The drugs don't work

It never ceases to amaze me how much rubbish the media get away with on a daily basis - how much they blow things out of proportion. Actually, "amaze" is the wrong word, "irritate" is more appropriate. However thankfully it's an irritation that doesn't get on top of me as blowing things out of proportion seems to be the main occupation for a lot of journalists and I'd be pulling my hair out if I got irritated every single time.

King of "blowing things out of proportion" is arguably the the Daily Mail and today was no exception. The front page lead with the headline "Tamiflu turned my children into hallucinating, sobbing wrecks" accompanied by a picture of the journailist Richard Price and his family. I'm hoping most if not all of you know what Tamiflu is - the drug used in the management of swine flu.

Apparently, Price's children were prescribed the drug by an on-call GP after they rang NHS Direct seeking advice about their children who had developed a cough and high temperature. They subsequently went on to develop unfortunate side-effects from the drug leading Price to stop the treatment and claim:

"So what happened when we defied government advice and eschewed Tamiflu in favour of Calpol and cuddlies? Within 24 hours both of our children were completely recovered, save for those with runny noses"

Similarly on Monday, there was another article in the Daily Mail about how GMTV presenter Andrew Castle almost lost his daughter to the "swine flu 'danger' drug", when he revealed on TV the side effects of the drug prescribed to his daughter whilst interviewing health secretary Andy Burnham. The drug was apparently handed out at her daughter's school by the Health Protection Agency when a pupil was suspected of having swine flu. The side effects of the drug apparently caused severe breathing difficulties requiring Castle's daughter to be hospitalised for three days.

Before I launch into my main points about these articles, let me quickly describe my own experiences of dealing with swine flu and the prescription of Tamiflu. Before the launch of the National Pandemic Flu Service (0800 1 513 513) a couple of weeks ago, we were being inundated with phone calls from patients with symptoms ranging from runny nose to full blown fever and bodyaches. I was typically taking over 20 calls per day dealing with potential swine flu concerns. To date, I have prescribed Tamiflu a grand total of two times.

As GP's, we are getting weekly updates on the lastest treatment suggestions for swine flu - it has constantly changed, but one piece of advice has remained the same - the use of our clincial knowledge and skill as doctors. In all my phone calls I take a detailed history, ask about close contacts and for me the key is the temperature control. Remember, swine flu in a healthy person is like any other flu. It causes the same symptoms and should resolve in the same amount of time (5-7 days). The important feature is how good is the temperature control. If paracetamol/ibuprofen are controlling the temperature and patients are seeing an improvement then the patient can continue with the treatment without requiring further intervention.

On the two occasions I've prescribed Tamiflu, once has been on a GP's insistence for themselves despite my misgivings and on the second occasion for a person who suffered with other chronic health problems and I felt the Tamiflu could potentially limit the extent of the flu for at least a couple of days and it seemed to help. There are different guidelines for unhealthy people, patients who suffer with chronic illnesses which would make swine flu more damaging, but for this blog, I don't want to get into that since I am assuming that both Price's and Castle's children are otherwise normal, healthy kids.

Sometimes, when consulting with patients, they are not happy when I suggest Tamiflu is not necessary. At that stage, I discuss the risks and benefits of the drug and explain what it is for. So far, all patients have agreed they rather hold off the prescription and wait to see how their symptoms progress. This is why Price's article irritates me. He casually states that the on-call GP "was pretty certain they had [swine flu] and it was better to be safe than sorry,"

I'm sorry, but I struggle to believe that. No doctor (GP or otherwise) will prescribe medication without discussing the benefits and risks of the treatment. I cannot believe that the GP would not have explained all this to Price before recommending the treatment. If he didn't, then Price received sub-standard care which is an exception and not something to blame the government or NHS over. If he did, then Price is omitting information in an attempt to exaggerate his article.

Like all drugs, Tamiflu has side effects. A quick look in the BNF (British National Formulary) reveals the side-effects include: "nausea, vomiting, abdmonial pain, diarrhoea, headache, less commonly rash, visual disturbances and neuropsychiatric disorders in children." These all sound rather alarming but then have a quick read of the side effects of common antibiotics used to treat a variety of infection. For example, amoxicillin's (used for chest infections, tonsillitis, cystitis) side-effects include: "nausea, vomiting, diarrhoea, rashes." Or cefalexin (used for cystitis, pneumonia), which can cause "nausea, vomiting, diarrhoea, abdominal discomfort, rashes, headache, fever, liver damage, hallucinations, confusion, dizziness." All very similar and yet I don't remember reading a report about someone's outrage after suffering from side effects caused by common antibiotics and attacking the government and NHS for prescribing them in the first place.

Among the side-effects of Tamiflu, there is no mention of respiratory problems which is what Castle's daugther suffered with after starting the treatment. It is however, a symptom of swine flu and it's not clear from the article whether Castle's daughter was suffering from flu symptoms prior to starting Tamiflu or not. It seems disingenuous to attribute the symptoms to Tamiflu when there is no evidence that it causes the symptoms that presented. However, to be fair, there is too much information missing from this story and it needs further clarification.

As far as swine flu goes, it is a new strain of virus (H1N1) which usually causes flu symptoms just like other flu viruses in healthy people. It can be more dangerous in patients who are already unwell, and like other flu viruses, there will be occasions when it can cause a lot of damage. It has caused national concern because it appears to be a lot more contagious than other flu viruses but the consequences remain the same. Over 12,000 people die annually in the UK from the flu and so far (as of the end of July) there have been 41 deaths from swine flu related illnesses, the majority in patients who had other chronic illnesses as well.

I come back to my original point, I feel that it has been blown out of proportion by the media. The government and the NHS are doing there best to manage the spread of the virus and reports such as Price's are not helpful in the slightest. There will always be people who suffer from side-effects and to try and blame the NHS is not fair. When Price concludes that:

"Yet the sobbering fact is that today alone, the NHS will hand out Tamiflu to thousands of vulnerable little children who will go through needless suffering as a result of scaremongering about an illness which is no more dangerous than seasonal flu.

Take it from us: it really, truly, is not worth it"

Who does he think is responsible for the scaremongering? How about the Daily Mail for articles such as this, this and this? Maybe Price should've taken advice from the Daily Mail's own GP about the use of Tamiflu:

"Q: Is it better for me to fight swine flu naturally if I am otherwise healthy, or to take Tamiflu if offered?

A:All medications come with potential side effects so, if there is the possibility of treating an illness more conservatively and still making the same recovery, doctors always prefer to do that. If you are otherwise healthy, it appears that swine flu is a mild illness lasting for three to four days with no complications: therefore, many GPs have been advising patients not to take the Tamiflu. So far many of those with confirmed cases of H1N1 have opted out of taking the drug and made a normal recovery."

Take care all,

Thoughts just flow, when do they have to make sense?