TWiV 284 letters

Robin writes:

Test subjects

For vaccines for viruses like Ebola, one testing option is to use politicians, economists and bankers since they are sufficiently similar to humans.

At one time, German was becoming the leading language for all of science. There are so many German names in anatomy, histology, basic pathology. It was on track to becoming de rigueur globally for all graduate and higher science education – until der Führer derailed it.

Christophe writes:

Hi Vincent et al.

I was wondering if you had read this blog post by Mark Crislip.

http://www.sciencebasedmedicine.org/cochrane-reviews-the-food-babe-of-medicine/

I would love to hear you and the TWiV team discuss his post.

regards,

Christophe

Yegor writes:

Dear TWiVers,

Please forgive the delayed follow-up. After listening to your episode #282, I posted a short comment about the Tamiflu paper in my blog and one of the readers pointed me to the following two blog posts that discuss the same paper:

http://www.sciencebasedmedicine.org/new-evidence-same-conclusion-tamiflu-only-modestly-useful-for-influenza/

http://www.sciencebasedmedicine.org/cochrane-reviews-the-food-babe-of-medicine/

They are quite interesting and put a bit of a different light on this review for me. The first post is shorter and more to the point. Let me quote from the conclusions:

“What the news coverage and the authors seem to be ignoring is that Tamiflu is demonstrably and meaningfully effective at preventing the spread of the infection. At the same time, there’s some real world evidence (albeit with limitations) that suggests that oseltamivir may provide a slight survival advantage in the very ill. “

The seriously-ill and those at greater risk for flu complications have not been included in the analysis. What the analysis says is that the drug is of limited benefit to healthy people during the relatively mild seasons of flu. One can’t generalize from this data to the potential benefits of the drug in the case of a more serious pandemic or to all populations.

The second post is a bit more rambling, yet still very interesting. It can be summed up with the following quote: “Just because something is labelled as a systematic review does not mean it is any good. We have to be just as vigilant now as ever. Even a review with a Cochrane label does not make it true..”

The author then goes over this paper and some previous Cochrane reviews to show some substantial flaws in the ways they were done or interpreted.

Finally, both posts (on the same blog, but by different authors) point out that two of the authors of the Tamiflu paper have a history of downplaying the seriousness of flu, going as far as suggesting that vaccinations against flu should stop.

After reading these posts, things don’t seem so clear cut to me. Certainly more studies are needed on the benefit of Tamiflu for treating serious flu cases. And perhaps we should not stop stockpiling the drug right away.

Best regards,

Yegor

Senior Science Officer

Global HIV Vaccine Enterprise

New York, NY

Joseph writes:

Greetings Drs.,

I wanted to follow up on the Tamiflu/Cochrane review discussion from episode 282. I can’t say that the results of the meta-analyses surprised me, as I am pretty convinced that these types of drugs have only modest effects in treating influenza infections. For one, and maybe this is naivety on my part, I am always slightly skeptical that anti-viral (or other anti-insert your pathogen of choice here) drugs that need to be given early during infection will have a significant impact on disease progression. Actually, I find that too many publications investigating the effects of compounds/drugs on pathogen replication etc. either a) ignore timing or b) incompletely discuss the issue of timing. That is not to say that these aren’t really interesting, good, and important studies, just that timing can make a big difference!

One thing that I thought about during your discussion was that for individuals who were critically ill from influenza infection, could that small time decrease in alleviation of symptoms be helpful? In other words, how would ID doctors view this report/data? Over at Science-Based Medicine Dr. Mark Crislip takes a look, although it does seem that he is not a big fan of some of the authors of the paper anyhow. It’s definitely worth the read.

http://www.sciencebasedmedicine.org/cochrane-reviews-the-food-babe-of-medicine/

– Joe

Postdoctoral Fellow

Immunotope Inc

Ricardo writes:

Hello Twivome

Today a newspaper political opinion maker, which I don´t usually like, due to differences in political spectrum, made a wonderful text about vaccination. Hopefully our country has a pretty good rate of vaccination, but as always sometimes bad winds come to shore. As I said it was a very well written text (http://expresso.sapo.pt/nao-vacinar-os-filhos-uma-moda-que-poe-todos-em-perigo=f863708) with the obvious mal informed comments from some readers but the majority of them with congratulations.

In the middle of the text it was a reference of a recent political mesure made by Croatia about vaccination (http://www.iflscience.com/health-and-medicine/croatian-court-upholds-vaccine-mandate).

Maybe in the end knowledge will prevail.

My best regards,

Ricardo Magalhaes, Ph.D.

Associate Professor of Microbiology

Faculty of Health Sciences of Fernando Pessoa University

Portugal