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NEWS: Richard Smith Social measures may control pandemic flu better than drugs and vaccines BMJ 2007; 334: 1341-a [Full text]

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Medical Scare System

BM Hegde   (2 July 2007)

Medical Scare System 2 July 2007
BM Hegde, Retd. Vice Chancellor Mangalore-575004 Send response to journal: Re: Medical Scare System	Dear Sir, The history of influenza pandemics in the past could help us today with reference to Tony's excellent editorial and Richard's report. In the last 400 years there were 12 pandemics, roughly three per Century. We had three in the last Century, Spanish 'flu of 1918 where there were a total of 640 million clinical attacks, 50% of the then population of 1.2 billion with 12.5% case fatality ratio with 80 million dead. The virus was H1N1 type. Next was the Asian 'Flu of 1957 with H2N2 type. The last was the Hong Kong 'Flu of 1968 due to H5N2 variety. If that trend had persisted in 2006, we should have expected total deaths of 2-3 billion (case fatality multiplied by clinical attack rate compounded by the population) what with the population now at 6.6 billion. The worst scenario would have been that all our hospitals, put together, would not have been able to cater to even 10% of patients, if the predictions went right. We have been predicting the unpredictable future, anyway. The unique feature of the recent Bird ‘Flu threat was the bounty that the drug companies took home, thanks to the medical scare system that we have adopted. As Richard rightly pointed out from the Bacelona meeting talk, preventive social measures would have had better effect. I had personal experience of the 1968 pandemic when I was a Registrar in a London sub urban hospital on duty during the Xmas week end. Old elderly with cardiopulmonary infirmities used to get admitted only to die within hours. I have seen a few young able bodied people die, cause of death was not clear- possible viral myocarditis. Oseltamivir is a new antiviral drug that might have an effect on this H5N1 virus. Two tablets a day for five days was the recommended dose but some people believed that it might have to be given for ten days. The cost then was $25 for ten tablets. As a prophylactic it had to be once a week for the duration of the epidemic. We did not know anything about its side effects. Another drug that might have been useful in the event of Tamiflu being unavailable was Zanamivir. The sad part of the story was that 90% of those drugs were bought and stocked by the G8 countries. The rest of the world had to make do with the remaining 10%. Really Mathew Law was working there: "He who hath shall be given." This is the level playing ground in globalization that our political masters are trying to push down our throats! Vaccine against the disease was ready but already doubts were cast on its validity as the virus seems to have mutated a bit even before the epidemic ever started. This is an egg embryo vaccine and takes up to six weeks to prepare and can not be prepared on mass scale. It is only 70% effective, anyway, even when it is good. A total of 300 million does were expected in 2006 with the G8 countries having placed orders for 90% of the stocks. Even those countries had to ration the vaccine only for the very young, old elderly, people above 50 years, the infirm and the health workers. There was, however, a possibility of doubling the capacity by mixing an adjuvant that might stimulate the immune system along with half dose of the vaccine! I must thank Mike Davis for his book "The Monster at our Door" for many of the details above. Thank God, the threat remained only on paper. The drugs stocked must be in the godown. The drug companies must have had the last laugh! Not disease mongering, I suppose. Yours ever, bmhegde Competing interests: None declared