There's no reason to stockpile Tamiflu

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A few weeks ago I brought some samples of the anti-viral drug Tamiflu (oseltamivir) to a TV studio to use as a prop on a show. But when I went to leave the show, I discovered that one of the producers had rifled through the box, and most of the samples were gone. This piracy was due to the fear of influenza A H1N1, otherwise known as the new strain of swine flu that has been petrifying the world this spring.

Unfortunately, most people don't have a clear perspective on either this new flu strain or the anti-viral drugs available to treat it. So let me see if I can provide some.

The influenza is a package of genetic material (RNA) covered by an envelope. The two main proteins on this envelope are hemagglutinin (H), which allows the flu virus to attach to a cell, and neuraminidase (N) which allows the virus to break off and move to the next cell. The anti-viral drugs Tamiflu and Relenza (Zanamivir) are neuraminidase inhibitors, meaning they stop this enzyme from working so the flu virus can't detach and move on.

Both Tamiflu and Relenza appear to be effective against the new swine flu strain, which though it is currently a mild virus, could end up causing more of a problem when flu season hits us next fall. But I am concerned that all the fear over this emerging virus has caused people to stockpile these drugs, and if they use them inappropriately (Relenza must be inhaled and can provoke asthma), they could cause side effects and even develop resistance from encountering flu viruses.

It is one thing to use Tamiflu appropriately in response to a flu, or as a prophylaxis to close contacts to help prevent spread, it is another to stockpile it and use it in response to the fear of a sniffle. This is why it is crucial for physicians to be in the loop. Governments should stockpile, not patients.

On the other hand I am grateful that these wonderful drugs exist and that the new AH1N1 strain is sensitive to them, especially when you consider that we don't yet have a vaccine.

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


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