Hacker News Reader

Your ex-gf's story seems a bit off. First, Gilead didn't license it to Roche until 1996 and it was approved in 1999. About the time it takes to conduct clinical trials and get FDA approval - no apparent delay.

The major Asian bird flu epidemic was ~2005, after it was already brought to market.

Tamiflu isn't a "cure", the effects are pretty limited, but it's used because we have nothing else.

Tamiflu has been wildly successful product for Roche, why would they not develop it and instead try to treat "symptoms"?

Tamiflu is not in short supply by any means, Roche produces huge stockpiles for the US gov't and the shelf life is pretty long. There is plenty to go around.

To summarize, your ex-gf's story sounds like a could-be-true story (for those who don't know better) that plays to the typical stereotypes for "big pharma".

I'll also add that the cost to treat someone with Tamiflu before it went generic was ~$100. Pretty reasonable considering what drug costs are like in general.

First, the CDC recommends Tamiflu:

https://www.cdc.gov/flu/professionals/antivirals/summary-cli...

Second, in 2003 Roche upped production. So yes they sat on it. SARS was in 2003 - and it takes 12 months to produce. What Roche was producing pre 2002 would prove or disprove the story, but I can't find this information anywhere -- I would gamble not much.

"It's pointless to look at ways for outsiders to produce Tamiflu, Roche's Reddy says. He notes that Roche can meet demand expectations faster than anyone else because it is familiar with the challenging production process. To meet current orders, Roche has quadrupled production capacity since 2003,"

http://pubs.acs.org/cen/news/83/i35/8335tamiflu.html

Your answer does not address the criticisms in the comment you are replying to. If the Asian bird flu epidemic was in 2005 there is no correlation to an increase in production in 2003. Could reduced production in the first 4 years of the drug's approved existence be explained by a challenging production process?

He did actually, but he used the medical term SARS (severe acute respiratory syndrome) [1] in place of "Asian bird flu". However, they refer to the same thing, and SARS does appear to have only been a major problem from late-2002 to mid-2003, a timeline that is consistent with his claims.

[1] - https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...

Ah, I understand the argument a bit better then, but I don't think that's really a valid substitute. Avian flu is H5N1, whereas as that article describes SARS is caused by SARS coronavirus. I suppose oseltamivir may be used to treat both, since it's an antiviral, but I'm not able to find much online indicating that. Regardless, I think the medically accurate term to substitute for "Asian bird flu epidemic" would be "the H5N1 epidemic in Asia."

Roche upped production so that's your claim that they "sat on it"?

Production is dependent on demand, which is dependent on how bad the flu season is and how many are treated with Tamiflu. Otherwise a company produces a ton of product that just expires.

Predicting what the next flu season will be like is hard as hell. I haven't seen anyone do a decent job of it. Even Google tried and failed miserably.

I don't see that as "sitting on it". Also, the drug was already approved. Why would Roche not just sell more Tamiflu, it's easy money? What benefit is there to "sitting on it"?

Your girlfriend is overstating the case. In tissue culture, almost 100% of circulating strains of flu are susceptible to oseltamivir. However, clinical and epi studies have shown, at best, a very modest effect on disease in otherwise healthy adults. It may reduce transmission, but it comes with an increased likelihood of vomiting and diarrhea. It is far more critical for those at risk of complications (the elderly, those with underlying respiratory conditions).

Widespread usage of oseltamivir will almost certainly lead to widespread resistance, and there aren't many other options for future, particularly nasty flus. This is the reason for the US stockpile--even though the data wasn't conclusive on its benefits, oseltamivir was the best plan for pandemic flu.

http://www.bmj.com/content/358/bmj.j3266 http://www.bmj.com/content/348/bmj.g2545 http://www.thelancet.com/journals/lancet/article/PIIS0140-67...

Cochrane Collaboration is a network of independent scientists. They analyzed the evidence and said that Tamiflu is no more effective than Paracetamol: http://www.cochrane.org/news/tamiflu-and-relenza-getting-ful...

A little more info:

"Tamiflu (the antiviral drug oseltamivir) shortens symptoms of influenza by half a day, but there is no good evidence to support claims that it reduces admissions to hospital or complications of influenza."

https://www.sciencedaily.com/releases/2014/04/140411091937.h...

Or the complete review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965...

YMMV.

On my trip to Japan I came down with a flu (Influenza-B). Got 40c fever, full-body muscle pain, the whole shebang. Slept through two whole days, occasionally taking ibuprofen to knock the fever off enough to be able to eat something. Then finally went to a doctor, who without any hesitation prescribed Tamiflu, a stock of which they keep in the office at all times. Two tablets later - the fever is gone, replaced with some dry cough and a bit of a runny nose.

I know my flu. I had plenty of them and if I have one, it lasts for 3-4 weeks before the temp drops below 38c. There is no doubt in my mind that I recovered from the last flu in 2 days exclusively because of Tamiflu and seeing it compared to Paracetamol makes no sense.

Your story is why we don't run single patient clinical trials. In fact, Tamiflu has pretty limited efficacy if not taken in the first 24-48 hours.

Do you mind clarifying who are these "we"? It might be my old BBS habit kicking in, but I really don't appreciate a random person on the Internet taking on themselves to speak on behalf of others with no apparent reason.

And it is a single anecdote, so, no, it'd be indeed very strange to base the results of a "clinical trial" on it alone. It does however mean that in at least one case the drug worked and it worked very well. As I said above "YMMV".

From context, "we" is the drug company running the clinical trial. And his first sentence did read very strangely, as you clearly weren't talking about anything other than an anecdote. :)

Having said that, his point other point seems to be valid. Tamiflu does not make a claim as to helping someone in your case, afaik.

There is not strong indication that the drug worked well or even at all. It was taken long outside the window where its best applied. Chances are that in your case, the illness has run its course and the pills were taken at the time you would have gotten better anyways. I’d bet that sleeping two days had a much stronger effect on your recovery than two doses of tamiflu. That’s why we - as a society - do not accept clinical trials that do not conform to a minimal scientific standard, statistical significance being one of the requirements.

Hey, random HN poster.

I too went to the kindergarten and know what statistical significance is. Surprise. So thanks a bunch, but no need for lecturing on the basics of scientific method. I am also a part of a rational part of the society, which you appear to be trying to exclude me from if I'm reading your comment correctly.

> I’d bet that ...

You can bet whatever you want. I had numerous flu's in my lifespan of almost 50 years. All but one were the same, and the exception ended in less than a week. It was lab-tested to confirm that it was in fact a flu virus. It was the only one when I was taking an antiviral med.

Hey, random HN anecdote teller. (Aren’t we all a bit random around here?)

You may have learned about statistical significance in kindergarten (props for the kindergarten for great education, I didn’t get there till high school) Still you’re displaying coincidence in a single case as correlation.

Neither did I question whether you had flu or not, you’re attacking a straw man there. I question that tamiflu was a strong factor in your speedy recovery.

"we" - the entire scientific establishment (a.k.a. the scientific method).

"It does however mean that in at least one case the drug worked and it worked very well." - unsubstantiated.

Ironically, you've (again) drawn a conclusion based on only your own experience. Which is why, as pointed out above, "we" don't run single patient clinical trials. Your recovery after using the drug simply cannot be attributed to the drug. In addition, it should be obvious (considering the contents of the comment chain to which you are responding) that it likely was not the drug that accelerated your recovery in this case. Does that makes sense?

> "we" - the entire scientific establishment

Obviously. It was a rhetorical question.

This is getting meta, but as an old Internet adage goes "Try and not speak on behalf of others", meaning that throwing around "we" in a discussion is counter-productive. It automatically pits a person against this implied "we" group, be it actually applicable or not.

The above comment is the perfect example of that - by using "we" the "refurb" person put me and the rational scientific community on the opposite sides of a line, implicitly invalidating whatever it was that I said. This is not an acceptable way to phrase arguments or even to express an opinion. "We" has no place in a public discussion unless there is in fact a group of people that one's qualified to represent.

PS. And don't put words in my mouth - I've drawn no conclusions except for the fact that based on _my_ prior experience with _my_ flu infections, this case was resolved in a very prompt manner and the only difference was the presence and the timing of taking in an antiviral med.

And your conclusion mistakes coincidence and correlation, which is the cardinal sin in medical trials. Quote “in at least one case the drug worked”. This is not a valid conclusion. All you can conclude from your singular experience is that in at least one case, taking the drug was followed by speedy recovery, but other factors were not controlled for.

Ah, you again. Yes, "correlation is not a causation". I am aware of that one too, believe it or not.

I really wonder why you’re so hellbent on defending “but it worked for me” if you’re acutely aware of “I tried it once and at the same time I go better” does indeed bear all hallmarks of falling into the classic human trap of mistaking correlation for causation. It’s literally one of the easiest mistake to make. We humans are just wired for it. I’m certainly guilty of making that same mistake at least a thousand times and more. I’m actually glad if people point out to me when I make that same mistake.

You say you are yet you make a strong definitive claim above that seems at odds with it.

If you have flu regularly, every few years, and they are all exactly the same, that is not the flu. That is something else, like Malaria kicking in.

It's the limited efficacy for all users? Isn't it possible some users+strain pairings respond markedly better, or are their studies showing that's not true either?

Please tell me what aspects of life must be held to scientific standards and what should not. If you had to have a scientific study before every decision you made, you wouldn't be able to walk 3 feet. Why is personal health something in which every judgement and decision must be backed by a double blind study? If you eat something and feel bad, don't eat it anymore. You don't need to wait for a test or study to tell you that. Please don't misinterpret me - science is incalculably valuable at saving lives, but it's not the only tool in our belt.

The flu doesn't last 3-4 weeks

That's a fair point, actually, and I should clarify that.

From where I'm from there's 36.6c, 37.7c and 39c temperature marks that respectively denote the "ok", "basic cold", "bed regime" and "burning hot" ranges. It does take me several weeks after getting a flu to get back to the "basic cold" level. With this antiviral thing I got there in 2 days flat.

>Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold

A much more convincing explanation is that your symptoms were ameliorated by your vaccination, which is a thoroughly-documented effect.

Actually, this is interesting as an explanation.

My toddler woke up yesterday with fever and I was starting to feel like I was coming down with something as well (no fever yet), so we went to the clinic. They tested her, flu confirmed, gave us all Tamiflu. I started feeling markedly better about 6-8 hours after first dose. Today, we’re all completely normal except for mild cold symptoms. And this happened basically exactly the same last year. So I find all these studies about how Tamiflu basically does nothing to be pretty hard to take seriously...

EXCEPT that we were all vaccinated, which I didn’t even consider until now. I had assumed that getting the flu was a binary thing, and the vaccination just protected you from coming down with it, but wouldn’t ameliorate the symptoms or cause you to recover faster. That’s a much more compelling story if true.

I’m no doctor

But a vaccine is basically giving your immune system a new toolbox for fighting diseases, so it would make sense to me that even if it didn’t stop you from getting the disease, it still equips your immune system to ease the severity

It makes sense, but I just never hear about that as a reason to get the vaccine, which seems crazy. The flu is miserable, so if the actual benefit of the vaccine is that you probably won’t get sick, and if you do, it’ll be for 36 hours instead of ten days, that seems to be a huge benefit they’re underselling.

It works that way yes, especially for the flu that changes so fast that its vaccination is no immune guarantee but rather helps to have milder symptoms. I guess how it's promoted depends on where you live. Also don't forget that not everyone has good cognitive capacities and such probabilities (you might still get sick with the vaccine, but symptoms might be milder) are not easy to grasp for everyone. I guess they just wanna keep the public message straight and simple.

The CDC discusses moderation of the illness some:

https://www.cdc.gov/flu/about/qa/vaccineeffect.htm

I guess they don't want to get too far out ahead of the science.

> Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold.

A couple months ago, I came down with the flu. I, too, had a flu shot. I didn't take antivirals. 18 hours later, I was fine.

Anecdotes aren't terribly useful in medicine.

P.S. If you look up the latest studies and CDC guidance, you may learn that (a) the flu shot seems to cause a decent fraction of people who subsequently get the flu to get over it very quickly and (b) Tamiflu, while probably effective in the "statistically determinable to be better than nothing" sense is only very slightly better than nothing.

My ex (5 years) is a clinician who works the ER, pediatrics, and urgent care, amongst other things. She has the opposite view: Tamiflu reduces the length of the flu by a total of 12 hours and most people don't need it. Wish she was on here to defend this view, since I am not qualified to debate it.

That's the generally accepted view on Tamiflu. Modest effect that you only see if started early on in the disease.

However, it's one of the very few options we have, so if the shit does hit the fan with a severe flu, it will save lives.

> Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply.

Yet during the swine flu scare, Roche handed out massive amounts of oseltamivir (Tamiflu) like it was candy to their employees (at least at the SF Genentech campuses). You'd call into a doctor, who would do nothing but verify your identity and issue a prescription. You'd then pick up the drugs on campus. Unfortunately pretty typical for Roche-Genentech, which is prone to fairly disgusting levels of spending on excesses.

> I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold.

What makes you think you had a flu in the first place and not just a cold?

Lol, post the studies not some business journal.

What you find, as you try to dig actual medical results up, is that it maybe knocks as day or two off the course of the flu, has side-effects, and is less effective than the vaccine.

Having some knowledge about both subjects, this is surrealistically close to the difference in how experts vs nonexperts think will keep them safe online (https://www.usenix.org/system/files/conference/soups2015/sou...)

Tamiflu will shorten flu by 1 day in Most good studies.

In Aus Tamiflu is often prescribed. In fact, significantly over prescribed. $100+ for a box of tablets, that someone needs to start taking before we even have actual PCR confirmation of flu virus? Does the benefit outweigh the costs? Probably in elderly or in situations with decreased immunity.

For the rest of people, it is probably good to go through a fever cycle once in a while. Your immune system needs something to run at, or else it can end up attacking itself, or missing cancers. The firm evidence base for this is low but my belief (as a biochemistry major and doc with heavy interest in immunology) is that if you are otherwise healthy and you get the flu, then it is probably doing ok for you. We need to stop pathologising all sickness. It’s normal to be sick sometimes, in fact it’s probably necessary for optimum function.

[0] - quick link from google as I am on mobile but well known to me in my professional capacity - http://www.center4research.org/tamiflu-not-tamiflu/

On the other hand, a lot of diseases (including lifelong, autoimmune ones) are triggered, at least in part, by infections[0]. Without ever experiencing even a common cold, it stands to reason that some cases of those diseases could be precluded. Also, for the elderly, respiratory illness should be avoided because it puts undue stress on the cardiovascular system[1].

We need to be come robots[2]!

[0] https://www.labroots.com/trending/health-and-medicine/4999/a...

[1] https://www.cbsnews.com/news/flu-tied-to-heart-attack-risk-i...

[2] http://i.dailymail.co.uk/i/pix/2015/12/02/00/2EF55A550000057...

And there’s also strong evidence that infection with ie. parasites decrease lifetime autoimmune infections, and fevers have been known to send cancer into remission

You maybe down voted because people here want links and proofs.

> Your immune system needs something to run at, or else it can end up attacking itself, or missing cancers.

This is patently untrue.

Whilst this is not a clear-cut case yet, it is certainly not patently untrue, and on the balance and from my position observing evidence and with the weight of the building evidence, I have no problem giving a hat-tip to this.

Observe the hygiene hypothesis as a starting point

[0] DOI: 10.1126/science.296.5567.490 - Allergy, Parasites, and the Hygiene Hypothesis

My doctor gave me a flu test recently, which involved swabbing my sinuses with a cotton swab and putting it in a plastic test kit about the size of a matchbox. Within 5 minutes she was able to tell me that I am positive for Influenzea B. What test is this that it is so much faster than the one you've mentioned?

I'm not aware of this test. In Aus last winter we were peforming nasal swabs but results weren't available for at least a day.

i've just come across [0] which describes roughly what you're talking about.

a bit further digging shows it was available at the hospital I work at according to their press releases. I assume it worked via some sort of compartmentalised ELISA which is pretty awesome.

[0] https://www.nsw.gov.au/your-government/the-premier/media-rel...

My family came down with the flu right before I was scheduled to return from a business trip and turn around two days later to spend two weeks out of the country. We took as many precautions as possible to avoid spreading it to me (frequent hand washing, not sharing food, all of that) but I also got a preventative Tamiflu prescription. It didn't seem to be in short supply or hard to get -- I literally just described the situation over my healthcare provider's chat app and they sent a prescription to the pharmacy for me to pick up on my way home from the airport. Cost me $10.

Whether the stuff works or not is a different question. I read some of the research and meta-analyses and meta-meta-analyses and it didn't seem cut and dry. I can say I didn't get the flu, but there are many other times I didn't get the flu without taking anything.

IMO this is technically criminal. States should be able to buy the rights and make a steady supply.

Roche is low on this.

Though China can be criticized on many fronts, I'm a little envious over the pragmatic strong arming of Roche with a "produce it or we will" approach in order to secure a supply.

There are serious things wrong with our system when the best allocation of capital is to acquire and park IP. "Non practicing" IP should have strong incentives to make it accessible. What are possible policies for that: taxation incentive, compulsory licensing, or others?

I can accept a dose of business cynicism, but viruses are outside this box.

Also, it reminds me the allegedly Chinese proverb saying doctors there weren't paid, but would pay if they didn't cure you. Different cultures ...

If at 65 sombody dies from flu, the problem was not the flu. 65 is not old age anymore.

You simply can not say this. Medical history is super important here.

Then the medical history is the problem, not the flue. A sane robust body is not supposed to be killed by the flue. If our society produce people that the flue kills, let's focus on those causes. Not the flue.

It's like focusing on making all houses flood proof. Most houses don't need it. If one needs it, relocating the house is probably a better idea that trying to make a new law saying all house should have floaters. The problem is that our society let us build houses on floodable area, not the flood.