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Zanamivir, influenza, and meningococcal disease

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7231.378 (Published 05 February 2000) Cite this as: BMJ 2000;320:378

Rapid Response:

Epidemics of Influenza?

Editor

Isn't prescribing Zanamivir a bit like playing with fire? Sialic acid
plays a major part in inflammatory (1), rotaviral (2) and cancerous (3)
conditions in animals (4)(5) and humans; is there any risk of 'Zanamivir
influenza inhibition' turning into an epidemic of cancers, H pylori (6)
infections, melanomas (1) and inflammatory conditions plus increases in
animal and human rotaviral outbreaks whilst 'playing about with' sialic
acid activity?

In Traditional Chinese Medicine (TCM) one cannot treat a respiratory
tract condition without recognising the potential for moving that
condition to 'linked areas' which, according to TCM, are the skin, lungs
and large intestine particularly. Sialic acid appears to have an affinity
for conditions affecting epithelial cells (7).

I note that research using Zanamivir for one month in HEALTHY
volunteers (8) realised 75% ADRs in both treated and placebo controlled
(not sure what placebo was used!). I wonder what long term follow-up of
those participants for such conditions as cancers, melanomas, inflammatory
events etc. was planned.

In the UK it is appears that our Department of Health are incapable
of accurately advising the public about 'flu epidemics' - last year we saw
a major 'epidemic' of mycoplasma pneumoniae causing serious mortality and
morbidity problems nationwide, which was reported as 'influenza' by all
major national newspapers and the TV yet the Health Department failed to
correct this misinformation. This year we have seen another 'epidemic of
flu', again misreported by the Department of Health as such and duly
criticised by 'The Royal College of GPs', yet some 'virus' has been
active, perhaps a variety, one of which I was reliably informed as being a
'pertussis-like virus' by a local medical colleague.

Even assuming Zanamivir is 'safe' from any adverse developments
listed above (and one has ensured avoidance of use by those who are
allergic to eggs - much cheap sialic acid is produced (9) by purification
from hens' eggs), with such apparent ineptness and inaccuracy of reporting
on 'flu' existence, how does one ensure that 'influenza treatments' are
only provided for those correctly diagnosed? How does one diagnose then
treat appropriately (in an evidence-based manner) with Zanamivir when it
must be prescribed before test results can be obtained?

Regards

John H.

No competing interests other than a desire for safety, efficacy and
accuracy of an 'evidence-base' for modern medicine.

Refs.

1. Ros-Bullon MR et al; Anticancer Res 1999 Jul-Aug:19(4C):3619-22

2. Kuhlenschmidt TB et al, Adv Exp Med Biol 1999;473:309-17

3.
http://water-cooler.com/WC/patentviewer/patent-4342567.html
(Kloppel et
al, 1977, Proc Natl Acad Sci 74, 3011-3013 "reported 2 5-fold increases in
serum sialic acid glycolipids in mice bearing transplantable mammary
carcinomas and 2-fold increases in human carcinoma patients")

4. Mendez E et al, Virology 1999 Oct 25;263(2):450-9

5. Mendez E, Arias CF, Lopez S, J Virol 1996 Feb;70(2):1218-22

6. http://www.uni-kiel.de:8080/Biochemie/kelm/pathogen/ examples.html

7. Krempl C et al, J Gen Virol 2000 Feb;81(Pt2):489-496

8. Arnold S et al, JAMA Vol 282 No. 1 July 7, 1999 "Zanamivir in the
Prevention of Influenza Among Healthy Adults"

9. http://www.tcp-ip.or.jp/~aiie-k-n/taiyo-43.htm

Competing interests: No competing interests

12 February 2000
John P Heptonstall
Director of Morley Acupuncture Clinic and Complementary Therapy Centre
West Yorkshire