD, led by Donald Rumsfeld at the time, accepted these claims. Perhaps because drug companies are so honest. Also, perhaps, because from 1997 to 2001 Rumsfeld was chairman of the company that manufactured Tamiflu, and still held $5 million of stock. What a coincidence.
Curious about the company’s claims, in 2009 the Cochrane group and the British Medical Journal asked Roche for the unpublished data, so they could assess it. Roche said, “no problem!”
Then, for four years, they refused to deliver the data. Repeatedly. In 2013, under pressure from governments, journals, doctors, advocacy groups, and the World Health Organization, Roche caved. They delivered the goods. In the form of 150,000 documents, all at once.
Tom Jefferson (who has his own Substack) and his crew at Cochrane worked tirelessly for months, with multiple full-time employees, sorting and calculating. Lo and behold, they found oseltamivir actually didn’t reduce serious illness, even for high risk groups, and didn’t prevent infections. Shocker.
The review did, however, find the drug reduced flu symptoms by 0.7 days. Unfortunately, it also significantly increased nausea and vomiting. Not a good trade. Question answered: Tamiflu doesn’t work.
But a more recent study has, apparently, led some doctors to once again fancy oseltamivir. In 15 countries over three flu seasons, the researchers randomized 3,326 people with a flu-like illness to receive either the drug, or no drug. Only half of participants tested positive for influenza, and the study was not blinded, i.e. participants knew they were taking the flu drug oseltamivir. Meanwhile, the control group was given no prescription or pill.
The report concluded that the drug group experienced 6 days of symptoms, on average, compared to 5 in the no-pill group. They also experienced more nausea and vomiting and 20% didn’t finish the drug.
Crucially, however, recall that half the group didn’t have influenza. Oseltamivir is a very specific drug, targeting the influenza virus. But all participants received the drug, or no pills. And the data show that taking oseltamivir reduced symptoms for both people who did and didn’t have influenza. In fact, it worked slightly better for the people who didn’t have influenza.
Huh?
Well, duh. The study proves, unequivocally, that a placebo can reduce flu symptoms. The effect wasn’t because of the drug, it was because they were taking a pill. It was a placebo effect, not a drug effect.
Which illuminates a path forward for flu-like illnesses. Doctors should recruit the placebo effect to help people recover faster. But not with a pill that causes nausea and vomiting—with kindness and support. Research shows this works, most prominently in a study from 2012 demonstrating that people with Irritable Bowel Syndrome had clear improvements when their physicians listened, were warm, friendly, and empathic, and told patients their illness would soon abate.
When George asked about cancer, as he later told Jerry, he wanted the doctor to say “Cancer!? Get outta here!” He wanted empathy, concern, and reassurance. That’s what people with flu-like illnesses want, and it’s what heals them better than any pill ever invented.
So when the subject of Tamiflu arises, there should be one response: “Get outta here!”