The BMJ Today: The FDA and CDC’s disagreement over Tamiflu, and the spy who isn’t

If you remain uncertain about the benefits or otherwise of oseltamivir (Tamiflu), you may not be much helped by consulting and comparing the pronouncements and statements issued by the two leading healthcare authorities in the United States, the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). As Jeanne Lenzer describes in her Feature today, the two bodies would seem to be at variance over the drug’s effectiveness in tackling the symptoms and complications of flu.

The CDC is urging people to take an antiviral if one is prescribed by a doctor, saying that it could “save lives,” while the FDA maintains that oseltamivir “has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.” The CDC’s director, Thomas Frieden, told a radio station last month that oseltamivir “might keep you out of the hospital, and could even save your life . . . To put it very simply, if I or one of the members of my family got flu or a flu-like illness, I would get them or me treated with Tamiflu as quickly as possible.” But others describe Frieden’s statement as “highly irresponsible.”

As evidence in favour of oseltamivir Frieden has cited a meta-analysis published in the Lancet last week. Lenzer speaks to several experts who draw attention to that study’s drawbacks, including its lack of reference to the parent studies to assess whether negative outcomes were due to drug toxicity or were actual flu symptoms and a reliance on reported symptoms and antibiotic prescriptions rather than x-ray pictures to determine complications such as pneumonia.

Lenzer also describes how funding from the oseltamivir manufacturer Roche gets to the CDC, something the former New England Journal of Medicine editor Marcia Angell finds worrying. Angell says, “The CDC has enormous credibility among physicians, in no small part because the agency is generally thought to be free of industry bias. Financial dealings with biopharmaceutical companies threaten that reputation.” And Lenzer draws attention to the network of inter-related organisations and funding behind the Lancet paper, including the Roche funded MUGAS and the Belgian PR firm Semiotics.

If you maintain a healthy scepticism towards drugs with a disputed evidence base such as oseltamivir, you’d be in good company with the doctor, author, and Telegraph columnist James Le Fanu, the subject of this week’s BMJ Confidential, who over his career has challenged accepted wisdom in healthcare, from drugs to genetic determinism and diet. His earliest ambition was to be a medical missionary, and he says that if he wasn’t a doctor he’d be a spy. In the oseltamivir saga as in so many other healthcare questions, it would seem that doctors need to be a bit of a spy as well or at least to have a forensic attitude to investigating evidence. We hope The BMJ continues to help doctors in this task.

Karl Sharrock is the lead technical editor, News and Views, The BMJ