Sorry list, two postings in the same day is too much I know. Do these help, Martin?

We’ve trawled the literature for oseltamivir to produce the best patient decision aids we can. You can access them via the link from our home page here http://www.npc.co.uk/

…..or directly on our NPCi e-Learning site here http://www.npci.org.uk/therapeutics/infect/commonintro/patient_decision_aids/patient_decision_aid1.php

It’s not great data but the best we can find. If you can find better please tell us, but the UK national committee haven’t.

In terms of decision making, values matter. National or regional public health values (driven by onerous responsibilities to see the health system optimally prepared, no avoidable catastrophes, disruption to essential services avoided / minimised, and an excess of flu related deaths at least as low as other developed countries) would indicate wide use of oseltamivir as being entirely reasonable despite the data being limited, at least in some patient groups. The trade off is the remoter risk of future resistance and the cost - but the swine flu is now and the resistance is a future possibility. Cf clopidogrel in ACS, any antibiotic prescribing for RTIs and many more examples.

Individuals (patients and clinicians) might make different choices based on their perspective and values, none of which are likely to be exactly the same as each others. And we might all make a different choice when we actually have the flu, or someone we know has had flu-related pneumonia or worse, as opposed to dispassionate discussions when we don't.

Australian hospital docs on a recent UK documentary were apparently also all for taking an antiviral too, based on the unavoidable problem that looms large in their values. They were most worried because no one can say at presentation whether an individual will be one of the many who will have a mild uncomplicated illness or be one of the few who gets very very very sick. We seem to be hard wired as humans to be prepared to treat lots unnecessarily to reduce the risk of an error of omission. That's one of our ways of dealing with stochastic uncertainty.

Both the population and the individual perspectives (and nota bene the plural) seem to me to be entirely legitimate.

Bw

Neal

Neal Maskrey, National Prescribing Centre, Liverpool UK

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From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Brian Alper MD
Sent: 21 September 2009 14:06
To: [log in to unmask]
Subject: Re: Do the antivirals reduce mortality in flu?

It depends on what outcome you are promoting the antivirals for:

If for mortality – there is observational evidence for seasonal influenza for hospitalized adults

If for duration of illness – there are randomized trials (seasonal influenza)

If for other complications – there some randomized trials (seasonal influenza)

If for reducing transmission to others – I’m not sure of evidence for “treatment” but there is evidence for prophylaxis

Brian S. Alper, MD, MSPH

Editor-in-Chief, DynaMed (www.ebscohost.com/dynamed)

-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Martin Dawes, Dr.
Sent: Monday, September 21, 2009 8:59 AM
To: [log in to unmask]
Subject: Do the antivirals reduce mortality in flu?

Sorry

Naïve question but I could not find any RCT's - am I missing something here or are we promoting unproven therapy?

Thanks

Martin

(neuraminidase and influenza and mortality) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))