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Editor's Choice

H1N1: now entering the recrimination phase

BMJ 2010; 340 doi: (Published 14 January 2010) Cite this as: BMJ 2010;340:c225
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

    If influenza was a rock band how would it rate its latest release, H1N1? Not too well, I suspect, despite the greatest prepublicity since—well, its previous release. And it all started so promisingly, in Mexico, whose population had been decimated by the very first outbreak of Spanish flu (and smallpox and measles), courtesy of Cortés and his conquistadores.

    The new lineup—two parts pig, one part human, and one part bird (The Chimerical Brothers?)—looked brilliant on paper. Once the international tour began, all eyes were on the southern hemisphere for pointers as to how things might play out in the northern hemisphere winter. So what happened next?

    For England, many more misses than hits. Since last August, the consultation rates for flu-like illness have hardly budged above the baseline threshold (doi:10.1136/bmj.c170). They’re now less than half that rate and falling. Even the most generous assessment couldn’t attribute this happy state of affairs to either the use of oseltamivir (Tamiflu) or vaccination against swine flu. Both interventions are now uncomfortably under the spotlight.

    This week we publish the latest in a series of letters looking at the downsides of distant diagnosis by algorithm. Catherine Houlihan and colleagues from Newcastle upon Tyne reviewed eight cases of potentially life threatening conditions where diagnosis and management were delayed because of an initial incorrect diagnosis of swine flu (doi:10.1136/bmj.c137). Last August we published a similar series from Middlesbrough (BMJ 2009;339:b3365, doi:10.1136/bmj.b3365). Once this pandemic is over, it would be interesting to tot up the national total of clinically significant diagnoses that were initially missed because of the too ready diagnosis of swine flu. Meanwhile, European governments, including the UK’s, are trying to offload their surplus stocks of swine flu vaccine as vaccination programmes are canned.

    The search for scapegoats has already begun. The chairman of the health subcommittee of the Council of Europe’s parliamentary assembly has called for an investigation into the role of pharmaceutical companies in the current pandemic (doi:10.1136/bmj.c198). His charge: “To protect their patented drugs and vaccines against flu, pharmaceutical companies have influenced scientists and official agencies, responsible for public health standards to alarm governments.” Meanwhile, the revelation of undeclared competing interests of Professor Juhani Eskola, an adviser to WHO’s Strategic Advisory Group of Experts (SAGE), has come as a gift to conspiracy theorists. SAGE advises member states on vaccines; GlaxoSmithKline, manufacturer of Pandemrix, is the main source of income of Professor Eskola’s employer (doi:10.1136/bmj.c201).

    Recriminations of a different kind in Liverpool. In “The Price of Silence,” Jonathan Gornall’s article on the Liverpool Women’s NHS Foundation Trust, he claimed that 12 compromise agreements entered into by doctors there contained gagging clauses (BMJ 2009;339:b3202). The trust’s chairman replied that such agreements affected only two doctors (doi:10.1136/bmj.c144).

    But Andrew Bousfield, whose father had been banned by the trust from going public with concerns about management and patient safety, had specifically asked for information relating to doctors, and under direction from the Information Commissioner the trust provided him with 12 redacted copies of compromise agreements (doi:10.1136/bmj.c145). So who’s right? We need an adjudicator to check the unredacted forms.


    Cite this as: BMJ 2010;340:c225