The Old Man and the Tamiflu

Winter is coming, and so is Tamiflu.  And, this year, we saw two meta-analyses regarding Tamiflu – the Roche puppet-sponsored analysis was pro-Tamiflu, and the non-sponsored analysis was anti-Tamiflu.  However, it should be made clear – anti-Tamiflu still agrees there’s still some small magnitude of effect that must be weighed against the side effects and cost.

The CDC has been repeatedly castigated regarding their continued zealotry regarding Tamiflu, despite the controversy surrounding its use.  The official statement contends their stance is based on more than just RCT data, including the whole of the observational data regarding its use.

And, so, they’ve gone and created some more junk observational data.

Through torturing the Influenza Hospital Surveillance Network (FluSurv-NET), these authors gathered three years of elderly patients hospitalized for influenza.  They extracted the date of influenza onset and the date of initiation for antivirals, and then examined these for a surrogate outcome for effectiveness: discharge to an extended-care facility.  They found, of course, that antiviral treatment was significantly associated with independent discharge, with an absolute unadjusted magnitude of effect of 4%.  However, they also found age, ethnicity, weight, chronic medical conditions, cardiovascular disease, neurologic disorders, influenza vaccination status, influenza virus type, time of illness onset to hospitalization, and surveillance site to be associated with outcomes – many with similar or larger absolute effect sizes.

So, the conclusions here are based on: the outputs of the statistical black box.  Given the degree of adjustments, and allocation and selection bias, there’s not much can be said here – except to make it into a HealthDay and ACEP daily news headline.  Unfortunately, the authors use these data to support early care and antiviral intervention.  This may be true, of course.  However, in the context of the current study, the suggestion ought not be to inform clinical practice – but, rather, to generate hypotheses for future trials, or to serve as surveillance safety for current practice.

That said, once the overall costs and potential morbidity of hospitalized influenza patients are taken into account, the additive penalty of Tamiflu administration is likely far less than even any small magnitude of benefit.

“Impact of prompt influenza antiviral treatment on extended care needs after influenza hospitalization among community-dwelling older adults”

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