Antiviral Tamiflu Stockpiling Fast, Despite Unclear Health and Environmental Effects

Tamiflu capsules (Photo: Moriori via Wikimedia Commons)

Amid media hype, speculation and alerts tweetin' faster than a virus, sales of antiviral drugs marketed as "effective" against the hybrid form of H1N1 "swine flu" virus have shot up dramatically. Governments and individuals around the world are now stockpiling antiviral drugs, leading investors to snap up shares of Roche, the Swiss maker of the antiviral Tamiflu, and GlaxoSmithKline, maker of Relenza.

But this antiviral-stockpiling frenzy begs the question: are drugs like Tamiflu effective against swine flu? How is Tamiflu made and are there any side effects? What are the long-term implications of manufacturing and releasing pharmaceuticals on the environment?
Is Tamiflu effective?
First and foremost, Tamilflu (or "oseltamivir") does not prevent nor cure the flu, but rather reduces the severity of symptoms and length of illness. Taken orally, flu patients must take the drug within 48 hours of first symptoms for it to be effective, for a period of five days.

But it's not clear whether Tamiflu will actually prove effective against swine flu. Earlier this year, the main strain of influenza A H1N1 flu in North America developed a resistance to Tamiflu, leading some scientists guessing whether the swine flu virus could also acquire resistance to Tamiflu. In addition, there have been reported cases of adverse reactions, "abnormal behavior, hallucinations, and even deaths" attributed to Tamiflu consumption during the avian flu scare of 2006.

How it's made: Ingredients & Side Effects
The main source of the active ingredient in Tamiflu? Star anise. Yep, that's right, the licorice-tasting fruit of a rare evergreen tree found in southwest China, parts of Vietnam and India, traditionally used to flavour duck meat and treat infant colic. Huge amounts of star anise are needed to produce the shikimic acid needed for the active component of Tamiflu.

Harvested by local farmers between March and May, the shikimic acid must be extracted and purified in a ten-stage process that takes up to a year. Already 90 percent of this harvest from China is utilized by Roche, as only this type of star anise is suitable for making Tamiflu.

The list of ingredients in Tamiflu's 75-milligram capsules, from Natural News:

Oseltamivir phosphate (active ingredient in Tamiflu); Black iron oxide (E172), Croscarmellose Sodium; FD&C; Blue 2 (indigo carmine, E132 - a synthetic dye); Gelatin (a protein product); Povidone; Pregelatinised maize starch Red iron oxide (E172); Shellac (a "natural plastic" secreted from the female lac insect); Sodium Stearyl Fumarate Talc; Titanium dioxide (E171) and Yellow iron oxide (E172).

The FDA notes side effects ranging from nausea, vomiting, diarrhea, bronchitis, stomach pain, dizziness and headache. There have been reports of adverse neural and psychiatric side effects, mostly in Tamiflu users under 17, however, Roche contends that it's difficult to determine whether these were brought on by severe cases of the flu or the drug itself. Nevertheless, cases of sudden onset of "aggression, disorientation, delirium, hallucinations, self-injury, suicidal thoughts, suicide, and death from falls and other accidents" were noted in countries like Japan, which uses more Tamiflu than any other nation.

Effect of pharmaceuticals in our water
It goes without saying that the ecological impact of millions of doses of antivirals being consumed within weeks during a pandemic and flushed into our waters, deserves some study. In the case of avian flu, this is the point raised by scientists such as Andrew Singer of Oxford's Centre for Ecology and Hydrology, and as some observers comment:

There is little biotransformation of [oseltamivir] in sewage treatment plants and it doesn't cling to sewage sludge, where it could be segregated. Instead both are highly soluble in water. Hence they will make their way readily into the aquatic environment, even after sewage treatment. Could the presence of Tamiflu in coastal or riverine waters contribute to antiviral resistance in aquatic waterfowl who are reservoirs of various influenza virus subtypes, including those like H5N1 that are potential pandemic viruses?

Good question — ultimately pointing to the possibility that governments may need to diversify their antiviral stockpiles beyond Tamiflu to address this scenario of antiviral resistance, which some are doing already. Moreover, the issue of how to keep residual pharmaceuticals out of the water supply would need to be addressed.

Personal stockpiling discouraged
There's no conclusive agreement yet as to how this flu strain emerged and plenty of theories, but governments are already trying to prepare themselves for a potential pandemic by ordering millions of doses of Tamiflu and Relenza. Some developing nations are trying to get Roche to lift its patent so affordable generic drugs can be made.

All in all, so far the biggest beneficiaries of this outbreak are pharmaceutical companies (and potentially Donald Rumsfeld, if conspiracy theories are to be believed).

So what's an ordinary citizen to do? As some experts have suggested, don't stockpile Tamiflu unless you want to become a "walking mutated virus bomb" — just take some commonsense preventative measures, and keep calm.

The Telegraph and Otago Daily Times
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