WEEKEND COLUMNISTS Have you had swine flu? If you read the newspapers and watch TV, especially in the UK, you would think that all 60 million of us were either infected or about to be. To the best of my knowledge I have not had swine flu (although I did have a nasty cough for a couple of weeks not long ago). Neither have the cost centres. Or have they? I suspect we may never know. Although there have been some deaths among those who have caught H1N1, as it is more properly known, in the UK they have mostly been people who had other things wrong with them already. Most of those who catch it seem to be (a) young and (b) suffer very few symptoms and get better very quickly. Should we really all be so very worried? And should we all be swallowing Tamiflu?
I suspect not. This is because, while antivirals have been shown to shorten the duration of the illness, to benefit from them you have to be taking the medication within 48 hours of getting sick. By the time most parents have worked out that their children might have swine flu and got them to a doctor, let alone sent a throat swab off to the lab and had the results, the crucial period has passed.
So the government has bought up the nation’s entire stock of the antiviral Tamiflu and made it available via the internet and a telephone hotline. As a result, legions of people are taking Tamiflu in the UK. Can this be a good thing? Not only are we developing a resistance to the drug just before winter arrives and with it a probably much greater outbreak, it also makes a lot of people who take it feel wretched. As the manufacturers say on the product website: “The most common side effects of Tamiflu are mild to moderate nausea and vomiting.”
My medical girlfriend has a private general practice in Oxford, a city with lots of young people, and so she has been super-busy of late. She has had to make lots of house calls as people are naturally wary of venturing forth with children whom they suspect should be in isolation. I have pointed out to her that she should be jolly grateful to whoever brought H1N1 to the UK – it has meant that she has been out to visit far more people than she would normally get to, and every household she visits is another potential advocate for her service. Having spent many years in Australia and London before that, she has had to start her business from scratch. What better than a swine flu pandemic to persuade consumers to sample her services?
Of course, until the government hotline/website opened, MG was rather handicapped by the NHS monopoly on supplies of Tamiflu. Even when she thought that the patients would benefit, she could not prescribe it. As a private GP, if she diagnosed a case of H1N1 after NHS surgery hours, she had to call out the (overworked) out-of-hours NHS service if the patient needed Tamiflu. I can understand the government wanting to make it available to all, and to prevent a black market in the drug, but surely it should be possible to license some private GPs?
MG is a very longstanding friend who assisted at the birth of CC#2. (CCs 1 & 2, born as they were of a mother obsessed with the capital markets and a father obsessed with cricket, were appropriately brought into the world by the late Peter Saunders, obstetrician, wicketkeeper and brother of the only person I have ever heard of who recovered from Alzheimer’s.) The only thing she has ever prescribed for me is a new bread knife, about 10 years ago. It is true that I am not good at selecting kitchen implements and had never given my bread knife a thought until MG outlined to me in some detail why a good one is essential. Precautionary doses of Tamiflu or a decent bread knife? I know which one I reckon brings the greater benefit. Thank you, doctor.
