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2008-02-03 -Signs, Portents, and the Weather-

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Posted by lotp 2008-02-03 00:00|| || Front Page|| [4 views ] Top

#1 I have long been dubious about the value of Tamiflu and similar drugs.

Simply put, influenzas consist of an H factor, which is how they enter cells, and an N factor, which is how they leave cells. (Thus H5N1 for avian flu.)

Tamiflu works by inhibiting the N factor, preventing the virus from breaking out of infected cells to infect other cells. But in a manner of speaking, this is closing the barn door after the horse has left.

To use a military analogy, it is like a static defense.

Instead of using Tamiflu as the first line of defense, it should be the last ditch method used, once several others have been overwhelmed.

To begin with, a defense in depth is always the best approach to an attack. In the case of influenza:

1) Vaccination, if possible. Even if they cannot make a vaccine for the exact H5N1 variant in quantity and time, which they can't, a generic H5N1-type vaccine could provide *some* protection, or reduce severity.

2) Avoidance of vectors and contamination. The virus must get from the infected to the uninfected in a short period of time, or else it dies out. Influenza acts something like a wildfire, and if intelligently blocked, it will burn itself out.

3) Prophylaxis and sanitation. Either blocking the virus with things like gloves, masks, and clear eyeglasses to absorb or stop the large droplets the virus is carried in; and using antiseptics to kill it. The most important of these is to use hand sanitizer when out in public during an epidemic. (Like right now, when much of the US is in the ordinary flu season.)

4) Adhesion inhibitors. There are some chemicals that can prevent viruses from sticking to cells they try to infect. If they cannot stick to them, then they cannot infect them with their H factor. One such chemical is common cranberry juice, which is known to prevent adhesion for some viruses, but it is not known if it would also do so for influenza. The emphasis here is the upper respiratory tract and sinuses.

5) Reproduction inhibitors. Several metals are known to inhibit the reproduction of both bacteria and viruses. These include zinc, silver, sodium, potassium, magnesium, and others. By delaying the progress of the infection, it gives the immune system more time to react. Again, the emphasis is in the upper respiratory tract and sinuses.

6) After all of this, comes Tamiflu and related N factor inhibitors.

7) The last form of defense, which is highly dangerous, is to suppress the immune system, to prevent the lethal "cytokine storm" effect, an overreaction of the immune system to the flu which is lethal. The fight happens in the lungs, and destroys them in the process. But many of the immune system suppressants are very toxic.

Posted by Anonymoose 2008-02-03 10:22|| 2008-02-03 10:22|| Front Page Top

#2 I've always had doubts about permitting medicines in countries that we know are going to be cut and made less effective against the disease by middlemen and officials in corrupt cultures. The usual process of nature is to evolve a strain that negates the full strength drug. You kill it. You don't nurture it.

Posted by Procopius2k 2008-02-03 13:15|| 2008-02-03 13:15|| Front Page Top

#3 The effectiveness of Tamiflu and other neuraminidase inhibitors (the N) has been questioned for a while, but they're the best we have.

As Moose notes, they work by inhibiting the spread of the virus. So one needs to start therapy the first day you have flu symptoms, or else the virus has replicated sufficiently that the drug is clinically ineffective.

If we get into a major bird flu epidemic with human-to-human transmission, we'll need a huge supply of the drug and we'll all need to take it RIGHT NOW to slow the epidemic. I don't think our public health system can move the current stockpiles quick enough, and those stockpiles are some limited.

Posted by Steve White">Steve White 2008-02-03 14:42|| 2008-02-03 14:42|| Front Page Top

#4 Dr. Steve, what is the shelf life of Tamiflu? I.e. what limitations are there re: stocking ahead of time?

Posted by lotp 2008-02-03 14:55|| 2008-02-03 14:55|| Front Page Top

#5 Think of it as evolution in action.

Posted by g(r)omgoru 2008-02-03 15:19|| 2008-02-03 15:19|| Front Page Top

#6 Not sure of shelf life. If it's like other oral meds, 6 - 12 months.

Posted by Steve White">Steve White 2008-02-03 19:25|| 2008-02-03 19:25|| Front Page Top

#7 Steve White: I've been wondering why there isn't a stampede to identify adhesion and reproduction inhibitors.

The FDA has identified the patented form of zinc in Cold-Eeze lozenges, which unlike typical zinc supplements is readily uptaken into the mucous membranes, as "reducing severity and duration" of URT infections. And that is just one metal, out of several with strong possibilities.

And ordinary cranberry juice (and other berry juices) have been shown to significantly interfere with several types of viruses adhering to cells in the bladder and bowels.

Between these two, you would think that there would be intense research to find a way to block infection in the first place. An inexpensive prophylaxis to help keep people from getting infected, with Tamiflu as just the icing on the cake in case they don't stop it all.

Especially since H5N1 needs just a fraction of the amount of pathogen of typical influenza to cause infection.

Posted by Anonymoose 2008-02-03 20:29|| 2008-02-03 20:29|| Front Page Top

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