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View Diary: Bird Flu: What We Don't Know (109 comments)

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  •  as to that (none)
    I think the money could be better spent on improving vaccine production, support equipment, and early detection and isolation.

    So do I. But "not first line" doesn't translate as "useless". Slowing down spread in an early pandemic is exactly what tamiflu would be best at.

    Rummy's big bucks are old news. get used ti it: old, white male R's have money. And the link you gave is to this year's seasonal flu, an H3N2 that has nothing to do with tamiflu's use with H5N1.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Sat Mar 11, 2006 at 05:55:20 PM PST

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    •  Only because (none)
      I couldn't find the link to the report by field workers that Tamiflu was useless in cases they'd tried it in. Vietnam or somewhere around there. Though I'm sure I read it.

      So show me any links that actually verify the efficacy of tamiflu in current bird flu cases. So far I haven't seen any evidence that it helps in actual field use.

      And just because it's old news doesn't mean it's not relevant. From where I'm sitting there's some reason that the US is purchasing millions of doses of tamiflu for a pandemic that may or may not be on its way for a strain of fly in which it may or may not be useful, and the reasons aren't very strong.

      I suppose you think Cheney and the no-bid contracts at Halliburton are unrelated too. Cheney is just a very rich Republican so I should get used to it.

      •  non sequitor that has nothing to do with flu (none)
        but since you brought it up, there's nothing you can do about Cheney's money (or Rumsfeld's) except whine about it. You don't have to like it, but it's a completely irrelevant topic.

        The tamiflu literature is extensive in animals, scant in humans (too few cases). The best review on the topic is by Anne Moscona in the New England Journal of Medicine, but the relevant paper is Monto and Webster (discussed here by anon_22 at Flu wiki:

        Virulence May Determine the Necessary Duration and Dosage of Oseltamivir Treatment for Highly Pathogenic A/Vietnam/1203/04 Influenza Virus in Mice Author(s) Hui-Ling Yen, Arnold S. Monto, Robert G. Webster, and Elena A. Govorkova Identifiers The Journal of Infectious Diseases, volume 192 (2005), pages 665-672

        <snip>

        Oseltamivir produced a dose-dependent antiviral effect against VN1203/04 in vivo (P<.01). The 5-day regimen at 10 mg/kg/day protected 50% of mice; deaths in this treatment group were delayed and indicated the replication of residual virus after the completion of treatment. Eight-day regimens improved oseltamivir efficacy, and dosages of 1 and 10 mg/kg/day significantly reduced virus titers in organs and provided 60% and 80% survival rates, respectively (P<.05). Overall, the efficacy of the 5- and 8-day regimens differed significantly (death hazard ratio, 2.658; P<.01). The new H5N1 antigenic variant VN1203/04 was more pathogenic in mice than was A/HK/156/97 virus, and a prolonged and higher-dose oseltamivir regimen may be required for the most beneficial antiviral effect.

        Conclusions. Oseltamivir prophylaxis is efficacious against lethal challenge with VN1203/04 virus in mice. Viral virulence may affect the antiviral treatment schedule.

        That is from the abstract. The full article also indicated that it is difficult to extrapolate to humans but 10mg/kg/d is equivalent to 75mg twice daily human dose (i.e. current standard dose) but further studies are needed. This is only a first study which sets some parameters for later more detailed analysis and using other animals.

        The one thing that convinces me that tamiflu works is this: On a 5 day regimen (and this is only on a standard dose) there was significant inhibition of virus in the lungs on day 3 and 6 but not day 9. Also, those receiving the lower dose had virus in the brain, but not those on 10mg/kg/d.

        So the broad result is that tamiflu does work. Now we just need more studies to determine how well. It is a race against time, IMO.

        It is the reference you were referring to.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 12, 2006 at 04:43:28 AM PST

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        •  Thanks for the references (none)
          The comments I'd heard were just the opposite from field observations, but I'll be darn if I can find them now. I'll go through this later.

          Still, not a very strong statement of support for something that the US and other countries are investing $100's of millions in.

          So maybe theyr'e grasping at straws and stockpiling in the hope that Tamiflu will make a difference until a vaccine can be developed that works.

          Or maybe it's not a non sequitur and the only reason that stockpiling has been given the go ahead is that some of the right people would profit from it and they can always just use the excuse that they were preplanning for a pandemic.

          Certainly from Frist's work to sneak liability releases into bills and Medicare's refusal to negotiate prescription prices we know the pharmas enjoy a plethora of special favors. Whether it would profit Donald personally or just people that he knows.

          I think it was Keith Olbermann that brought the virologist in that says this whole thing is much ado about nothing.

          •  stockpiling (0+ / 0-)

            So maybe theyr'e grasping at straws and stockpiling in the hope that Tamiflu will make a difference until a vaccine can be developed that works.

            That's exactly what it it. Europeans and Australians have done far more extensive stockpiling than the US, and they could care less about Rummy.

            Look at europe now. They're losing billions in poultry dollars even without human-to human spread. And as far as experts go, take your pick. My favorite is Robert Webster, who discovered that all flus are aquatic bird flus. See also here.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Mon Mar 13, 2006 at 04:10:22 AM PST

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