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'Stockpiling' Drugs is No Answer for Flu Fears, S.C. Doctor Says

Posted on: Tuesday, 10 January 2006, 09:01 CST

By Linda H. Lamb, The State, Columbia, S.C.

Jan. 10--Dr. Allan Brett understands that the avian flu might scare you.

In fact, for anyone who pays attention to health news, it has been hard to avoid the impression that when avian (bird) flu makes its inevitable, disastrous appearance, the resulting cataclysm will be a medical version of Armageddon.

But in light of reports that some patients have begged their doctors for Tamiflu -- a prescription drug that might help fight the bird flu -- Brett wants people to calm down.

Specifically, he wants doctors to deny those requests -- and patients to understand that stockpiling the antiviral drug Tamiflu (oseltamivir phosphate) is a bad idea.

"It's an understandable reaction," said Brett, an internal-medicine physician and a professor at the University of South Carolina School of Medicine.

There are parallels with the anthrax scare of 2001, he said. After the 9/11 terrorist attacks, people were fearful when anthrax in the mail was used as a weapon and a handful of people died. As with the bird flu, a wider catastrophe was feared, and some demanded prescriptions of an antibiotic used to treat anthrax infection.

"In both cases, a practicing physician was kind of caught between individual patient requests and issues relating to public health," Brett said.

Brett and a co-author, Dr. Abigail Zuger of New York, wrote an essay in December for the New England Journal of Medicine, focusing on the ethical issues in the run on Tamiflu.

Brett said both doctors had received requests for the drug from patients worried about bird flu. (Concerned about stockpiling, the drug manufacturer even halted shipments of Tamiflu to the United States for a while.)

"A busy outpatient office is no place to think through complicated ethical dilemmas," they wrote, contending that's what doctors face when asked to prescribe such a drug for people who aren't even sick.

In South Carolina, the Department of Health and Environmental Control did send out an advisory to health-care providers in November. It includes a statement that DHEC "strongly discourages stockpiling of antivirals for personal use" and advises doctors not to prescribe it for that purpose.

Brett and Zuger cited several pitfalls of such prescriptions. With Tamiflu shipments resuming as flu season gets under way -- the first laboratory-confirmed S.C. case was reported Dec. 29 -- you might want to keep these in mind:

-- At this point, any bird flu scenario here is strictly hypothetical. No birds in America have the disease, let alone any humans.

-- It's not clear that Tamiflu or any other existing antiviral drug will be effective against bird flu if it does turn up here. (Since Brett and Zuger wrote their essay, two Vietnamese patients died of bird flu despite having taken Tamiflu.)

-- Administering a drug like Tamiflu is not as simple as plopping an Alka-Seltzer in a glass of water. Doctors may use it as a preventive measure, or to prevent flu in a person who's been exposed to it, or to treat symptoms that already have appeared. People taking the drug on their own might not use it correctly.

-- As with overuse of antibiotics, overuse of antiviral medications might lead to development of drug-resistant disease strains.

-- Supplies of Tamiflu are limited. Stockpiling by those who don't really need it may deny treatment for those who do need it.

With logic on their side, why would doctors be persuaded to grant prescriptions for a drug like Tamiflu against their better judgment?

"I think that most unfortunately, the answer that fits most cases is that it's the path of least resistance," Brett said.

"Physicians are human beings, like patients. You don't want a dispute or resistance; you want to please your patients. I think there's a perception by physicians that if they refuse those requests, it's going to set up a tense or even hostile relationship."

Brett added that in his experience, taking time to communicate with worried patients helps them understand why they shouldn't be stockpiling antivirals.

Brett noted that last year when flu shots were in short supply, doctors got federal support as they tried to explain why only high-risk patients were supposed to get the vaccine. The Centers for Disease Control and Prevention issued a statement to that effect, which could be posted in doctors' offices.

"This year, the CDC should have issued a statement regarding personal stockpiling of antiviral drugs, when patients began to demand them," Brett said.

Reach Lamb at (803) 771-8454 or llamb@thestate.com [mailto:llamb@thestate.com].

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Copyright (c) 2006, The State, Columbia, S.C.

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Source: The State (Columbia, S.C.)

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