Friday, 1 May 2009

A little swine flu silliness for your Friday

19 comments:

Anna said...

I'm so glad someone wrote about swine flu so I can have a rant about it. Normal flu kills tens of thousands of people every year - because they're unwell, elderly, or don't have access to adequate health care (ie a big chunk of Mexico). Are we panicking about the threat caused by this particular flavour of flu, or the novelty of it? Is the swine flu more dangerous than any other kind to those of us in affluent bits of the world?

Or am I just being pig-headed? Get it? Eh?

Whoever manufactures Tamiflu will have the last laugh...

Giovanni said...

Of for crying out loud - no more "it's a media/pharma/vegan conspiracy" nonsense, please. The WHO is concerned and they're not in the business of being concerned for no reason. H1N1 might yet kill fewer people than the seasonal flu, but has the potential to kill a lot more, hence the state of alert of health organisations worldwide. We've got to learn to deal actual risk as grown-ups - as somebody put it, can't quite remember whom, it's not a time to worry, but it's a time to be prepared.

Giovanni said...

Oh, and loved the cartoon. Anything that suggests killing off a Winnie the Pooh character goes down well with me.

Anna said...

I'm not suggesting that swine flu isn't serious - I'm suggesting that normal flu is serious and kills people all the time, but no one gives a shit because they're generally poor people on the other side of the world. Dysentery also kills hundreds of thousands, and I don't see mass panic about that either.

We're affluent enough to have the choice of which flu we die from. And we misuse Tamiflu as a preventative measure because we can access it readily, causing the virus to mutate. Rad.

Giovanni said...

Mmhhh... actually, the ordinary flu kills plenty of people in the first world as well, and a pandemic would still hit poorer countries the hardest. Check out the statistics for Spanish flu in Western Samoa and amongst the Maori population of New Zealand (as linked to by Russell earlier this week). So, to the extent that it's a class issue (as health in general certainly is), it's not going to cease to be a class issue just because some affluent people are going to be hit as well.

That said, of course, dissentery, the measles and malaria still kill a horrendous number of people every year. And there are many worse ways to spend one's money than buying a net.

Anna said...

Yes, the flu kills first world folks, but it's more likely to be those whose health is compromised for other reasons (not that this is a good thing), who at least had a chance of survival because they had access to good healthcare, and who have a hope of dying in some level of dignity or comfort. People's indifference to class discrepancies in health in their own countries doesn't make international health discrepancies any more palatable.

There's every reason to be concerned about swine flu, but the world would be a happier place if we also cared about shite that doesn't affect us directly.

Why can't we all just light candles and hold hands around the world? I guess because it would be difficult to hold the candles.

Anonymous said...

And we misuse Tamiflu as a preventative measure because we can access it readily, causing the virus to mutate. Rad.I take it then you're against giving Tamiflu to poor countries, because that would make the virus mutate even more?

Julie said...

What would all those lit candles do for global warming Anna!! ;-)

Anna said...

Not at all, Anon - why would anyone support that? I think it should be prescription-only so people are less likely to misuse it in a panic.

Anna said...

My candle idea would at least give global warming a cheery glow. Add some aromatherapy, and environmental cataclysm could be downright relaxing.

Giovanni said...

It's only OTC in flu season and the pharmacist doesn't dispense it willy nilly, actually. In most other countries it's prescription only.

Anna said...

Pharmacists differ in how stringently they advise. I know this because I've seen Target. Twice.

I think the possibility of mutant flu strains is a very good reason to be cautious with medication - no point panicking about the flu itself then treating it in an irrational way which increases the severity of the pandemic...

That's the guideline for antibiotics, after all.

Anonymous said...

I'm confused Anna, because you're saying on the one hand the medication is overused (causing mutations) but on the other hand it's underused (people in the third world not getting any). This seems contradictory.

If more people take tamiflu, the virus will be exposed to tamiflu more often, thus leading to more mutations.

Anonymous said...

Pharmacists differ in how stringently they adviseIf only those professionals would get out of the way and leave decisions on when to treat up to anonymous internet bloggers... the real experts.

katy said...

When I lived in Japan there were several awful cases of teenagers being killed after taking Tamiflu. They would be so out of it that they would jump out of windows or stand on a motorway. Roche argued that it was a result of the flu symptoms... The following is from 2007 but I don't think anything has changed since then. So while I can see that Tamiflu might be quite handy in this situation, I wouldn't want to be dependent on it.

"According to Japan’s health ministry, most of the 54 Japanese who died after taking Tamiflu by October last year [2006], succumbed to liver or other organ failure, most likely caused by influenza. But 16 of them were children aged 16 or under, several of whom had exhibited “abnormal” behaviour."

http://www.timesonline.co.uk/tol/news/world/asia/article1549260.ece

Anna said...

Anon the second, that's pretty dumb. Pharmacists are businesspeople, and if they all subscribed to the same ethical standards, there'd be no problem with people sourcing methamphetamine ingredients, would there?

And I note you take a swipe at people posting anonymously, which you're doing and most others on this thread aren't. Sharp.

Maybe you should take a chill pill? They're available from your local pharmacy.

Anon the other - I'm not saying Tamiflu is overused or underused. I'm saying that it can be incorrectly used, just like antibiotics. When people don't take the whole course (often because they believe they're better), the virus can mutate. The Pharmaceutical Society of NZ explain it thus: http://www.stuff.co.nz/taranaki-daily-news/news/2377023/Call-to-use-Tamiflu-responsibly

Anonymous said...

Anna, your understanding of the pharmacist's release seems to differ from mine. Here's the key phrase for me.

'If used irresponsibly too many strains of influenza can become resistant to the anti-viral in the future'

You seem to have read from this that taking a full course of tamiflu will prevent the virus from mutating from exposure to antibiotics, and that mutation is only a danger if the antibiotics are used incorrectly. I don't think this is what the article is saying.

It's a pretty well established fact among biochemists that any exposure to vaccines or antibiotics will give the virus opportunities to mutate - this is called the 'reverse vaccination effect', since it's effectively the virus taking advantage of the same phenomenon that makes vaccination work. It occurs whenever an antibiotic is taken.

In fact, if people without the virus take tamiflu, there is no chance of the virus mutating, since the virus isn't in their systems and thus isn't exposed to the antibiotics!

The dichotomy here is not between incorrect use and mutation vs correct use and no mutation. It's incorrect use with mutation and no benefit to be had, and correct use, which also brings mutation but has the benefit of potentially saving somebody's life, which makes the mutation an acceptable risk.

But I guarantee that if tamiflu was given for free to all sufferers, particularly in the third world, the virus would mutate much faster. This is in my opinion an acceptable price to pay (and indeed the only alternative is to not treat at all). So when I see people complaining about virus mutation, I get concerned.

Anna said...

Thanks Anon - that's very interesting. My concern is not so much whether people get it free or not (I'd cheerfully give it free to everyone who needs it, third or first world!), or the fact that correct use of the drug also causes mutation. The alternative to treating is pretty horrific (although I have heard people argue against vaccinations on the grounds that, in time, the species will develop immunities - it'll just mean a big bunch of babies will die in the meantime).

The idea of people faking symptoms to get the drug doesn't bother me much, because as you say, there's no virus to mutate. It would bother me if people faked symptoms to get the drug, which they then onsold. You'd hope it wouldn't happen, but Tamiflu did run out during the bird flu panic, which caused further alarm.

I'm more worried about people taking incomplete courses of the drug, as is common with antibiotics - it's my understanding (and it might be wrong) that this causes quicker mutation than would be expected if the flu wasn't treated, or was treated comprehensively across the population? It's quite common for people to be 'stoical' about drugs and stop taking them the moment they feel they can do without them. This happens despite antibiotics being prescription only and coming with clear instructions, which I guess goes to show that a doctor's visit doesn't guarantee correct use of meds.

I think there's a lot to be said for quarantining - it seemed to be effective in quelling the Wellington spewy bug (not the scientific name) which brought the capital and other bits of the country to a halt a few years ago. (An example of how a less severe bug can cause a lot of trouble, by affecting emergency services staff, etc.) Unfortunately, people feel a lot of pressure to go to work when they're sick, and the population is generally more mobile than it was one or two generations ago.

Very interested to hear more of your thoughts, Anon, if you're about...

PS A friend of mine is doing pharmacological (sp?) research work in Jordan - apparently antibiotics have all but ceased to work there. Not sure whether this is because of overuse, misuse, or a combination.

Anonymous said...

I'm more worried about people taking incomplete courses of the drug, as is common with antibiotics - it's my understanding (and it might be wrong) that this causes quicker mutation than would be expected if the flu wasn't treated, or was treated comprehensively across the population?I'm pretty sure this is wrong. If anything I would think an incomplete course is -less- likely to cause mutation, since less of the drug is administered.

I suspect the problem in Jordan isn't just viral mutation - such a mutation is unlikely to be limited to such a geographical area. Maybe it's generally poor health/housing in the populace? An antibiotic won't work if somebody's immune system is compromised. It's a scary concept though, because for many illnesses antibiotics are basically the only treatment.