alexberenson.substack.com/p/urgent-tamiflu-kills
2 corrections found
每年有数百万美国人（其中大部分是老年人和病人）服用一种药物，但这种药物似乎不仅无效，而且还会致命。
现有试验结果并不支持把奥司他韦描述为对“每年数百万美国人”都无效且致命；官方说明明确说，这一信号只来自 ICU 危重流感患者，且不适用于社区或非 ICU 患者。
Full reasoning
这句话把一项针对特定危重人群的结果，改写成了对“每年数百万美国人”服药效果与安全性的总体判断。
REMAP-CAP 官方面对公众的说明明确写道：这些结果来自**“only the sickest flu patients, who needed to be admitted to an ICU”，并且“there is evidence for the safe use of oseltamivir in the community (outside of hospital)”。RECOVERY 试验团队也表示：这些担忧特指需要器官支持的患者**；并指出奥司他韦“has been used widely in hospitalised patients for decades without major safety concerns”，只是这一新结果提示需要更多强有力证据。澳大利亚 Living Evidence 指南同样限定，这些建议只适用于危重患者，不适用于轻中度流感。
所以，当前证据支持的最远结论是：在ICU 中的危重流感患者里，奥司他韦未显示获益且出现高概率伤害信号。把它概括成对“每年数百万美国人”都“无效而且致命”，超出了研究结果本身。
3 sources
- REMAP-CAP results: Oseltamivir (anti-viral medication) for critically ill patients with influenza infection
It is important to note that these results are from only the sickest flu patients, who needed to be admitted to an ICU. There is evidence for the safe use of oseltamivir in the community (outside of hospital) to both prevent and treat flu.
- For Site Staff - RECOVERY Trial
The concerns apply specifically to patients requiring organ support... Oseltamivir has been used widely in hospitalised patients for decades without major safety concerns.
- New Guideline: Drug treatments for people with influenza who are critically ill
These recommendations only apply to people who are critically ill... and do not apply to people with mild or moderate influenza.
442名住院重症患者接受了为期5天或10天的奥司他韦或安慰剂治疗，同时接受了鼻氧等标准治疗。
REMAP-CAP 的对照组不是“安慰剂”，而是“不使用任何抗病毒药物”。官方试验说明明确写的是 oseltamivir 5 天、10 天，或不接受抗病毒治疗。
Full reasoning
这句对试验设计的描述有一个关键错误：REMAP-CAP 的比较臂并不是“奥司他韦 vs 安慰剂”。
REMAP-CAP 官方公众 FAQ 说明，患者被随机分到“接受 5 天或 10 天奥司他韦”或“不接受任何奥司他韦”的组。官方结果页也把比较写成了 oseltamivir 与 no antiviral。更早的 REMAP-CAP 抗病毒方案附录甚至明确写着：“No antiviral agent (no placebo)”。
因此，把这项研究写成“奥司他韦或安慰剂治疗”是不准确的；它的对照是无抗病毒治疗，不是安慰剂。
3 sources
- Oseltamivir General Public FAQs — REMAP-CAP Trial
Adult patients... were randomly put into groups to either receive oseltamivir for 5 or 10 days ... or to not receive any oseltamivir.
- REMAP-CAP results: Oseltamivir (anti-viral medication) for critically ill patients with influenza infection
By day 90, 19.4% of critically ill participants who received oseltamivir had died, as compared to 13.7% of participants assigned to receive no antiviral.
- REMAP-CAP Antiviral Domain-Specific Appendix Version 1.0
Patients will be randomly assigned to receive one of the following open-label antiviral strategies... No antiviral agent (no placebo) ... Oseltamivir ... for 5 days ... Oseltamivir ... for 10 days.