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The Problem with Tamiflu, Relenza, Swine Flu, GSK, and the FDA.
May 10, 2011 5:37 PM   Subscribe


 
But... but... won't someone think of Tamiflu stockholder Donald Rumsfeld? The poor man stands to lose SO MUCH!
posted by flapjax at midnite at 5:42 PM on May 10, 2011


Is this going to end up like the anti-vax stuff or will there be actual science behind this "article"?
posted by humanfont at 6:05 PM on May 10, 2011


humanfont: here's a link you can use to find out
posted by !Jim at 6:10 PM on May 10, 2011 [15 favorites]


Is this going to end up like the anti-vax stuff or will there be actual science behind this "article"?

RTFA
posted by Blazecock Pileon at 6:11 PM on May 10, 2011 [3 favorites]


Is this going to end up like the anti-vax stuff or will there be actual science behind this "article"?

No need for the scare quotes. Despite what you think of the content and ideas expressed in it, it is, unquestionably, undeniably and incontrovertibly, an article.

Otherwise, the answer to your question will only be arrived at by reading the article. That's my understanding, anyway.

Or, on preview, what IJim said.
posted by flapjax at midnite at 6:12 PM on May 10, 2011 [3 favorites]


Damn, "RXFLU" doesn't seem to exist. Anyone know what ETF it really means? I'd like to buy in before, say, September. :D
posted by pla at 6:16 PM on May 10, 2011


This is a really difficult thing to analyze. Of course drug companies are going to try to position themselves to profit from illness, that is what they do.

Was the lack of swine flu pandemic, because its danger was overstated or is it because the warnings were taken seriously and the protocols worked? Whichever it is, it is important to remember that there have been flu pandemics in the past and there probably will be another in the future.
posted by psycho-alchemy at 6:19 PM on May 10, 2011


Summary of the article: A few doctors begin to question the effectiveness of Tamaflu and similar products manufactured by Roche. They find that the main studies of the drug's effectiveness (a single study really) were all funded by Roche. They also find that other articles regarding the drug's effectiveness and/or necessity were also either funded by Roche and/or PR firms hired by them.

The doctors notice discrepancies in the studies . They ask Roche for the drug trial studies and Roche refuses to release key data.

The article also brings out that certain elements in the nation's warning system regarding flu epidemics are heavily influenced by the Pharmaceutical industry. Case in point the swine flu epidemic a couple of years ago that never really happened. The authors also question the data collection methods of that alleged epidemic that indicated out that children were dying of the flu at a much higher rate.
posted by Poet_Lariat at 6:26 PM on May 10, 2011 [4 favorites]


During the ten years leading up to the pandemic declaration of 2009, scientists associated with the companies that were to profit from the WHO’s “pandemic preparedness” programs, including Roche and GlaxoSmithKline, were involved at virtually every stage of the development of those programs. The companies funded the documents giving guidance on preparing for the influenza pandemic, in which the WHO recommended the stockpiling of Tamiflu and Relenza. Consultants drafted parts of these documents and joined WHO officials in fund-raising for the Tamiflu stockpile. Industry-supported scientists were also on the committee that issued the “pandemic emergency declaration.”49 That announcement caused developing countries to request assistance from the WHO’s Tamiflu stockpile fund, and these requests contributed to a tripling of the drug’s sales in 2009.50 By declaring a pandemic and linking the response to Tamiflu stockpiling, the WHO could not have done a better job of promoting Roche’s interests. Until Roche shares more information on Tamiflu with independent researchers, we won’t know whether the agency did so at the expense of the rest of us.
Thanks for this post.
posted by dabitch at 6:27 PM on May 10, 2011 [1 favorite]


Yeah, I read about the kids with hallucinations in the Japanese media back when it allegedly happened. The reports struck me as about the same quality and veracity as previous reports of childrens' adverse reactions from watching certain flashing lights sequences on the Pokemon TV show.

This article is antivax bullshit. They are claiming that the antivirals only shorten the flu by one day so they are not worth it. BULLSHIT. Back when I got H1N1 in Dec 09, I would have done almost anything to get a scrip for Tamiflu or any antiviral, but none were available. Everyone I know who got Tamiflu was back up on their feet in 1 week. Me, after a week, I was rushed to the ER, dehydrated and at the brink of death. I didn't recover for another 8 weeks. My health has never been quite the same.
posted by charlie don't surf at 6:28 PM on May 10, 2011


"This article is antivax bullshit. "

No it is not. It has nothing to do at all or in any way with the anti-vax movement which anyone actually reading the article should certainly know.

The article points out legitimate discrepancies in the effectiveness of a certain drug, Tamaflu, and shows how the drug manufacturer, Roche, refused to release data to confirm or deny those discrepancies. The article then goes on to point out industry ties between the FDA and Roche that that helped triple Roche's stock prices .

It has nothing to do with withholding vaccines fro people and everything to do with misleading drug company data on the effectiveness of a specific drug.
posted by Poet_Lariat at 6:33 PM on May 10, 2011 [9 favorites]


Epstein has 3 main points here:
  1. The threat of a virulent cross-species influenza pandemic is overblown.
  2. Tamiflu and Relenza would not, in the event of such an outbreak, do a great deal of good, and might even cause some deaths.
  3. Big Pharma leaned on the WHO to exaggerate the probability and severity of an outbreak so it could sell stockpiles of Tamiflu and Relenza to world goverments.
I'm by no means a clinical trials wonk, so I'll provisionally cede the second point to Epstein. And I have no doubts that the WHO and FDA are compromised to at least some extent by Roche, GlaxoSmithKline et al.

But I would need a lot more convincing to get behind point 1. Epstein's "terrifying, if unlikely, possibility" has already happened. Trillions of little evolutionary engines are grinding their way to the second round at this moment. I have no problem with massively expensive projects to prepare civilization for a flu pandemic - providing, of course, that we concentrate on drugs that will help* more than they harm.

*Cytokine storms, pharmaceutical industry! That page hasn't barely changed since H1N1 broke. Will you get on that shit already?
posted by Iridic at 6:35 PM on May 10, 2011 [3 favorites]


I teach pharmacology to medical students and yeah, the anti-flu drugs are really limited in their usefulness. This is standard doctrine. You have to take them within the first two days of symptoms and then they only do a little to shorten the disease course. The problem is they prevent the infection of cells and by the time you come down with full symptoms, every cell that is going to be infected is already infected.
posted by dances_with_sneetches at 6:45 PM on May 10, 2011


Mmmmm. Footnotes.

This sentence for example: Data analysis is a subtle art, and some companies even use “data-mining” computer programs to extract positive findings from unpromising data. is, allegedly supported by this article making it sound like, while patients on the drug did worse than the placebo, you can massage the data and show that left handed Baptists actually did better and go the the FDA with that. (I mean you could. I'd point and laugh, but there is no physical law stopping you.)

What the footnoted article actually is talking about is the fact that, for any set of observations, there are going to be some correlations that don't equal causeation. So you're careful search for polymorphisms and what not is liable to give you big pile of worthless leads to follow. This is not the same as going to the FDA with a big pile of worthless leads and them saying, "Huh, oh sure, you can inject that school children and little old ladies. When's lunch?"

That being said, once upon a time there was a drug, where in phase I, we had several people with refractory metastatic melanoma who had basically been told "get your affairs in order". Several of them are, to the best of my knowledge, still with us today. That's an atypical outcome for refractory metastatic melanoma.

When we pulled the plug on the phase III study, I believe the word the clinical stats people used was "futile".

You better believe that we data mined the shit out of that. (You'll note that Wikipedia article doesn't have to explain that there used to be this disease called cancer, that actually killed people or that the drug in question is now commercially available. My last samples went into a big red tub last year some time.)
posted by Kid Charlemagne at 6:45 PM on May 10, 2011 [1 favorite]


Cytokine storms, pharmaceutical industry! Will you get on that shit already?

Been there, done that. The T-shirt polo shirt! featured a ball and chain diagram of the molecule that had been re-imagined as a three headed sea serpent kind of thing with little eyes and little red bows in it's hair binding domains.

I wish I was making this up.

That one failed in the clinic too. We suck at the data massaging shit. I feel like such a failure.
posted by Kid Charlemagne at 7:06 PM on May 10, 2011


Poet_Lariat, thanks for posting that abstract.

1. The threat of a virulent cross-species influenza pandemic is overblown
. I've seen lots of fear-mongering and chicken-littling about pandemic flu. Some of it is overblown. But the risk of a pandemic influenza similar to the one in 1918 is real, and scary. Between 50 and 100 million people died (@ 3% of the world's population), making it one of the worst disasters ever. The hoohah will die down, and we may or may not be prepared. People tend to prepare for familiar disasters. A pandemic might happen this year, or in 30 years. Being prepared for pandemic illness is a good idea, so all that hoohah will probably be beneficial, one way or another.

2. Tamiflu and Relenza would not, in the event of such an outbreak, do a great deal of good, and might even cause some deaths. I'd like to see some independent research, and another article or 2, for balance.

3. Big Pharma leaned on the WHO to exaggerate the probability and severity of an outbreak so it could sell stockpiles of Tamiflu and Relenza to world goverments. Big Pharma = money-grubbing corporations, so it wouldn't surprise me at all.

A few years ago, I went to a presentation on influenza by Dr. Michael Greger. Well-documented, thorough and reasonable. His site is full of good links and information.
posted by theora55 at 7:08 PM on May 10, 2011


What the footnoted article actually is talking about is the fact that, for any set of observations, there are going to be some correlations that don't equal causeation.

That's not what the article is saying. What it is saying is this: among other things, the power of many analyses is so low, that if you see an effect, you've should give high odds that it is false. That's because if you have no effect at all, you still have small chance of finding an effect. If your odds of finding an effect when it's not there are nearly the odds of finding an effect when it IS there, finding an effect doesn't give you much faith than an effect actually exists. Add into that researchers' biases, etc, and you've got a real problem for a lot of science (including the science I happen to publish in...).

That article has nothing to do with correlation vs. causation. Why is it whenever statistics is mentioned, people bring that up?
posted by Philosopher Dirtbike at 7:13 PM on May 10, 2011 [2 favorites]


We need better regulation and requirements for the companies to release all the data (I actually thought that a clinical trials database now did require this: maybe it hadn't gone into effect then?). Anyway, the FDA also needs to be better funded. If the drug companies don't stop fucking with the data, it's going to be impossible for us to trust the science and we're going to be no better off than we would be if we relied on woo.

The whole point of science is to minimize bias by using methods like randomized double blind trials—it's rather useless if you then essentially fake the numbers. The corporations should realize that trust is a precious resource and that if they continue along this path, they're going to either collapse in a big disaster from hiding stuff that's killing people which will ultimately be discovered or they're going to get hyperregulated and lose more money that way or both. We need to incentivize a focus on the long term before corporate shortsightedness causes catastrophe for all of civilization and therefore, ultimately for companies too.
posted by Maias at 7:21 PM on May 10, 2011 [1 favorite]


Some people may benefit from a drug at the same time that other people (especially kids) experience severe side effects from the same drug. I can find everything in the article likely to be true without doubting that there were both people who were helped by Tamiflu and other people who died directly or indirectly from it.
posted by immlass at 7:22 PM on May 10, 2011


That article has nothing to do with correlation vs. causation. Why is it whenever statistics is mentioned, people bring that up?

This deserves further research. There does seem to be a correlation here of nearly r =1. I posit that the mention of statistics is the cause.
posted by humanfont at 7:54 PM on May 10, 2011 [2 favorites]


"Correlation vs causation" and "sample size" are the standard Metafilter study and statistics bugbears, whether or not they are relevant.
posted by Justinian at 8:06 PM on May 10, 2011


Overall, yes. But the only place "data mining" is mentioned is in a blue box labeled "Box 1. An Example: Science at Low Pre-Study Odds" where he specifically discusses the idea of a polymorphism appearing to be associated with schizophrenia when no such connection really exists.

The sentence where he references this article is where he says that drug companies are ompanies even use "data-mining" computer programs to extract positive findings from unpromising data, implying that he is referencing a shocking expose, rather than more of this.
posted by Kid Charlemagne at 8:06 PM on May 10, 2011


It has nothing to do at all or in any way with the anti-vax movement which anyone actually reading the article should certainly know.

It has the same distinctive stench of antivax bullshit. Take a heaping pile of paranoia about big pharma, multiply by paranoia against big government, and divide by dubious Japanese media reports of kids seeing ghosts. Baffle everyone with statistics and pseudoscientific BS and the lies travel around the world before the truth gets its shoes on.

From P_L: 1. The threat of a virulent cross-species influenza pandemic is overblown.

In my own scientific statistical sample of one person (myself), 100% of the population succumbed to a virulent cross-species pandemic of H1N1 and death was only narrowly averted by emergency hospitalization. The threat was not overblown at all.
posted by charlie don't surf at 8:14 PM on May 10, 2011


charlie don't do science

(Which is to say, the article presents scientific claims, but you are attempting to refute those claims them with emotion and anecdata, not science.)
posted by ericost at 8:18 PM on May 10, 2011 [3 favorites]


It has the same distinctive stench of antivax bullshit.

You are what's reminding me of that. Fuck science! I believe!
posted by Trochanter at 8:19 PM on May 10, 2011 [1 favorite]


Overall, yes. But the only place "data mining" is mentioned is in a blue box labeled "Box 1. An Example: Science at Low Pre-Study Odds" where he specifically discusses the idea of a polymorphism appearing to be associated with schizophrenia when no such connection really exists.

Exactly. That's not "correlation versus causation", that's "correlation versis no correlation".
posted by Philosopher Dirtbike at 8:45 PM on May 10, 2011


> (snyrbl)

Gesundheit!
posted by brenton at 10:16 PM on May 10, 2011 [1 favorite]


Wow. This was an incredibly poorly written article, and although I agree this author's axe needs grinding (drug companies are evil fuckers that lie, manipulate, and compromise the public health in order to turn a profit), I think much has been distorted. Forgive me, more of this is based on experience (I'm a primary care doc for an urban uninsured population both inpatient and outpatient medicine, my wife is an Infectious Disease doc at the county hospital) than statistics that I would like, but that's because the epidemic continues, and continues to evolve. Hopefully someone smarter than me chimes in.

My major criticisms boil down to:

1. The author assumes that because millions didn't die like in 1918, this was all a bunch of overblown hysteria. Hysteria is created by news outlets, the CDC deals with science and in my opinion, the response was generally proportionate to the threat and effective. There is much about this strain of influenza that we don't know and the pandemic continues to go on, it's just not behaving in the way anyone expected. In 2011, the majority of influenza virus isolates in King County where I live and practice were due to novel H1N1, as were influenza deaths. We don't know why its affecting pregnant women, diabetics, and the morbidly obese so disproportionately. And we don't know why there is such a strong inflammatory lung injury associated with this. And we continued to see sporadic new cases throughout the summer, outside of flu season. No, we didn't see entire families dying in the street, but was it wrong to mobilize the public health infrastructure? There's no way to really test that hypothesis.

2. The author talks about billions "wasted" on influenza preparedness, but she doesn't define what the total budget for the influenza response was, only a mention of 4 billion in Tamiflu sales, and nothing more in footnotes. It turns out, this number isn't readily available, after 30 minutes of research just now. Much of the money spent came from state and county health authorities, not just the federal government, not to mention employers and private health insurance companies. I think it is supremely disingenuous to imply that the majority of the money allocated by the government must have gone to Glaxo, when in reality billions were spent on vaccines, developing infection control plans, and public education. I personally must have spent excess of $100,000 of government money fighting influenza last year, yet prescribed Tamiflu twice, both times in the ICU when we really were just throwing everything we had at patients, and one of them died.

3. Concerns about psychiatric and behavioral disturbances with Tamiflu were neither unheard of nor supressed. In fact, I just looked through my 2010 prescribing guide and under "serious reactions" numbers one, two, and three are "delirium", "behavioral disturbance", and "self-injury, including fatal." Furthermore, the clinical evidence from the day it was approved was extremely weak and any doc who isn't doing his or her job half assed knew it. You take the drug in the first 48 hours and you'll be back to work in 6 days instead of 7.

4. Except for references to public health statistics on case numbers, most of the article's footnotes reference other opinion articles.

Finally,

Since one influenza strain usually dominates all others during a typical flu season, H1N1 may actually have saved lives by displacing more aggressive viruses.

is just a bizarre, uncited statement.

And now I know why so much bad, biased science writing lives on unchallenged in the popular press having spent the last 45 minutes writing a bad rebuttal when I should have been finishing my beer, watching Anthony Bourdain.
posted by Slarty Bartfast at 10:27 PM on May 10, 2011 [11 favorites]


Anyone wanna buy this rock? It repels tigers!
posted by ShutterBun at 10:32 PM on May 10, 2011


charlie don't surf: “In my own scientific statistical sample of one person (myself), 100% of the population succumbed to a virulent cross-species pandemic of H1N1 and death was only narrowly averted by emergency hospitalization.”

And my friend's kid was autistic right after the kid vaccinated. Medicine has to look at statistics for a reason: because one case study doesn't demonstrate anything for a whole population.

I agree that anti-vax bullshit is virulent, but the way we defeat it isn't through bluster or by resorting to the anti-vaxxers' own irrational tactics. It's through rationality, clear-headedness, and evidence-based medicine. We find ourselves in a difficult time right now; on the one hand, we have anti-vax people who'd have us believe that science is out to get us – and on the other hand, we have big pharma, which seems to go further every year in twisting medicine around to make it profitable at the expense of exactitude and therefore health.

Steady on, now. I trust there'll be some good refutations of the more outlandish claims in this article. I'd hold off until I see them.
posted by koeselitz at 10:37 PM on May 10, 2011 [1 favorite]


These drugs are as useless as any treatment on the market. I've been in medical practice for 15 years. I've never prescribed them and no doctor I know has ever prescribed them, to my knowledge.
posted by neuron at 10:40 PM on May 10, 2011


Take a heaping pile of paranoia about big pharma, multiply by paranoia against big government, and divide by dubious Japanese media reports of kids seeing ghosts. Baffle everyone with statistics and pseudoscientific BS and the lies travel around the world before the truth gets its shoes on.

I understand what you're saying: the accusations in this article, which are not really proven, are going to end up as weapons in the arsenals of various anti-science agitators who mislead people regarding what effective medicine is.

And, yeah, I agree with you, this article feeds charlatans. And it's sort of unavoidable that every instance of questionable activity by pharmaceutical companies strips some of the authority, not only of those researchers, but of every person and institution connected to them. As in, when drugs don't do what they're supposed to, people stop trusting their doctors.

But the article doesn't just arm pseudoscience. Even if the article insinuates more than can really be proven, the reasons that things can or can't be proven are really important, and concerns about a little too much cuddliness between pharmaceutical companies and government agencies are justified (even if the public considers drug companies way more demonic than they really are).

But even more than that, as pro-science folks, we can't judge criticism like that in the article on the basis of who's side it's going to serve! The instant that we do that, we stop being pro-science.
posted by nathan v at 10:44 PM on May 10, 2011 [1 favorite]


Thanks nathan for putting that a little more clearly than I did. I personally don't see the need to refute pseudoscience that is so clearly political axegrinding. But I'm glad you took a shot at it.

koselitz: And my friend's kid was autistic right after the kid vaccinated. Medicine has to look at statistics for a reason: because one case study doesn't demonstrate anything for a whole population.

The difference being, there is a directly causal relationship between H1N1 viruses and developing a severe case of the flu. Do I really need to show you the logical fallacy in your statement?
posted by charlie don't surf at 5:03 AM on May 11, 2011


Baffle everyone with statistics and pseudoscientific BS and the lies travel around the world before the truth gets its shoes on. posted by charlie don't surf

You do realize that ANY hysteria (either pro- or con-vaccine) is harmful though, right? The hype surrounding H1N1 certainly led to vaccine shortages (which you seem to have been directly affected by), not to mention lots of "boy who cried wolf" scenarios, which may have eventually led to errors in diagnosis.

I didn't interpret the article as anti-vax, just anti-hysteria.
posted by ShutterBun at 5:51 AM on May 11, 2011 [1 favorite]


charlie don't surf: “The difference being, there is a directly causal relationship between H1N1 viruses and developing a severe case of the flu.”

We both accept that, but that's not what you were trying to say. You were trying to claim that H1N1 is in all cases very severe because it was very severe in your case. I'm sorry, but that's not something I necessarily accept.
posted by koeselitz at 7:35 AM on May 11, 2011


This is article does a decent job at trying to look at the evidence of Tamiflu's effectiveness. Spending billions on a drug based on a single manufacturer-sponsored study whose raw data remain hidden seems to warrant a little skepticism. This article is anything but anti-science.

Even less helpful is someone's tale of how they got a really bad case of the flu after not taking Tamiflu.
posted by kevinsp8 at 8:00 AM on May 11, 2011


The lack of transparency in drug testing and approval in the US is appalling. And there is good reason for the people to be skeptical about the safety and rigor of the process. Vioxx / Celebrex and heart failure, anyone? That's probably only the best known of the cases, but it was a biggie. And there's a lot of drugs which get pushed through which have bizarre side effects which aren't even known until they're being taken by the masses. Mirapex and its compulsive gambling, Ambien and nighttime binging/driving, etc.

The public is skeptical because the system doesn't have built into it the kind of transparency needed for the public to have faith that they're being protected by the agency which is in place to do exactly that. And there seem to be indicators that Big Pharma is working to rig the system in their favor, treating those taking the drugs more as potential piggy banks than as people with medical issues which need quality treatment.

That Tamiflu's maker is willing to obscure the results of their study, and even blatantly refuse to provide them when asked by those who should have the right to ask for them... doesn't really help any of the mistrust.
posted by hippybear at 8:13 AM on May 11, 2011


The issue of how to interpret scientific results is an important one. Unfortunately, the only people who really understand how all of the data works are statisticians, who are the same people doing the data manipulation. Not that I'm accusing statisticians of being fundamentally untruthful, but from the statisticians I've worked with they tend to say things like "look what I can make this data do" in excited tones because they are math geeks. Whether or not researchers or corporations then use these statistical tools for evil or self-interest is up to them.

On the one hand, working in a research environment where the results had profound financial impacts for everyone around me, I learnt to be a little skeptical of published results. Too often I heard that the statisticians would "fix" something that had gone wrong in the experiment implementation. And this was despite the fact that I worked with very well-meaning and earnest people who were trying to improve the lives of children and made every attempt to be scientifically sound.

On the other hand, I have heard too many people automatically dismiss every finding of scientific studies because "you can trust any of them" and instead just go with whatever they feel is right. And I'm talking about people with graduate degrees.

So I think something needs to be done about improving the authority of science. The trouble is that any solution is almost impossible to politically implement.
posted by threeturtles at 10:11 AM on May 11, 2011 [2 favorites]


Here's the problem. While I readily admit that H1N1 in its 2009 form was overblown, nobody, and I mean nobody, can predict with any accuracy whatsoever how an influenza virus will mutate.

Imagine sitting next to someone with red hair on the subway every day for 5 months. The next day, when you get off the subway, you catch a glimpse of yourself in a mirror - and your hair has spontaneously turned red. This is the kind of thing viruses do all the time.

It wasn't irresponsible to vaccinate people - though there was some hysteria, the real danger with influenza is in the way it mutates. If it suddenly mutated into a virus that became deadly within 36 hours to everyone who was not originally vaccinated, the lack of vaccination would be a problem. As it stands, there's a chance that people who were vaccinated for H1N1 would be resistant to most mutations of the virus.

Not necessarily set in stone—but nothing with influenza is. The WHO and drug companies were perhaps not entirely admirable, but they were not behaving like looters after a hurricane, either. I am just saying.
posted by FunkyStar at 1:58 PM on May 11, 2011


As it stands, there's a chance that people who were vaccinated for H1N1 would be resistant to most mutations of the virus.

True, but there's also a chance that a mutation of H1N1 would be completely outside the realm of a vaccine developed for the old version of the virus. Or there's a chance that natural immunity received from contracting a flu in the past would work just as well to fend of whatever the new mutation is.

I'd be curious to know where I can contract this ginger virus of which you speak. I've always felt my brown hair was a bit drab, and have always had a thing for redheads.
posted by hippybear at 3:09 PM on May 11, 2011


We both accept that, but that's not what you were trying to say. You were trying to claim that H1N1 is in all cases very severe because it was very severe in your case. I'm sorry, but that's not something I necessarily accept.

----

Even less helpful is someone's tale of how they got a really bad case of the flu after not taking Tamiflu.


Okay, you guys are just deliberately being obtuse, right? Because it would take deliberate effort to misunderstand my meaning. But just in case this is an application of Hanlon's Razor, I will restate it again, simply, just in case you actually are stupid.

Out of a group of maybe a dozen or more people I know (including myself) that were all intensely sick with H1N1, they all recovered within a week by taking Tamiflu, except me. I could not get any Tamiflu or other antivirals, and I nearly died, and took over 2 months to recover.
posted by charlie don't surf at 10:14 PM on May 11, 2011


Cool story bro.
posted by Trochanter at 10:18 PM on May 11, 2011


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