Stories about tragic flu deaths wrongly portray Tamiflu as a panacea

A number of news stories on Monday linked the flu-related death of a Texas schoolteacher to her reluctance to fill a prescription for a generic version of antiviral drug Tamiflu.

They were misleading because there’s no evidence that antiviral medications can prevent an otherwise healthy person from dying of the flu.

They’re also emblematic of fear-mongering coverage that suggests otherwise healthy people are dropping dead in this year’s severe flu season.

Amid a steady stream of hair-raising statistics about local and national death tolls, the story of Heather Holland, a 38-year-old mother of two who died within days of feeling her first symptom, served to put a human face on the epidemic. It’s not at all clear, however, that her case is representative of people who have died from the flu.

After appearing last week in the Wall Street Journal and the Weatherford (Texas) Democrat, Holland’s story was picked up by several news organizations that focused on her decision not to fill a prescription for the antiviral:

Newsweek: Texas women dies from flu after rejecting expensive Tamiflu medication.

Antiviral medications such as Tamiflu should not be portrayed as a life-saving flu treatment.

CBS: Texas teacher dies from flu after deeming antiviral drug too costly

BBC News:  U.S. teacher dies after opting out of costing flu medicine

Atlanta Journal-Constitution: Texas teacher dies from flu after spurning medication that cost $116

Misplaced emphasis on antivirals

The coverage seems to imply that if Holland had received the medication she might have lived. But in fact, the FDA has concluded that Tamiflu is not proven to saves lives, as medical journalist Jeanne Lenzer wrote in 2015 in the BMJ.

The Food and Drug Administration told The BMJ that data submitted to it for review do not support the claim that the neuraminidase inhibitor oseltamivir (marketed by Genentech and Roche as Tamiflu) ‘saves lives.’ The FDA said 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.’

None of the stories made that point.

ABC’s Good Morning America featured the story of a different 38-year-old mother from New Hampshire, Amanda Franks, who chose not to take the Tamiflu prescribed by her doctor because of worries about side effects. “Two days later she got sicker and died on the way to the hospital,” the report tells us, adding that the drug is “proven to be effective.”

Other stories have fed potential concerns about the availability of antiviral medications due to heightened demand. They include GoodRx’s Tamiflu prescriptions reveal shocking flu trend  and the Rochester, Minn. Post-Bulletin’s You need Tamiflu, but can you get it?

But contributor Preeti Malani, MD, a professor of medicine at the University of Michigan, cautioned there’s no way to tell whether taking a prescription antiviral would have saved the life of the Texas woman, or anyone else. Some patients take an antiviral promptly after getting their first flu symptoms and die anyway, she said.

“I don’t think people should be panicked if they don’t get their Tamiflu,” she said. “It is not this amazing panacea, the way an antibiotic might be in fighting an infection.”

Only a modest benefit

While the CDC maintains there’s a role for antivirals in stemming the symptoms and spread of flu if taken within two days of the onset of symptoms, there’s only modest evidence of a benefit.

A 2014 Cochrane review based on a review of data of trials in more than 24,000 people challenged the assumption that antivirals Tamiflu (oseltamivir) and Relenza (zanamivir) are effective at fighting the flu.

The Cochrane review confirmed “small benefits on symptom relief, namely shortening duration of symptoms by half a day on average,” but said there’s little evidence that drugs reduce hospital admissions, lower the risk of developing pneumonia, or prevent the spread of the flu.

Another recent Lancet analysis found that Tamiflu can help prevent hospitalizations from the flu. But as Vox reporter Julia Belluz pointed out, this finding applies only to people who are at high risk of complications from the flu (for example due to an existing chronic illness); otherwise healthy people saw no reduction in the rate of hospitalizations.

The hyped stories about Holland’s death didn’t mention the weak evidence about the effectiveness of antivirals or address the potential harms, which according to Cochrane includes heightened risk of nausea, vomiting, psychiatric effects and stomach pain in adults and vomiting in children.

ABC’s coverage mentioned those risks, but implied that Franks’ decision not to take the drug was foolish and tragic in hindsight because the medication could have saved her. ABC didn’t cover the substantial evidence that supports Franks’ choice to forego treatment.

‘Seemingly healthy adults’ at risk

Along with overstating the case for antivirals, coverage has fixated on the notion that even healthy people are vulnerable.

The Journal’s piece, headlined “The Deadly Flu No One Saw Coming: Thousands of people have been treated at hospitals, including seemingly healthy adults, marking the worst season in a decade,” focused on Holland and one other 30-something mother who died of complications from the flu.

In both cases, the women reportedly died within a week of their initial symptoms. The Journal portrayed them as exemplifying thousands of people who “have been treated this season at hospitals for pneumonia and other complications, including seemingly healthy adults with no underlying medical problems.”

However, the story doesn’t offer data on how many “seemingly healthy adults” are actually dying of the flu.

Deaths of healthy people are rare

Similarly, the USA Today Network declared that “reports of otherwise healthy or young people dying from the infection are flying around,” without providing data.

A Washington Post story reported that “officials are seeing unusually high levels of hospitalizations in non-elderly adults, with the rates for 50-to-64-year-olds significantly higher than what they were at the same period in the severe 2014-2015 season with the same predominant flu strain.” Its coverage included an anecdote about a 58-year-old woman who died of the flu, but again, with no data to back up the idea that the flu is killing scores of people in their prime.

The Post story also mentioned Holland’s death, writing that “the cost of prescription antivirals has led some patients to hesitate using them, with tragic consequences.”

Cases of seemingly healthy people dying of the flu are really an anomaly, Malani said, and news organizations need to point that out along with the fact that patients who die often have an underlying risk factor that isn’t always evident, such as such as pregnancy, heart disease, or obesity.

The CDC has estimated the total number of U.S. flu deaths these season could be close to 56,000, and most of those are expected to be either the elderly or young children.

‘Over the top’ coverage

Harold DeMonaco, MS, a visiting scientist at the MIT Sloan School of Management and one of our expert reviewers, said via email that some of the coverage this flu season has been “a bit over the top.”

“I think that the message of getting a flu shot even now is being missed in most of the coverage,” he said. “The flu is not a benign infection so the stories of the unfortunate deaths are probably helping emphasize that point. The old adage ‘an ounce of prevention is worth a pound of cure’ comes to mind.”

That singular message about the importance of the flu vaccine is emphasized by the FDA.

Meanwhile, scary new reports appear to be contributing to record emergency room volumes at the University of Michigan Health System, Malani said.

“All these news stories about this person who was fine and hours later they died, they put people into a panic,” Malani said. “They need to be balanced with the actual numbers.”

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