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I have an expression that I like to use when describing a drug's fall from grace—I call it going from panacea to panic. This description suits the latest media focus on the anti-viral flu drug, Tamiflu.          

Tamiflu was wrongly touted as a potential cure-all for the bird flu craze just two years ago, and its manufacturer, Roche, was ramping up to increase its supply at a time when H5N1 bird flu was responsible for the deaths of millions of birds in Asia but only a rare human being, and hadn't come to the US at all—and still hasn't. Nevertheless, two years ago people were begging their doctors for prescriptions of this perishable and expensive drug, without any idea how or even if they were going to use it.                                                                                                      

At the same time, Tamiflu has real uses against the yearly human flu that kills hundreds of thousands around the globe. Many millions of doses have been prescribed around the world, especially in Japan. It is not surprising that rare side effects such as behavior abnormalities and anxiety that may be associated with Tamiflu have been reported in a country where the drug is prescribed so freely.                                                                                                                                                     

It is a difficult decision whether or not to warn against a rare side effect for a drug that is used so often, and perhaps over-prescribed. On the other hand, Tamiflu clearly has an important role. None of the four anti-flu drugs currently on the market are cures—they are all intended to decrease the length and severity of symptoms in patients. But these drugs when used judiciously can save lives—because there are many patients with chronic illnesses who are not strong enough to survive the full force of the flu.                                                                                                                                                

And of the four anti-flu drugs available, Tamiflu, a neuraminidase inhibitor, has the least amount of drug resistance, and still appears to be the best tolerated.                                 

In the face of indiscriminate use of a drug, warnings may be prudent, as long as they don't convince people who really need the drug not to take it.

Marc Siegel, MD, is an internist and associate professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear

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