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What did we learn from Tamiflu?

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m626 (Published 19 February 2020) Cite this as: BMJ 2020;368:m626

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Re: What did we learn from Tamiflu?

Dear Editor

Excellent article! Pharmaceutical agents may be of considerable value, and robust research is always needed. Much modern pharmacology is derived from origins in herbalism - it is thought that in 1945 over 75% of a GP's prescriptions were herbal.

So is there anything to learn around alternatives to Tamiflu in the treatment of influenza, as well as the standard advice of supportive approaches of hot fluids, keeping warm, additional vitamin C to support the immune system (humans, as opposed to other mammals, do not make their own) and nourishing food?

A 2015 study head to head of Echinacea, a well known herbal immune stimulant, against oseltamivir in the treatment of influenza showed that Echinacea in the form of a proprietary preparation was as effective as Oseltamivir, with similar rates of recovery. This was seen in those diagnosed clinically during peaks of influenza infection, and also in those with infections confirmed virologically. The Echinacea outperformed the oseltamivir in terms of complications and safety. Echinacea is of course an over the counter medicine, not a prescription one, so could be available at the earliest onset of symptoms, as an important factor in the treatment of influenza.[1]

The advice to use echinacea is not widely known in medical circles. It is not known why this is so, when echinacea is an effective and inexpensive over-the-counter resource. The herbal medicine industry do not have the same marketing abilities or resources as a major pharmaceutical company, nor is echinacea patented, thus is less profitable. Medical students learn nothing about echinacea in pharmacology or therapeutics, so there may be an unconscious system bias against such approaches, even if valuable and cost effective.

Wise use of resources and helping people to self-care may become drivers to embrace such evidence based approaches.

1 Raus K, School R, Pleschka S. Klein P, Fisher P. Echinaforce [proprietary name] versus Oselatmivir in influenza: a randomised, double-blind, double-dummy, multicenter, non-inferiority clinical trial, Current Therapeutic Research 2015 https://www.ncbi.nlm.nih.gov/pubmed/26265958

Competing interests: No competing interests

28 February 2020
Andrew Tresidder
GP Patient Safety Lead, GP Educator
Somerset, UK