Talk:Oseltamivir/Archive 3

Archive 1

Archive 2

Archive 3

Disagreement in the literature

The conclusions of all are fairly similar for prevention and treatment in those who are otherwise healthy. The CDC does not recommend oseltamivir for prevention generally. And does not explicitly recommend treatment in those who are otherwise healthy without complications.

Disagreement is primarily within those at high risk. Doc James (talk · contribs · email) 02:03, 9 December 2014 (UTC)

• Sorry but I don't agree, and on a few levels.
• Staying first with just the CDC...
  • With regard to treatment of otherwise healthy, the CDC's top bullet is "Clinical trials and observational data show that early antiviral treatment can shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, and respiratory failure)." Later, it says "Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.† One randomized clinical trial in children with uncomplicated influenza demonstrated a modest reduction in duration of symptoms and virus shedding in patients initiating treatment after 48 hours; post hoc analysis suggested that treatment initiated 72 hours after illness onset reduced symptoms by one day compared with placebo (Fry, 2014)." and † = "Recommended antiviral medications (neuraminidase inhibitors) are licensed by the FDA for treatment of children aged 14 days and older (oral oseltamivir) and for those aged 7 years and older (inhaled zanamivir). Oseltamivir was used for treatment of 2009 pandemic influenza A (H1N1) virus infection in children aged younger than 1 year under an Emergency Use Authorization, which expired on June 23, 2010. Limited information regarding use of oral oseltamivir for children from birth through age 1 year is available; however, the use of oseltamivir for treatment is recommended by the CDC and the American Academy of Pediatrics for children of any age".
  • That is very different from "benefits in those who are otherwise healthy do not outweigh its risks." which is what EBM section starts with. Direct contradiction. It is true that the rest of the paragraph is more in tune with CDC. But what you lead with, is not

• • with regard to prevention they are indeed closer.., CDC makes a recommendation: "Use of antiviral chemoprophylaxis to control outbreaks among high risk persons in institutional settings is recommended." (which you described as "can be considered" - I fixed that and will assume that was an accident - you did this remarkably fast!) Earlier on in the more general section, it says: "Antiviral medications are approximately 70% to 90% effective in preventing influenza and are useful adjuncts to influenza vaccination" warns against doing it widely in healthy folks (and of course emphasizes vaccinations) and later specifies certain populations where it "can be considered" (not a recommendation, but not warning away either"
  • That is different from the EBM section which says "low to moderate evidence that it decreases the risk of getting symptomatic influenza by 1% to 12%".

• Going back to a higher level, it is unclear why you left the consensus represented by just CDC, and don't mention ECDC, IDSA, NICE... but you cite lots of different reviews in the EBM. Why the difference? Objections if I bring in the rest of institutional consensus? Thanks. Jytdog (talk) 02:41, 9 December 2014 (UTC)

IDSA says they support the position of the CDC. We could change CDC to "they". I am just looking at NICE. Doc James (talk · contribs · email) 02:57, 9 December 2014 (UTC)

WRT "That is different from the EBM section which says "low to moderate evidence that it decreases the risk of getting symptomatic influenza by 1% to 12%" No it isn't. One is an absolute risk reduction. The other is a relative risk reduction. Doc James (talk · contribs · email) 03:06, 9 December 2014 (UTC)

why did you pick just CDC and do you object if i introduce the rest? Jytdog (talk) 03:27, 9 December 2014 (UTC)

No I just have not gone through all of them yet. Doc James (talk · contribs · email) 21:44, 9 December 2014 (UTC)

Removed

Not sure why this was removed "as are criticisms of the recommendations." Happy to see it returned if others also feel it is important. Doc James (talk · contribs · email) 23:38, 9 December 2014 (UTC)

agreed. the edit note from the IP editor who bombed by just said "implied". i restored it. Jytdog (talk) 23:42, 9 December 2014 (UTC)

Garbled Text

"The United States and European Centers for Disease Control (CDC), Public Health England, Infectious Disease Society of America, and the American Academy of Pediatrics, and Roche (the originator) reject these conclusions, arguing in part that the analysis inappropriately forms conclusions about outcomes in people who are seriously ill based on results obtained primarily in healthy populations, and that the analysis inappropriately included results from people not infected with influenza.[22][5][6][7][23][24] The EMA did not change its labelling of the drug in response to the Cochrane study.[25]"

This was put in the text in a way that it refers to the meta analysis of meta analyses, but the objections were voiced not this this study but to the Tom Jefferson meta analysis. Simulataneously, the conclusions of the meta analysis of meta analyses were misstated, so now after fixing the conclusions of this study this section does not make any sense. Can someone fix it? I don't see where the Jeffererson ref went. Formerly 98 (talk) 02:48, 9 December 2014 (UTC)

Sure added it before the disagreements with it. Doc James (talk · contribs · email) 03:04, 9 December 2014 (UTC)

doc James edit was has a lot going on, and I am still thinking it through. The surface thing, is that it minimizes direct conflict b/n institutional consensus and Cochrane 2014 (with its very strong and somewhat ranting "Implications for practice" section: "On the basis of the findings of this review, clinicians and healthcare policy-makers should urgently revise current recommendations for use of the neuraminidase inhibitors (NIs) for individuals with influenza....First, our findings imply that numerous national and international bodies appear willing to accept biased or incomplete trial reports seemingly at face value. This ready willingness is in contrast with the considerable time and effort needed to change their recommendations.... ") On another level, Cochrane 2014 is just about healthy people, so it doesn't directly read on the main recommendation about at-risk... again, sophisticated way to organize....

another thing going is that the content minimizes the medical consensus to 1 representative organization (CDC - not a bad one to pick for flu, but it is just one)

and it puts the rebuttals by all the medical organizations only where their recommendation is strongest.... and doesn't have the rebuttal directly go against Cochrane where Cochrane does appear. Avoiding the direct contradiction can be elegant elision ("let's not go there') or a sweeping under the rug...

Some of this is just plain structural difficulties... where do you put the rebuttal when there is this three-part structure?

lots going on. it is interesting. Like I said I am thinking about it. Jytdog (talk) 03:26, 9 December 2014 (UTC)

So Cochrane states that oseltamivir prevents flu you want to use the CDC to refute that? Doc James (talk · contribs · email) 04:03, 9 December 2014 (UTC)

my growing sense is that the Cochrane review got big media splash, and thus a necessary response from the establishment, because of the way that Jefferson came out swinging in the Implications section and in interviews etc. with things like "urgent need to change guidelines." This is where Crislip really went off on him - the basic work was generally good, but some of the conclusions were off, and the recommendations got really ax grindy and out of line with the findings. The more I look at this the more the 2014 Cochrane study (and Jefferson's overall arc) looks like the Seralini affair as I mentioned above. Don't know if you know what I am talking about. But Gilles Seralini is a french scientist/antiGMO activist. He did a pretty ambitious study - a 2 year feeding study of GM corn and glyphosate in rats - that got some interesting data but was underpowered. he nonetheless made a huge splash of a press conference (and demanded that reporters sign a CDA before receiving a preprint), released a movie and a book, and showed big gory pictures of rat tumors. and mostly because of his dramatically overreaching conclusions and the way he scared the hell out of the public, the establishment came down on him like a ton of bricks. (and he had done similar things on a smaller scale, including suing the agbiotech companies for their research data and making a big deal out of that) that is the issue here. the text i added makes it clear that the reaction of the establishment is about the recommendations more than the statements that are close to the data, which are ~generally~ more reasonable. how do you think we should handle? Shall we just ignore the over-the-top Implications section and elegantly duck the problem? Jytdog (talk) 04:34, 9 December 2014 (UTC)

We should concentrate on stating conclusions in simple and boring text. The fact that each side disagrees with the other over some aspects is obvious from the conclusions. The fact that they agree on some aspects is also obvious. Doc James (talk · contribs · email) 20:39, 9 December 2014 (UTC)

hm! are you making a distinction between "conclusions" and "recommendations"? if so there is room to resolve a lot of problems maybe.. Jytdog (talk) 23:36, 9 December 2014 (UTC)

Not sure what you mean? I think both conclusions and recommendation should be presented in simply boring text. Doc James (talk · contribs · email) 03:13, 10 December 2014 (UTC)

FDA statement

This article should represent the FDA' view. Any suggestions? QuackGuru (talk) 03:48, 9 December 2014 (UTC)

the article is a report from a workshop on the general problems of determining appropriate dosing in pregnant women, as they are generally excluded from clinical trials but may have special dosing requirements as they are undergoing physiological changes (obviously) and so there may be different pharmacokinetics. So this is a very "by scientists for scientists" kind of article. It discusses what those physiological changes are & how they may affect PK overall, and discusses what animal models might be most appropriate for estimating PK and thus dosing in pregnant humans. It uses tamiflu as a model for the problem, partly because a) pregnant women are an "at-risk" group so are included in treatment recommendations; b) because of that, there have actually been 2 studies in pregnant women, so there is actual data to work with (which is useful to have at a workshop). It notes each study came out with different PKs and that the studies are difficult to generalize b/c the populations in them were too different. So where would content based on this article fit, if we want to use it at all? We don't discussing dosing per MEDMOS. It could go in the PK section, with content like: "Two PK studies have been conducted in pregnant women. One study with African-American women found that the bioavailability of oseltamivir is significantly lower in pregnant women compared with nonpregnant women and that the clearance of from plasma was significantly faster. The other, conduced with women primarily of Hispanic origin, found no differences in PK in pregnant women compared with nonpregnant women." That might be OK, but is pretty WP:TECHNICAL. Jytdog (talk) 13:01, 9 December 2014 (UTC)

There might be something useful to add. Maybe we can add the FDA's position on Oseltamivir using another source. QuackGuru (talk) 20:17, 9 December 2014 (UTC)

Williams, Denita; Basavarajappa, Mallikarjuna S.; Rasmussen, Sonja A.; Morris, Suzanne; Mattison, Donald (2014). "Highlights from the United States Food and Drug Administration's public workshop on the development of animal models of pregnancy to address medical countermeasures in an "at-risk" population of pregnant women: Influenza as a case study". Birth Defects Research Part A: Clinical and Molecular Teratology. 100 (10): 806–810. doi:10.1002/bdra.23319. PMID 25296888.

Here is the source if anyone finds anything useful for the article. QuackGuru (talk) 20:17, 9 December 2014 (UTC)

Does the FDA state this position on their website? Doc James (talk · contribs · email) 20:32, 9 December 2014 (UTC)

nope, that is just a publication out of a workshop by technical staff of the FDA and collaboration scientists on thinking through pk in pregnancy. the current label has a bunch of content but the key bit is: "Available published epidemiological data suggest that TAMIFLU, taken in any trimester, is not associated with an increased risk of birth defects. However, these studies individually are limited by small sample sizes, use of different comparison groups, and some lacked information on dose, which preclude a definitive assessment of the risk. In animal studies, there was a dose-dependent increase in the incidence rates of a variety of minor skeletal abnormalities and variants in offspring of rats and rabbits exposed at maternally toxic doses 100 and 50 times human exposures, respectively. TAMIFLU should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus." From my perspective, that is not worth adding to the article. Jytdog (talk) 21:42, 9 December 2014 (UTC)

We already have that conclusion in the article. Doc James (talk · contribs · email) 21:43, 9 December 2014 (UTC)

Does the FDA have a position statement for Oseltamivir? Is the position statement by the FDA in the article? QuackGuru (talk) 01:51, 16 December 2014 (UTC)

? the FDA has approved it and it has a label. not sure what other kind of thing you could be asking about. other than approving or not, the fda doesn't have "positions" on drugs. Jytdog (talk) 02:15, 16 December 2014 (UTC)

Yes the FDA is just a licensing body for the United States. It determines what a medication can be sold for. Not how it can be used. Doc James (talk · contribs · email) 04:04, 17 December 2014 (UTC)

RfC: WP:WEIGHT in the Oseltamivir article given direct contradiction between Cochrane review and the consensus of medical authorities

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

Option 2 just about has the edge in this discussion, but this needs to be kept under review as it is certainly not a clear cut case and the balance is very likely to change, so I recommend this RfC is revisited at the end of the 2015/2016 flu season, or sooner if the guidance from one or more bodies of national standing changes before then. I would not want this to be seen as an indefinite binding close to this matter. Guy (Help!) 18:15, 23 February 2015 (UTC)

---

With regard to this drug, every major medical body in the infectious disease arena recommends it for at-risk (vulnerable) people within the first 48 hours. The consensus of the medical community (WHO, the CDC, the ECDC, the Infectious Disease Society of America, NICE) is very clear - so far it is unanimous ( I expect one or two stragglers may appear, but what we have is clear medical consensus). On the other hand, the Cochrane collaboration (and a couple of other groups, some including the lead author of the Cochrane reviews) has put out several meta-analyses saying the drug is ineffective and (since every drug has side effects), is actually more harmful than beneficial.

WP:MEDRS currently says: "Wikipedia policies on the neutral point of view and not publishing original research demand that we present any prevailing medical or scientific consensus, which can be found in recent, authoritative review articles, in statements and practice guidelines issued by major professional medical or scientific societies (for example, the European Society of Cardiology or the Infectious Disease Society of America) and governmental and quasi-governmental health authorities (for example, AHRQ, USPSTF, NICE, and WHO), in textbooks, or in some forms of monographs. Although significant-minority views are welcome in Wikipedia, such views must be presented in the context of their acceptance by experts in the field. Additionally, the views of tiny minorities need not be reported."

We recently debated that paragraph of MEDRS here (very long debate).

Definitions:

• a) The "Cochrane position" is that oseltamivir is ineffective and even harmful
• b) The "medical consensus" position is that the drug is recommended for at-risk patients in the first 48 hours of infection.
• Note that each is very aware of the other, and rejects the other.

So the options:

• 1) Should we treat the Cochrane position as WP:FRINGE, and remove it from the article, since it is rejected by every major medical body?
• 2) Should we treat the Cochrane position as a "significant minority" and mention it, but give it minimal WP:WEIGHT?
• 3) Should we give the Cochrane position equal WP:WEIGHT to the medical consensus position?
• 4) Should we treat the medical consensus as a "significant minority" and mention it, but give it minimal WP:WEIGHT?
• 5) Should we treat the medical consensus view as WP:FRINGE, since it is rejected by the most recent meta-analyses?

Before yesterday the Cochrane perspective completely dominated this article. (see this version.) That is pretty much #4 and almost #5. As of this posting, it looks like this, which is kind of #3 but still gives the most space to Cochrane...but also states the medical consensus clearly, so comes a bit closer to 2 in that regard. The current version is brand new and not stable.

Looking forward to discussion Jytdog (talk) 14:19, 8 December 2014 (UTC)

Discussion

• I favor 2 at least, and possibly 1. Wikipedia strives to represent the consensus of the expert institutions in our society that produce and use knowledge. That is what we are all about here. In this case, the institutional consensus is dead clear and that should be given dominant weight and the dissidents should be given minimal weight, if not treated as outright FRINGE due to the current unanimity among institutions in rejecting their perspective. I want to note that Tom Jefferson, who runs the Cochrane infectious disease unit has been harshly criticized by Mark Crislip of Science-based Medicine for doing some serious ax-grinding in the Cochrane reviews, see Cochrane Reviews: The Food Babe of Medicine? and elsewhere: One Flu Into the Cuckoo’s Nest And by "minimal weight" I mean dramatically less real estate in the article relative to the medical consensus position. Jefferson looks more and more like Seralini on GMOs to me. Way out there today- not mainstream. Things may change in the future and institutions may swing around, but that is not how things are today. We are not here to WP:RIGHTGREATWRONGS, yet that is how this article was weighted before yesterday. Jytdog (talk) 14:25, 8 December 2014 (UTC)
• Here is another option: "XYZ organization(s) says this, but Cochrane/BMJ/PLOS says this." -A1candidate (talk) 14:27, 8 December 2014 (UTC)
  • This is a question about WP:WEIGHT - would you please respond to that and give your option? Thanks. Jytdog (talk) 14:33, 8 December 2014 (UTC)
    • Equal weighting, if that wasn't obvious enough. -A1candidate (talk) 14:34, 8 December 2014 (UTC)
      • • Note - Jefferson is the lead author on the Cochrane meta-analysis and the BMJ meta-analysis and is listed as "Editor" (unsual!) on the PLoS meta-analysis. You are basically putting one guy equal to the entire medical establishment. That is not reasonable position on WEIGHT to me, at least. Jytdog (talk) 15:07, 8 December 2014 (UTC)
• I think this is a really interesting case that illustrates many of the issues we have discussed on the MEDRS page. As a vote I'd probably say 2, but minimal should not be one sentence.

• We started with an article that heavily overweighted Cochrane vs. everyone else's opinion. This in part reflects the aspect of meta analyses that is WP:PRIMARY, e.g., conclusions and theories that are not summaries of other people's results, but the result of a novel analysis. As the "secondary" sources (medical societies, etc) rolled in over several months, it became apparent that this "new result" was not universally accepted as correct.
• I also agree that Jefferson is way, way out there on many issues, as is Dosi. And this speaks to the issue I have raised many, many times: The fact that a meta analysis always reflects the presuppositions and subjective judgements of it's authors. And two authors' opinions should not be overweighted.
• I've been pretty active here in seeking a rules-based solution to this issue, and that of cherry picking review articles, which is very common here. I've strongly emphasized treatment guidelines as a better measure of medical consensus. But I have to admit there are legitimate concerns about financial ties between industry and many of the groups issuing treatment guidelines. The reviews, which should not be cherry picked, are independent voices (of 2-10 people at a time), but in aggregate show some level of external support for Cochrane's position and should be taken into account.
• Taken in sum, I'll take a more nuanced position that I have taken in the past. I still think this was a pretty good version with reasonable balance. https://en.wikipedia.org/w/index.php?title=Oseltamivir&oldid=637069978

Formerly 98 (talk) 15:55, 8 December 2014 (UTC)

• I favor 2. The response that is generated by this meta-analysis by the medical community demands that it be discussed, but the specific position of the review should not given undue weight. We basically have one author vs. the rest of the medical community. Yobol (talk) 16:50, 8 December 2014 (UTC)
• I'm going with #2. Also, in my quick look, it appears that the Cochrane papers say something closer to "we don't know whether this works", which is very different from "we know that this doesn't work", which is (almost) how they were previously presented in this article. "Weak evidence" is not the same thing as "evidence of no benefit". WhatamIdoing (talk) 19:11, 8 December 2014 (UTC)
• The conclusions of the CDC should be summarized first. The positions of EBM and regulatory agencies should be given equal weight. Doc James (talk · contribs · email) 22:40, 8 December 2014 (UTC)
• Both should be given equal weight. We should state the major positions. Cochrane/BMJ/PLoS One are major positions along with the regulatory agencies. Per A1candidate' comment. QuackGuru (talk) 21:27, 9 December 2014 (UTC)
• I have not as yet taken the time to look through the relevant sources, but of the options given, 2 most closely conforms to what I'd expect to see from a policy-consistent representation of the sources, assuming Jytdog's summary is agreed to be basically factually correct. A claim is not WP:FRINGE nor invalid under WP:MEDRS simply because it happens to diverge from the general research consensus. But neither should it necessarily be given absolutely equal weight. Present the facts for our readers more or less exactly as they were for this RfC: most anyone would be able to understand the confines of the research and debate in those terms, I think. Snow talk 00:45, 11 December 2014 (UTC)
• I am not qualified to give an opinion on the main issue. But I think the lead could do more to make it clear what the disagreement is about. It is not "does Tamiflu work?" – it clearly does inhibit virus growth, they acquire resistance to it – but "is it worth the risks?". Maproom (talk) 08:14, 20 December 2014 (UTC)

• Cochrane Primary as that seems the most important aspect in number of ways for a number of reasons

• • Needs more MEDICAL views add clinical and practitioners, not just government/political arms, and even for government I see negative views e.g. NIH [1] and Europe EMA [2]
  • Respect the wiki if the wiki had arrived at Cochrae belongs, then give that some respect
  • Respect the RSS major independant publications seem more on controversy of vendor mmm 'controlling' the test data which seems to need a mention e.g. ForbesMyth of Tamiflu and Atlantic Tamiflu Myth and Misconception
  • Avoid censorship - 'Medical consensus' seems either euphemism or equivalent to censorship based on who is picked to talk, and I'll object in prinicple to limiting the topics and being sock-puppetry or corporate advertising.

Markbassett (talk) 16:12, 23 December 2014 (UTC)

• Comment Only here for the RFC. I cannot go through all the material presented here, much less go back and reconcile the research papers and clinical assessments and reports with the meta analyses, and if I could it wouldn't be ready in time anyway. Just some comments.
  • It seems as though there is a great deal of heat and partisanship here (what a novelty in medical and pharmaceutical assessments and recommendations!) For us as a non-medical body (I realise that as a community we include many medical men of great experience in many fields, but the position of WP is essentially a lay position that rejects expertise in its participants in favour of wikilawyering and warriors, a childhood malady that we had bloodywell better grow out of, if you want a medical opinion) there is little option to go much further than raw citable references, so we do not nominally have much scope for balancing opposing positions (Synthesis, remember?). In other words, no common sense; we are supposed to be gramophones,not PA systems. Skating on the brink of the groove however, we may note that clinical and lab work are sensitive to circumstances and assumptions, and meta-analyses are intrinsically treacherous.
  • In the light of available citations we have no obvious justification for plumping for one side or the other as being so unassailably authoritative that we can dismiss the other out of hand, though I accept that some parties would happily do so.
  • Accordingly, on a basis of scientific or evidence-based medicine, we cannot ignore either side nor dismiss either as fringe.
  • This does not forbid us to include suitably citation-supported mention of the controversy in its own context as a matter still to be settled. I think it might be a good idea to give it a separate sub-section under History, but I do not insist on that.
  • In these terms it seems to me that, as some correspondents already have suggested, something between options 2 and 3 would be proper. It would have to be impartially phrased (by which I do NOT mean that either commendatory or damning evidence should be suppressed if properly supported by citation) and would have to make it clear what the continuing status of the controversy is.
  • I have no fish to fry in this matter, as I get annual flu shots and if a new strain were to appear with any question as to its virulence and ability to evade existing immune responses, I should have no hesitation in trying promising neuraminidase- and/or haemagglutinin-inhibitors, irrespective of statistical suggestions of possible adverse effects. So don't bother to shout at me for getting over-excited about the matter. JonRichfield (talk) 06:36, 28 December 2014 (UTC)
    • Option 2. The article previously gave way too much weight to the one opinion. 68.110.131.106 (talk) 04:46, 31 December 2014 (UTC)

The above discussion is preserved as an archive of the debate. Please do not modify it. No further edits should be made to this discussion.

Chemical formula does not match structure diagram

In the infobox the chemical formula ends in 0₈P but the structure diagram at the top only shows 4 oxygens and no Phosphorus - Looking at the FDA page it says "Tamiflu (oseltamivir phosphate)" but where on oseltamivir is the phosphate attached ? Whole article seems to use Tamiflu and oseltamivir without distinguishing. I'll add a few "phosphate"s to clarify. - Rod57 (talk) 11:03, 20 July 2015 (UTC)

Wrong endpoint chosen?

https://www.sciencebasedmedicine.org/influenza-eye-roll/#more-39949

"My favorite endpoint is death. A nice, binary endpoint with no issues about diagnostic definition. Death is easy to diagnose, just look for the sobbing family at the bedside as their 25 year old daughter goes into influenza induced multi-organ system failure, the EKG slowing to flat line. Been there. Done that. Too many times. Not a fan.

What about oseltamivir and death? In Asia, prompt oseltamivir lead to

The incidences of hospitalization and the mortality were lower

If pregnant

As compared with early antiviral treatment (administered < or = 2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3).

If elderly

oseltamivir therapy initiated after 48 hours (OR = 3.32, 95% CI = 1.02–10.8, P = .04) were identified as independent variables associated with mortality

If in Thailand

Treatment with Oseltamivir is associated with survival in hospitalized human influenza pneumonia patients.

In AIDS patients

Delayed administration of oseltamivir in hospitalized patients was significantly associated with mortality (P = 0.0022).

That is a fairly consistent finding. In at risk populations (humans), prompt use of oseltamivir decreases the risk of death. And at $135 dollars, a lot less expensive than the $10,000 average cost of a funeral.

And if you are ill enough to be admitted to the hospital with influenza, early oseltamivir leads to less progression.

And at what cost? Nausea, vomiting, and headache. Those who let the bibo Cochrane reviews do their critical thinking for them are impressed with the number need to harm of 28 for nausea, 22 for vomiting, and 32 headaches. As if you can’t stop the medication or treat the symptoms if the potential benefit, depending on the patient population, is death. Let’s see. Death. Nausea. Death. Vomiting. Death. Headache. I’d tend towards avoiding my death and I would hope my doctor would as well."

Count Iblis (talk) 15:27, 13 December 2015 (UTC)