Neuraminidase inhibitors—the story behind the Cochrane review

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5164 (Published 8 December 2009)
Cite this as: BMJ 2009;339:b5164

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  1. Peter Doshi, doctoral student
  1. 1Program in History, Anthropology, Science, Technology and Society, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
  1. pnd{at}mit.edu

    Although billions have been spent on oseltamivir in the face of pandemic influenza, the team updating the Cochrane review of neuraminidase inhibitors in healthy adults found that the public evidence base for this global public health drug was fragmented and inconsistent. Peter Doshi tells the story

    Since August 2009, our Cochrane review team has tried to obtain the data needed to verify claims that oseltamivir (Tamiflu) lowers serious complications of influenza such as pneumonia. We failed, but in failing discovered that the public evidence base for this global public health drug is fragmented, inconsistent, and contradictory. We are no longer sure that oseltamivir offers a therapeutic and public health policy advantage over cheap, over the counter drugs such as aspirin. If the public is to trust in public health policies, the scientific basis informing knowledge of the harms and effects of those interventions must be public and open to independent analysis.

    How a Cochrane review update turned controversial

    Systematic reviews are designed to synthesise the most reliable evidence on the effects of interventions. Following the outbreak of influenza A/H1N1 in April 2009, the UK NHS National Institute of Health Research commissioned an update of the Cochrane systematic review of neuraminidase inhibitors in healthy adults. In retrospect, our review began on a naive note. Although the review had last been updated in 2008, our new task was to include a safety assessment component. Tom Jefferson, who led the review, wrote to the group then just being formed, “Dear Friends…although it is always dangerous to pre-judge the issue, I expect no new effectiveness data but a lot of pharmacovigilance data.” Two days later, a paediatrician from Japan, Keiji Hayashi, submitted a comment to the Cochrane Collaboration that would ultimately leave us doubtful about the ability of systematic reviews to deal with the challenges of contemporary pharmaceutical evaluation1 (see …

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