Dec. 5 (Bloomberg) -- Susan Wolfson says her teenage daughter became frightened in September by a TV news program highlighting the threat that avian flu will mutate into a pandemic capable of killing millions of humans.
Wolfson responded by getting a doctor's prescription for Tamiflu, the antiviral drug that has shown some benefit against the flu in lab tests. She then hid 30 capsules behind other items in a medicine chest to reduce chances that anybody visiting her home might swipe them.
``I know it sounds really crazy, but this drug seemed more precious than other things that I own,'' says Wolfson, 52, the president of Sensei, a New York public relations firm. ``It's the best available defense that I know of to protect my kid and myself.''
Now Wolfson -- and thousands of other Americans who have stocked up on the drug -- must face the reality that guarding against the looming threat of a flu pandemic with Roche Holding AG's Tamiflu may not be as surefire or simple as many consumers think, according to infectious-disease specialists.
``It's a difficult drug to use properly,'' says John Treanor, a 51-year-old professor of medicine at University of Rochester in Rochester, New York. ``People who hoard the drug might use it improperly or store it improperly, so it won't work. Hoarding is a panic thing.''
Misuse would waste drugs -- needed if a pandemic does occur -- and squander the money spent on Tamiflu, Treanor says. Ten capsules, or enough drugs to treat one person for five days at Roche's recommended dose, cost $78.99 on Drugstore.com, an Internet seller.
Hoarding
``There's no reason to hoard Tamiflu,'' Treanor says. ``The likelihood of a pandemic is extremely small.''
Tamiflu sales are jumping nonetheless. U.S. drug stores filled almost 422,000 prescriptions for Tamiflu during the 14 weeks ended Nov. 18, more than four times the total in the year- earlier period, according to Verispan LLC, a research company in Yardley, Pennsylvania.
The sales increase might have been ever larger had not Roche, based in Basel, Switzerland, temporarily suspended Tamiflu sales in late October to ensure that supplies would be available later.
Some doctors are refusing to comply with requests for the drug.
``We're trying to explain to parents that avian flu is really not a concern at this point for their children,'' said Kathryn Mandal, a 31-year-old pediatrician in Waldorf, Maryland. She said has declined to write Tamiflu orders for about 10 parents who requested Tamiflu during the past two months.
Upset Parents
``Most of them have gotten upset,'' Mandal says. ``Some parents told us they'd go to other sources.''
There have been 133 confirmed cases of the H5N1 avian influenza in humans -- resulting in 68 deaths in five Asian countries -- since late December 2003, according to the World Health Organization. Health authorities believe the victims came into direct contact with the feces or blood of infected poultry.
Experts at WHO, an arm of the United Nations, say the world appears closer to a flu pandemic than at any other time since 1968, as the H5N1 avian flu virus might mutate into a form readily transmissible between humans.
The extent to which Tamiflu would help fight a pandemic flu won't be known until such a virus emerges. The drug, available since 1999, can help someone with seasonal flu by blocking the virus from spreading once it is inside the body and has infected some respiratory cells.
Studies have shown that Tamiflu can cut as much as day off the period that the symptoms persist, its use by an infected person can reduce the virus's ability to spread to others, and taking the drug can lower one's risk of getting the flu.
Mouse Studies
Research this year found that mice infected with bird flu that were given large doses of Tamiflu were more likely to survive than those who received a regimen more like what is now prescribed to patients. No studies have been done in people infected with the bird virus.
Even if people correctly diagnose the flu, their timing must be precise to benefit from Tamiflu, Treanor said. Treatment must be initiated within the first 48 hours of symptoms such as fever, sore throat or muscle aches, according to Roche. The need for proper timing -- and the requirement that patients get the drug prescribed by doctors -- is one reason that the antiviral and a similar one from GlaxoSmithKline Plc. called Relenza have not proved popular in the past, according to infectious disease specialists.
While Tamiflu could be taken to protect against a flu, the price would add up. A flu season can extend several weeks or months. People who now have saved 10, 20 or 30 pills may have difficulty getting many more, given shortages of the drug as a result of Roche's production limits.
Zero Refills
Drugstore.com, citing shortages, says on its Web site that it currently will dispense no more than 10 capsules per person, ``with zero refills.'' Larger quantities may be dispensed in regions with flu outbreaks, the site said.
``The drug is effectively only while you are taking it,'' Treanor says. ``You need to administer it during the entire period'' -- that is, from beginning to end of the flu threat.
If a pandemic flu does hit, and just one member in a family falls ill, there is a question of whether giving Tamiflu to the sick person would increase danger to the others -- by making the virus resistant to Tamiflu.
``The chance of getting resistance in that person is very high, and then we lose the protective effect in the other family members,'' Stephen Wolinsky, a professor of medicine at Northwestern University in Evanston, Illinois, said at a conference on avian flu held on Nov. 16 in New York.
The unanswered questions haven't stopped people from squirreling away Tamiflu.
``It's human nature,'' says Stephen S. Morse, a 52-year-old associate professor of epidemiology at Columbia University in New York. ``There's almost a talismanic quality to it,'' Morse says. ``It's like having an amulet to ward off evil: It can give a false sense of security.''
