alexberenson.substack.com/p/urgent-tamiflu-kills
2 corrections found
An influenza drug prescribed to 25 million Americans since 2014 roughly doubles the risk of death in hospitalized patients who receive it, researchers have found.
The REMAP-CAP result was not for all hospitalized flu patients. It applied only to critically ill ICU patients aged 12+ with severe influenza, and the trial team says it does not tell us whether oseltamivir helps or harms other hospitalized patients.
Full reasoning
This sentence overgeneralizes the study population.
The REMAP-CAP investigators' own public and clinician summaries say the finding was specific to critically ill ICU patients:
- Patients in the trial were adults with severe flu who needed ICU admission and were either given oseltamivir or not given oseltamivir.
- The investigators explicitly say the results are "from only the sickest flu patients" and "do not provide any information" about patients with flu who are hospitalized but not admitted to ICU.
So the study did not show that oseltamivir roughly doubles mortality in hospitalized patients generally. It found a high-probability harm signal in a much narrower group: critically ill ICU patients with severe influenza.
2 sources
- Oseltamivir General Public FAQs - REMAP-CAP Trial
It is important to note that these results are from only the sickest flu patients, who needed to be admitted to an ICU... these results do not provide any information about whether or not oseltamivir is helpful for patients with flu who are not critically ill. This includes patients with flu who are admitted to hospital but are not admitted to ICU.
- REMAP-CAP results: Oseltamivir (anti-viral medication) for critically ill patients with influenza infection
Critically ill patients include those patients, usually cared for in the intensive care unit, who are on organ supports... These results indicate that, among critically ill patients (aged 12 or older) with confirmed influenza, treatment with oseltamivir was found to be ineffective in reducing 90-day mortality compared with no antiviral, and had a high probability of harm.
442 hospitalized and critically ill patients received either a five- or 10-day course of oseltamivir or placebo
The REMAP-CAP comparison group was not given a placebo. The official trial materials say patients were randomized to oseltamivir or to no antiviral treatment, and treatment assignment was not blinded.
Full reasoning
This description of the trial design is incorrect.
According to REMAP-CAP's official summaries, ICU patients with severe influenza were randomized to receive oseltamivir for 5 days, oseltamivir for 10 days, or no antiviral treatment. The trial materials describe this as patients being given oseltamivir or not given oseltamivir; they do not describe a placebo control.
That matters because a placebo-controlled, blinded trial and an open-label trial with a no-antiviral control are different designs. Calling the control arm a placebo arm misstates how the study was actually conducted.
2 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
In this trial, adult patients with severe flu who needed to be admitted to Intensive Care Units (ICU) were randomly put into groups who were either given oseltamivir, or not given oseltamivir. All other parts of treatment were decided by the team caring for them.