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Monday, July 28, 2014
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Published: Saturday, 11/12/2005

A medical dilemma

PATIENTS and doctors are partners who make decisions jointly in health care's new era. Good riddance, indeed, to the old mindset that doctor-knows-best and should be an authority figure who rules from on high.

That turnaround is ruffling the medical establishment's feathers over Tamiflu, the only drug known effective in preventing and treating bird flu.

Despite doubts that avian influenza will explode into an epidemic this year - or any year - some patients want to keep Tamiflu on hand for themselves and their families. Businesses and other organizations also want "just-in-case" prescriptions to protect key employees.

Physicians are being deluged with requests for Tamiflu prescriptions. Demand just forced Roche, the big Swiss-based drug company, to temporarily stop shipping Tamiflu to pharmacies in the United States and Canada. Roche holds the Tamiflu patent, and is the world's sole manufacturer.

The American Academy of Pediatrics is urging physicians not to prescribe Tamiflu in advance for individuals or businesses. The American Medical Association also opposes "personal stockpiling."

Doctors can afford to take that stance. They would have instant access to the drug in an epidemic. Some reportedly have already socked away plenty of Tamiflu for themselves and their families.

Some consumers, on the other hand, fear they could be left twisting in the wind. Tamiflu must be taken right after symptoms appear. Getting it quickly may be difficult if an epidemic does occur. Both flu victims and healthy patients seeking Tamiflu may overwhelm doctors, and pharmacies could run out.

Viewed in that light, requests for just-in-case prescriptions seem quite reasonable. They may even represent sound disaster preparedness that could ease demands on physicians during an epidemic, and prevent illness and death.

Physicians who play the authority-figure card and refuse just-in-case prescriptions should watch their own tail feathers. Patients and families who were refused, and later suffer tragic losses in a bird flu epidemic, may head for court.

Roche's decision amounts to an acknowledgement that the firm is unable to make enough Tamiflu to meet global demand, despite past assurances. Roche already is considering requests from countries and drug companies that want to manufacture Tamiflu.

It has no choice now but to grant permission quickly so ample supplies of Tamiflu are available - just in case.



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