October 22, 2005
The word is out, and it is Tamiflu. Around the world, patients frightened by avian flu are clamoring to stock up on the antiviral drug that is the primary oral medication useful in fighting the flu.
This has doctors and public health officials worried, for several reasons. One is that hoarding may deprive patients who really need the drug from getting it. Another is that overuse of the medication could cause the emergence of a Tamiflu-resistant flu strain.
World health officials have been publicly wringing their hands about the possibility that the fast-spreading bird flu will mutate into a form that can be spread through human contact. That could result in a pandemic -- a fast-spreading worldwide outbreak of a flu strain that no human is immune to.
Of course, it's quite possible that won't happen. Or, if a pandemic breaks out, it could be short-lived. Sometimes a virus remains virulent for a lengthy period, potentially killing millions. Others mutate, weaken and fade away. No one can say for sure what will happen to the current avian flu strain.
It's not only individuals who are stockpiling the drug. Nations are doing the same, filling warehouses with millions of doses that can be dispensed if an outbreak occurs. Retail demand has also taken a sharp upturn in the last month.
Although prescriptions for the drug have spiked in recent weeks, public health officials noted that many doctors routinely prescribe a course of Tamiflu treatment for high-risk patients once flu season begins.
Tamiflu is not a vaccine, though when taken once a day it can help fight off an active viral infection. It is taken twice a day once infection has occurred. A five-day course of two pills a day costs $80 to $90 and a prescription is required in the United States.
Some doctors are granting patients' requests for Tamiflu prescriptions while others are refusing, on the grounds that the patients are not yet sick and scarce resources should be saved for those who need them, not for the worried well.
"I do know that I personally can't give everybody who wants Tamiflu a prescription for it. It just doesn't seem right to me," Harry Oken, 51, an internist in Columbia, Md., told The Washington Post. "If there really was an avian flu epidemic, people who don't need it have it, and people who really need it can't get it."
The Centers for Disease Control and Prevention and the Infectious Diseases Society of America are each drawing up advice to practitioners on the issue of home stockpiles, spokesmen said.
First Step: Flu Shot
Even though no vaccine is yet available for the bird flu, many doctors say the most important thing consumers can do now is to get a flu shot. If a bird flu pandemic breaks out, those who are already sick with the "regular" winter flu might be more vulnerable.
It's also possible that bird flu could "merge" with the "normal" flu virus, in which case the flu vaccination might be helpful. Again, no one can say for sure what course the viruses will follow.
Consumers should also equip themselves with surgical masks that they can wear when out in public, should a flu epidemic break out, according to ConsumerAffairs.com's Dr. Henry Fishman.
Even without consumers hoarding stockpiles of the drug, there may not be enough to go around.
Roche, the drug's sole manufacturer, says it is working with other manufacturers to begin producing massive quantities of the drug, made from an acid produced from the Chinese star anise plant. The plant is grown in only four provinces in China and is harvested between March and May. Roche will soon start making the drug in the United States in an operation that involves six factories.
Bird flu, technically known as H5N1, is passed easily among birds and can be transmitted from birds to humans. When it is, the results can be dire. Since late 2003, 118 people have contracted the disease and 61 have died, according to the World Health Organization.
More than 140 million birds -- mostly chickens and turkeys -- have been killed in an effort to halt the spread of the virus.
