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Comment by GiraffeNecktie | Hacker News Reader

A more nuanced view is available on the Effect Measure blog (http://scienceblogs.com/effectmeasure/2009/12/the_tamiflu_do...).

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That's a useful perspective, but I often get the sense from 'revere' (at Effect Measure) that he's shading his analysis to promote "the message" he thinks the public needs to hear.

For example, in the link you provided he impugns the motives of the publishers of this latest analysis, and says about the their acceptance of the paper: "I don't think it served the public purpose or the public health."

A couple places, he emphasizes "during a pandemic, no less" or "here we are in the middle of a pandemic" as factors that should weigh against raising doubts about Tamiflu's effectiveness at this time.

That kind of political calculation applied to scientific or medical results creeps me out -- and often backfires on the officials who try it.

His blog is completely focused on public health so it seems reasonable that he frames his response in those terms (i.e. what serves the public purpose and public health). He made several points about the study: that it didn't say anything that wasn't known (i.e. Tamiflu is of limited value); their methodology was murky; and the way it was handled by the BMJ contributed to sensationalizing the story in a way that might make Tamiflu not used in situations where it would have some value. Seems like a valid point to say that there's an impact on public health.

Yet, it is a pandemic. That fact does change the calculus of whether to recommend treatment. Do you say, "I don't have enough evidence yet to recommend it?" Or do you say, "Based on the evidence we have, it is a good idea?" There is no right answer until post-pandemic studies.

No it is not a pandemic:

# epidemic over a wide geographical area; "a pandemic outbreak of malaria"

# an epidemic that is geographically widespread; occurring throughout a region or even throughout the world

# existing everywhere; "pandemic fear of nuclear war"

wordnetweb.princeton.edu/perl/webwn

the first hit searching define"pandemic on Google

Um, your first two definitions describe H1N1, the third is irrelevant. Besides, it's a settled question if the WHO calls it a pandemic. http://www.who.int/csr/disease/swineflu/en/

'Pandemic' just means a new strain reaches the same widespread distribution as old strains. No one doubts that the new strain has done that.

The troubling subtext I saw in revere's comments is the suggestion that we're in some sort of unique crisis where it's irresponsible to give prominent coverage to substantive doubts about Tamiflu. We're not in such a crisis, and even in a real crisis, we need to retain our skeptical faculties.

Tamiflu is a relatively new drug (not many decades old) with known and potentially-unknown side-effects.

It's being used being to treat a disease for which, whether new-strain or old-strain, 99.9%+ of all sufferers recover completely. (Recent CDC estimates are that 1-in-6 Americans has already had H1N1/09, with up to 10K deaths. That's a 99.98% survival rate.)

And, the strongest case for Tamiflu's effectiveness seems to be that if given promptly at the right early stage of infection, it might make symptoms a bit less severe or duration a little shorter.

People with a high risk of complications may still find the costs and side-effects worth it, but for everyone else, it's important to know and emphasize how tentative and limited the evidence is for Tamiflu's effectiveness.

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