Here’s a particularly worthless article from the AP: Docs say Tamiflu won’t affect foetus.
This is clearly an important question. In the event of a pandemic, Tamflu will be used prophylactically in pregnant women, either by choice or because the women don’t know they are pregnant. There is currently no reliable information on effects of this drug on a developing fetus, and there may not be before we are faced with the problem. So data points are useful. But this example is utter non-sense.
In Jakarta, Indonesian doctors are giving a 35 year old 2 months pregnant woman Tamiflu after she developed bird flu symptoms. They will be monitoring her closely for effects on her pregnancy. Entirely reasonable and a useful exercise. But not much information to be gained. If there is a problem, this is an older mother in a country where pregnancy and childbirth still has many complications and who may be ill with a serious disease with its own effects on reproduction. If there is no problem, we have just a single data point. Suppose the risks were extraordinarily high, i.e., 50% of pregnant women suffered immediate miscarriages. The lack of miscarriage in this case wouldn’t be particularly informative, perhaps only assuring us the risk was not higher than, say 95%.
Which is why we think both the headline and this statement by the Indonesian doctor are ridiculous:
Dr Luhur Soeroso, who is treating the 35-year-old woman from Sumatra province, said she has been taking the drug for over one week and “so far has not had any problems with her pregnancy.”
He said he believed other strong antibiotics being administered to the patient, who continues to suffer from high fever and respiratory problems, were more dangerous to the foetus’ development than Tamiflu. (AP)
Dr. Luhur only knows the drug didn’t cause an immediate miscarriage. Any other effects on the fetus are unknown. Nor does he know what the risk of an immediate miscarriage is, only that it isn’t 100% and probably not 90 – 95%. Nor, I suspect, does he have any idea of the risks of the antibiotics he is using. To sum up, pretty much Dr. Luhur has no idea.
The question is important. Until it is answered, we will be doing the usual blind risk – risk trade-offs. A robust and effective public health infrastructure able to monitor, surveil and follow-up public health interventions like prophylactic Tamiflu use could answer this question at some point, although probably only after some event triggered widespread use of the drug. So the information would not be available if a pandemic were to occur in the near future, even if we had such infrastructure (which we don’t).
But it is very discouraging to think that whatever information might be gleaned about this important topic will be lost in any event, because we didn’t invest in an effective public health and social service system (including maternal and child health public health services).