Wednesday, May 6, 2009

Buy Tamiflu? - Will it be fake or out of date?

April 30, 2009

Drugs can be let off the prescription leash and we survive

The history of which drugs go on sale without a prescription is a history of how much governments think the public are selfish idiots - and how much the public think governments are incompetent and patronising.

Take the anti-influenza drug Tamiflu, and its less fashionable sister, Relenza. A few years ago, at a meeting in San Francisco of the world's most eminent specialists in infectious diseases, a speaker asked the audience how many kept a supply of anti-flu drugs at home, just in case. A large proportion of hands went up. Next he asked how many were thinking of doing so. Most of the remaining hands went up.

This isn't surprising, when you hear the evidence of doctors such as Graeme Laver, who helped to develop Tamiflu and Relenza. In his evidence to the Royal Society about a pandemic in 2006, he said that the UK's prescription-only model was wrong, and that

we should adopt a system like that in New Zealand, where anyone going to their chemist with flu symptoms could get the drug. To wait two days is “too late”, he said. “Tamiflu is most effective when given very soon - 6 to 12 hours - after the first symptoms are experienced and the time taken to get a prescription renders it ineffective.” 

This sounds likely enough. You can imagine, feverish with swine flu, you are on hold to the doctor's surgery, which is on hold to the lab, which is on hold to the drug stockpile, watching as those 48 hours tick away.
But remember that we are also selfish idiots. We may, so the argument goes, overuse the drug, thus creating resistance to it in the flu virus. But the best example of this happening is with antibiotics which are, oh yes, prescription-only.

In Japan, where Tamiflu is used to treat winter flu, with about ten million courses prescribed a year, only limited resistance has developed. In America, Tamiflu-resistant flu has occurred, but not, according to the Centres for Disease Control and Prevention, because of overuse. 

Really, the Government and public must learn to trust one another. Whevenever a medicine is let off the prescription leash, a great deal of nervousness and moral panic occurs. The painkiller ibuprofen was made available over the counter only in 1983. No one worries about its use now. The morning-after pill was made over the counter in 2001 to a great deal of shock and horror. We have survived.
Diseases don't respect borders and neither do people.

Since the swine flu outbreak there has been a huge surge in British demand for Tamiflu over the internet. It often turns out to be counterfeit. The wrong drug at the right time is just as useless as the right drugs - whole stockpiles of it - prescribed too late.

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