CDC’s advice to take Tamiflu is compromised by financial conflicts of interest

In his public messages about this year’s influenza outbreak, Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), has repeatedly urged people to take an antiviral drug such as Tamiflu if they develop symptoms of the flu and their doctor prescribes it.

Taking an antiviral drug is the third piece of “action” advice in the CDC’s new “Take 3” campaign. The other two: get a flu vaccine and practice good “everyday” prevention, such as washing your hands frequently and avoiding close contact with sick people.

The CDC has “compelling evidence” that Tamiflu and other neuraminidase inhibitors work if used early enough in the course of the disease, Frieden has been telling reporters.

“Anti-viral flu medications are greatly underutilized,” he explained at a press conference. “But if you get the flu, and if you get medicines early, they could keep you out of the hospital; they could keep you from having to go into the intensive care unit; and they might even save your life.”  

FDA does not agree

But as Jeanne Lenzer, an independent reporter and associate editor at the medical journal BMJ points out in a recent article, there’s a big problem with Frieden’s advice: The Food and Drug Administration (FDA) has determined that the clinical trial data submitted to it for review does not support the claim that Tamiflu “saves lives” or even reduces hospitalizations, including for the elderly and others most at risk.

When Lenzer asked Frieden to explain this discrepancy, he told her in an email that the CDC’s own review of the scientific literature supports the “observation” that early treatment with drugs like Tamiflu can reduce the “risk of death among hospitalized patients with laboratory-confirmed influenza.” (Note: In his public messages, Frieden has been advocating that doctors prescribe the drug to non-hospitalized people, even when the flu is only a suspected, not a confirmed, diagnosis.)

Frieden also cited a recent meta-analysis of nine clinical trials (4,328 patients) involving Tamiflu. The study, published Jan. 30 in the Lancet, reported that adults with the flu who took Tamiflu were less likely to require hospitalization for lower respiratory tract complications.

That finding, however, directly contradicts the results of another meta-analysis published last year by the Cochrane Collaboration. It reviewed 46 studies (24,251 patients) involving either Tamiflu or another anti-viral flu drug, Relenza, and found that the drugs had limited effects on symptoms and did not reduce serious complications or hospitalizations.

Both studies found that the drugs have unpleasant side effects, most notably nausea and vomiting.

Conflicts of interest

The Cochrane Collaboration is well established as an independent, not-for-profit, global network of scientists. The group of researchers who conducted the Lancet study was described in a commentary that accompanied their study as also being “independent.” But is that true?

No. As Lenzer points out (in her BMJ article and in a later follow-up piece), all four coauthors of the Lancet meta-analysis have received speaker’s or consultancy fees, grants or contracts from either Roche, the company that makes and sells Tamiflu, or Gilead, the company that holds the patent to the drug.

And the conflicts of interest don’t end there. The listed funding source for the Lancet study — the Multiparty Group for Advice on Science (MUGAS) — received an unrestricted grant from Roche specifically to pay for the study.

It gets even murkier. MUGAS was co-founded by the managing director of a Belgium-based public relations firm, Semiotics, which receives 20 percent of its funding from Roche, according to Lenzer.

For the record: The authors of the Lancet study deny that Roche had any influence on their study’s design or its results.

CDC’s conflicts

Yet the web of financial conflicts is even more pervasive than that, for it extends right into the CDC itself, as Lenzer explains:

The CDC Foundation, created by Congress to “connect CDC to the private sector to advance public health,” provides funding to the CDC. The foundation confirmed to The BMJ that the CDC received a directed donation from Roche via the foundation for the [“Take 3”] campaign, stating, “Roche provided a grant of $198,000 to CDC Foundation [which] has an administrative fee of 13.5%, so $174,800 was provided to [the CDC to] support qualitative research into influenza prevention and treatment messaging.”

This is not the only money the CDC takes from the industry. Unbeknownst to many, the CDC receives substantial industry funding through the CDC Foundation. A spokesperson said that over the past three years the foundation has received an average of about $6.3 [million] from the industry a year, 21% of the foundation’s overall funding. Since 1995 the foundation has received funding from more than 150 corporate “partners,” including Gilead, which holds the patent on oseltamivir [Tamiflu], as well as Genentech and Roche, the drug’s manufacturers.

Neither the CDC nor the foundation provided data on how much funding Roche, Gilead, and Genentech have donated to the CDC in addition to that for the Take 3 campaign.

Broken trust

As Marcia Angell, former editor of the New England Journal of Medicine, told Lenzer: “The CDC has enormous credibility among physicians, in no small part because the agency is generally thought to be free of industry bias. Financial dealings with biopharmaceutical companies threaten that reputation.”

More to the point, they threaten the CDC’s reputation with the public — and at a time when we really need people to trust what our public-health officials are saying.

Lenzer’s BMJ article is, unfortunately, behind a paywall on the journal’s website. But she’s also posted a follow-up piece on how the media has covered the CDC’s “Take 3” campaign, which contains some of the details in her original BMJ article, on the Minnesota-based Health News Review website.