Podcast 5 – Tamiflu: What is it?

Tamiflu: What is it?


Chad: This is Dr. Chad Edwards and you are listening to Podcast number five of Against The Grain.


Male: Welcome to Against The Grain podcast with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy life style. Get ready, because we are about to go Against The Grain.


Brian: This is Brian Wilkes here with Dr. Chad Edwards. Chad, how are you doing today?


Chad: Man, I am excited to be in flu season and talk about some awesome topics.


Brian: Flu seasons, by default half your listeners aren’t listening, right? They have the flu.


Chad: Exactly, maybe because they’re home from work, they have nothing better to do than listen to me ramble on about a bunch of stuff.


Brian: Yes, there’s that. Our topic of our podcast today is I have the flu now I need – do I say Tamiflu? Like the woman’s name.


Chad: You can.


Brian: Tamiflu.


Chad: I think most people would say Tamiflu.


Brian: Tamiflu, it reads Tamiflu.


Chad: To be brand nonspecific, also Tami view.


Brian: It does read Tamiflu, interesting. Okay, there’s that. We have some sponsors that keep the lights on around here. Revolution Health and Wellness clinic, Dr. Chad Edwards Clinic, tell us a little bit about your clinic Chad.


Chad: Functional Medicine Clinic Tulsa Prolotherapy, Premier Functional Medicine clinic, we look for the underlying cause of illness and disease and we will use any tool that has the potential to help someone and not harm them to get them better. Lots of IV nutrition, bioidentical hormones, comprehensive lab testing, looking at the overall health picture, doing whatever we can. We also do Tulsa Prolotherapy stem cell, PRP or Platelet Rich Plasma Therapy for sport injury athletes, musculoskeletal pain, great stuff. Give us a call at 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org. Come in and see us.


Brian: You never say this when I ask you about your clinic. One of the things I like best about it is there’s not a long waiting game.


Chad: Not a long waiting game to get an appointment, not a long waiting game to —


Brian: Both, just really great service.


Chad: I will say this, sometimes we’re running a little bit behind but it’s because we’re focussed on each patient individually, one at a time. I wouldn’t make a nine o’clock appointment thinking you’re going to get in right at nine because sometimes that didn’t happen. We are going to take care of you in the best way that we can. We’ve got an amazing staff, I feel so blessed to have the people that we have. Tulsa Prolotherapy


Brian: Boy, I get in right away every time. Really, seriously, you probably feel bad because you don’t pay me to do this podcast so they get Brian right in, right?


Chad: Exactly.


Brian: There you go. Our next sponsor is Upper Cervical Health Centres. Upper Cervical is not your typical chiropractic office, they’re different in that they never jerk, twist, snap or crack your spine. They actually do an overall holistic evaluation of your health. It’s interesting to know their patients report an improvement of over 75% in their own health. Their number is 9-1-8-7-4-2-2-3-0-0 or you can go to their website at www.uppercervicaltulsa.com/newyou. Tulsa Prolotherapy


Tamiflu, Chad, let’s talk about it, what is it?


Chad: Let’s talk about Tamiflu.


Brian: Let’s talk about Tamiflu.


Chad: I used to do a lot of emergency medicine, I used to work in urgent cares and things like that and I would get patients that would come in and at the time I was much more traditional in my approach to medicine. Then I’ve got the patients on the other side where they’ve got the flu — Tulsa Prolotherapy


Brian: Pretty focussed young doctor doing it by the book.


Chad: Yes exactly, I’ve got to help these people, I’ve got to give them their pill. You get somebody that has the flu and what are you going to do? Well, you give them the anti-flu drug. There’s some older ones, amantadine and then some other anti-viral medications. The Tamiflu is what we’re going to focus on, Relenza is another anti-viral that’s been shown to have some effect. Most of the marketing stuff has been on Tamiflu. Tulsa Prolotherapy


Brian: Tamiflu for the people that don’t know, I imagine most do but they’ve heard it on the news. It is a controversial subject but it’s, if I get the flu, if I have the flu, Chad, I take Tamiflu and it reduces the symptoms. It’s the claim.


Chad: Yes, so that’s an interesting point. Let’s talk about a couple of things. The first one is, yes, the thought is that Tamiflu is going to make you better. What’s actually been shown in the studies, Tamiflu is developed by Roche, R-O-C-H-E, that’s the drug manufacturer that developed it. They did some studies and there’s some controversy around that and we’ll talk about that after we get through some of this stuff. Because that’s going to be part of the Against The Grain stuff that we’ll discuss.


According to their package insert, the package insert it’s the safety information, who should get it, the prescribing information and how do you prescribe it, warnings, indications, contraindications, all those things. According to their package insert – Excuse me, I’ve got this cough.


Brian: You need a Tamiflu, get him a Tamiflu right now. Marshall, can we get a Tamiflu in here?


Chad: According to their study, they breakup their results based on the studies that were done in two age groups. They’ve got two weeks to one year, there are two studies that were performed. They’ve got one to 12 years old and they’ve got 13 years and up, and then they’ve got geriatric patients. I believe those were over the age of 65, I believe but I don’t remember that. According to the package insert, two weeks to one year, again like I said there’s two studies and the “in that”. Let me start with the beginning, Tamiflu according to their statement is indicated for the treatment of acute and complicated illness due to influenza infection in patients two weeks of age or older, who have been symptomatic for no more than two days.


When we look at two weeks to one year, because remember it’s indicated for two weeks of age and older. In the two studies that they performed, these clinical trials were not designed to evaluate clinical efficacy or viral logic response. In other words, we don’t know that it works on two weeks to a year, we have no studies proving that it works. That was directed —


Brian: Here we go again.


Chad: Exactly, that was directly from theirs, but these were safety studies. Is it safe to give it to these kids? They concluded that it was safe. There’s no studies on patients less than two weeks of old.


Brian: It doesn’t necessarily prove effective in treating the symptoms but I’s safe.


Chad: Well get into that too, stay tuned. They second group, one to 12 years of age, in the studies that were performed they got better one point five days faster. If you consider something like a flu, say seven to 10 days, you’ll get better at eight and a half days instead of 10.


Brian: It sounds like a miracle jack.


Chad: Yes. 13 years and up, they got better at one point three days faster, and geriatric patients, they got better one day faster. We’re talking about somebody that’s diagnosed with the flu, that has had symptoms less than two days, can get a medication and it makes them better one point three days faster according to the package insert.


Brian: For those of us that are in those categories, that have children in those age, it just means that they postpone their next sickness for one point three days.


Chad: In that group it’s one point five days.


Brian: One point five days. Your kids are going to get sick again now with a different strand of something in literally three days.


Chad: Yes, but again I think it’s important to understand that this is the data that was released by Roche and again, there’s a lot of controversy about this and we’re going to go over that more specifically.


Brian: Roche again is the manufacturer of Tamiflu, correct?


Chad: That’s correct.


Brian: How much do you know about Roche? Is it Roche?


Chad: I think it’s Roche.


Brian: Roche, do we know anything Marshall about Roche?


Marshall: I don’t know anything about Roche but I can look it up.


Chad: It sounds good, I didn’t research that.


Brian: No, I want to know more about this company. What do they do? Are they a publicly traded company? What other treatments do they have? We’ll get to that, Marshall is going to look it up.


Chad: Awesome, cool. Okay, then further things about Tamiflu, who should take it? According to the CDC, only certain groups. Those sick enough to be hospitalized with the flu and again, we’re looking at this because there’s potential for some harm, there’s potential. We talked about a bit safe, well, the CDC says only certain groups should take it.


Brian: Can I ask you a quick question?


Chad: Yes


Brian: What the heck is Tamiflu? Is it a pill?


Chad: Yes, well, it can be a liquid, it comes as a liquid, it comes as a – I can’t remember it’s a capsule or a tablet, I don’t remember on that one.


Brian: Okay.


Chad: The dose for adults, 75 milligrams, take one twice a day for five days. That’s the standard treatment dose.


Brian: You’re supposed to take it early in on the —


Chad: The earlier the better, at least according to those studies. This stuff is relatively expensive, some insurances will cover it, many wont. You’re looking at about $125 for a one dose pack, five days, twice a day.


Brian: Got you.


Chad: That’s about what you’re looking at. I think that $125, CVS, those kinds of places. That’s about what you’re looking at, plus or minus a little bit. Tamiflu, it’s this medication, it’s what’s called a neuraminidase inhibitor. When you talk about the flu, we’ve all heard about H1N1. The Hs and the Ns actually refer to proteins that are on the lipid envelope of this virus, the flu virus. You have the hemagglutinins and then you have the neuraminidase. Anything that ends in –ase medically speaking is an enzyme and an enzyme catalyses a reaction. It makes-a reaction go from point A to point B. That reaction may or may not occur without the enzyme, but the enzyme makes it go much faster and makes it go that way.


Neuraminidase is basically an enzyme that works on sialic acid and it helps with what’s called the virulence factors of flu. You have different ones, different neuraminidases. The H1N1 is type one of the hemagglutinin and type one of the neuraminidase. You might have H5N3, which is a different virus structure and it release the capsule, those proteins on the outside which make it more severe or less severe. That’s why with swine flu, the H1N1 there was such, “Oh my gosh this is really bad. H1N1 is bad,” because of those virulence type factors. I apologize I have to clear my throat.


Tamiflu is a neuraminidase inhibitor. It prevents that protein, that enzyme from doing its thing. Since one of the functions of neuraminidase is enabling that virus to spread, release itself from the infected cell and to be able to migrate through the respiratory epithelium. That’s the cells that line your nose and lungs and all those things. That neuraminidase helps that virus propagate, go to the next cell, come out as virus particles that we can cough out and spread. Tamiflu is a neuraminidase inhibitor, so in concept, it prevents that process. If you can prevent it from releasing from the infected cell, it can’t spread, either in the host, the sick person, or going to somebody else. That’s the idea and the concept.


Brian: It doesn’t kill it per say. It represses it to spread.


Chad: That’s correct. Yes, it contains it. It’s a containment strategy.


Brian: That’s important, you make it better a day and a half faster, but it doesn’t necessarily reduce your symptoms immediately.


Chad: That’s exactly right. Again, anytime we’re going to use that day and a half faster, this is based on Roche’s original reported data.


Brian: Got you.


Chad: We’re going to come back to that. Okay, so who should take this stuff? This neuraminidase inhibitor called Tamiflu? Those sick enough to be in the hospital? If you have severe, complicated, progressive health problems such as COPD, asthma, diabetes, heart disease, suppressed immunity system, those kinds of things. Anyone less than the age of two, pregnant women, now this is interesting to me because it’s a pregnancy category C.


Brian: Pregnant women can’t take anything, can they? They can’t drink, they can’t smoke, they can’t take aspirin. Can they take aspirin?


Chad: No.


Brian: There is that.


Chad: Exactly. Pregnancy category C means there is no human trials showing outcomes. There are some animal trials on Tamiflu, but there is none for humans. That’s why it’s a category C.


Brian: Okay, hold on a second. That’s important, category C means?


Chad: It basically means there is no evidence of harm. With pregnancy categories there is, A, B C, D and X. X is like if you remember thalidomide back in the ’60s, ‘70s, somewhere in the ‘60s, nausea drug for that morning sickness stuff caused major birth defects.


Brian: It’s like eating poison?


Chad: Exactly. Statins like Lipitor and Crestor and all those things, those are category X drugs. You do not take those when you’re pregnant. Category D is there’s evidence of human harm and you’ve got to seriously weigh the risks outweighed by the potential benefits. This one is category C, there’s really no evidence either way. Category B is shown to have some safety and category A, is like free for all. You can take it and that’s like oxygen.


Brian: In this category C for Tamiflu, because I think this is important for people, when they say, “It is unknown,” is it that it means because there’s not enough research? It can mean a consortium of different things correct?


Chad: Well, but nobody is going to do studies on pregnant women to see is this really safe? There’s a lot of drugs out there that are category C. There’s a lot and I just think it’s interesting that we are recommending that pregnant women take Tamiflu if they get the flu when we don’t really know.


Brian: Yes, It’s important.


Chad: There are some observational studies showing women on Tamiflu didn’t have any apparent negative effect.


Brian: Right, but it’s an unknown fact and doctors do recommend for pregnant women when they get the flu to take Tamiflu in general?


Chad: In some cases, yes.


Brian: Interesting.


Chad: You’ve got to look at risks, benefits all those kinds of things and you’ve got all kinds of doctors out there. Some doctors don’t know enough and will say, “Oh yes here is your Tamiflu.” Some doctors are very well versed and would say, “I really wouldn’t recommend it in this case.” It’s really an individual kind of thing.


Brian: Got you, okay.


Chad: Those patients that are less than 19 years old on long term aspirin therapy, American-Indians or Alaskan natives, morbidly obese, nursing home and long term care facility residents, those are the categories according to CDC who should be taking Tamiflu if it’s indicated. Then we talked about the safety thing. Again, I’m sticking to the package insert that comes with Tamiflu. The major things that we have seen are skin reactions and hypersensitivity. We’ve seen some anaphylaxis, so major hypersensitivity, allergic reactions, got to go to the hospital, airway breathing problems. You could die of you don’t get treated.


Then you have what’s called toxic epidermal necrolysis and Stevens-Johnson, again potentially fatal skin hypersensitivity reactions. Those are possibilities. That only happens in hypersensitivity kinds of cases. Interestingly, there are neuropsychiatric manifestations. Again, just straight from the package insert. These are mainly in kids, but we’ve seen hallucinations, delirium and abnormal behaviour. Now, that sounds like, “Well, my kid was acting up yesterday and he had abnormal behaviour.” That’s not what we’re talking about here. We’re talking about some serious cases.


In some of these cases, the abnormal behaviour was so severe it resulted in fatal outcomes. In other words, apparent suicides. In fact, if my memory serves me correct, Tamiflu was banned in Japan, because of a few of these cases. We’re talking about one percent. We’re not talking half the people that take this, small percentages, but when it’s that severe, you’ve got to look at the risks and benefits. When you say it’s safe, I would argue, “Maybe that’s not a hundred percent the case.”


Brian: I think to your point if we’re talking about a cure for cancer, obviously there’s a risk reward situation there, a life and death situation. When we’re putting in what you said in context for the day and a half, a day and a half normally or somewhere around that, is it worth even the one percent chance? A day and a half I’m feeling better versus even that one percent risk I could get some serious mental disorder, right? It’s not worth it in my opinion.


Chad: Absolutely, again I’m going to be very cautious saying, “Do not do this or absolutely do this,” because I cannot, unless we have a doctor-patient relationship, one-on-one, face-to-face, individual relationship, do not misconstrue anything that I say as that medical advice.


Brian: Because it could be the case that you have, I know my youngest son, Cash, at one year old came down with a rotavirus. It’s pretty serious for little guys. We were in the hospital with IVs. If I could have bought a day and a half of him not being sick and throwing up among other things, it might have been worth it. Because there can be life and death situations when it comes to those things, but generally speaking probably not worth it.


Chad: In my perspective and certainly not with every patient, but what I’ve seen, is when I was in urgent care, ER, those acute care setting kind of situations when I would diagnose them with the flu and they would be like, “Okay, give me that Tamiflu.” You’ve got a mild fever. You feel bad. You feel bad, but this is not a panacea for the flu. It’s not and the CDC doesn’t even recommend it in those cases.


Brian: Marshall do you have any information on Roche, because I want to do a little blurb here if I will on the business side of things Chad here.


Marshall: Okay, so Roche is known has F. Hoffman-La Roche AG. It’s a Swiss global healthcare company. It operates worldwide under two divisions; pharmaceuticals and then diagnostics. Okay, and so in 2014, they did $48 billion worldwide and they’re the third largest pharma company worldwide.


Brian: They’re based in Switzerland?


Marshall: Based in Switzerland.


Brian: Interesting. It’s a whole different dynamic folks of how things operate and how things are regulated with the Swiss, I think we all have the general understanding of that. I’ll say this, having worked my background is politics but also packaging, I’ll the 2Ps, right, packaging and politics and the third one is PR, right? They all go together. One of the things I learnt in packaging with some high end pharmaceutical companies is, it was a decision made a couple of decades ago that drug companies were sick of trying to prove to doctors that their drug worked, right, they were sick of it.


Chad: Interesting.


Brian: Yes.


Chad: “I don’t want to market anymore.”


Brian: Yes, “We are done with you doctors who want to know science and stuff like that.” Trust me a billion dollar company does not start with the public health factor, that’s not where they start, they start with profit and they have to. Hopefully the consumer is educated enough to either send them back a profit or not based on their results, right? That’s how it works.


Chad: Absolutely.


Brian: Yes. The problem though with their theory is couple of decades ago they were going through doctors or otherwise known as scientist like yourself Chad, right? Now, they have bypass with the mediums that are available, the scientist and going direct to the consumer, it’s a big push. The reason they do that is, one, they can educate the consumer who they generally think is not as smart as the doctor. Which they would be right because don’t make buying decision on facts, they make buying decisions on feelings, right? I think we all know that. The second factor is that it’s much cheaper. Your distribution channel is much, much cheaper if you can align it correctly.


We have the internet, first of all we have the television which has gotten broader in scope and it’s easier to get to the consumer. What they did was as you see this commercials were, means the average have no idea Viagra is good for me. I have no idea if Tamiflu is good for me. I see the commercials, I see the information on the internet, on, WebMD if you will. I say to your point about you working in a clinic people are now coming and the effect has been very positive for these drug companies, for these billion dollars Swiss on drug companies. Because now you have people making buying decision Chad on what drug they are going to use before they even come into your office. They say I want Tamiflu. What the heck do they know about Tamiflu?


Chad: Exactly, and that’s much to my point. Now, what we’ve done so far is stuck to what Roche wanted you to here. What Roche wanted you to know, and that’s that you get better one point three to one to one and half days faster.


Brian: They didn’t hear that via scientists, they heard that via a commercial, a PR campaign or whatever the case is direct to the consumer.


Chad: I actually saw this commercial last night which I hadn’t paid attention to until my office staff was telling me about it. They said there is no small flu and so you’ve got these gigantic characters. You are big kid, big adult walking around everything, else is small talking about how big the flu is and Tamiflu fixes all of that. This was yesterday, in the commercial it said, “You get better one and a half days faster,” that’s I’m paraphrasing but it was one and half days, I remember that specifically. Because I had just done all the research for this podcast and talking about where does this data come from? That’s what the manufacturer of Tamiflu want you to know.


Brian: Try suing a Swiss owned billion dollar company because of misinformation, try that, see how that works for you.


Chad: Here’s the interesting thing and we’ve talked about British Medical Journal before. This is a very prestigious major medical journal and I want to read this and then you can go to bmj.com/Tamiflu and that’s the British Medical Journal. This is where I’m getting this data. They have what’s called the open campaign which aims to achieve appropriate necessary independent scrutiny of data from clinical trials. “Working with others, we seek to highlight the problems caused by lack of access to data and we welcome any suggestion on how to take things further.”


Then they say the Tamiflu story, “Our first open data campaign initiative relates to a public promise Roche made in 2009.” Now this drug was released in 1999, we are talking about a 10 year difference. “In 2009 to released four clinical trial reports in response to an investigation by the British Medical Journal and Cochrane collaborators; Peter Doshi and Tom Jefferson.” Now, if you look at the Cochrane database Tom Jefferson is on virtually on every one of those as a Cochrane collaborator, reviewing all of the data. He is in the middle of the flu stuff, period.


They were looking through all of this and they said, “There’s some problems here and we need the data.”


Brian: In other words, there’s some science problems here, right?


Chad: Correct. We don’t have all the data, we don’t have all the information.


Brian: Certainly not profit problems


Chad: Exactly.


Brian: I got 99 problems in profit ain’t one.


Chad: Exactly. Under that pressure Roche in 2009 made a promise to release their full data.


Brian: Sure, yes.


Chad: Here is their bottom line. The World Health Organization recommends Tamiflu but has not vetted the Tamiflu data, and this is from the British Medical Journal, prestigious journal, this is not from my opinion.


Brian: The British Medical Journal is pretty important —


Chad: It’s a major peer review medical journal, right?


Brian: Yes.


Chad: The EMA which is European Medicines Agency I believe approved Tamiflu but didn’t review the full Tamiflu data sheet. The CDC and the European EDC encouraged the use and stock piling of Tamiflu but did not vet the Tamiflu data. The majority of Roche’s face two treatment trials remain unpublished over a decade after completion.


Brian: Wow.


Chad: They completed the studies, 10 years later they hadn’t published it.


Brian: Wow.


Chad: They made their recommendations, this one to one and half days after based in their incomplete data. They just picked the ones that worked and used that, we’ll get into that. In December 2009, Roche publicly promised the independent scientists access to full study reports for selected Tamiflu trials, but today, now was as at 2009 the today part. The company has not made even one full report available. Releasing the trial report would allow independent academics to answer questions about this globally stock pilled Tamiflu drug. Roche has been very reluctant


By October 2013, the Cochrane reviewers had received the full clinical study reports for 107 studies from the European medicines agency, Glaxo Smith client who developed Relenza and Roche. Then the Cochrane review actually did an update in 2014, and both the Cochrane library and the shortened version as two separate views one per compound in the British Medical Journal. What did the Cochrane review conclude? Well, they said that for adults they reviewed all the data. They found that the adults actually instead of one point three days, they got better 16 hours faster. 16 hours.


Brian: Yes. Which seems like an eternity when you have the flu.


Chad: It can sure, it can.


Brian: Certainly not eternity, yes.


Chad: We are talking a drug that costs $125 for a five day pack that has potential to course severe psychiatric problems in some patients that gets you better 16 hrs faster. Is it worth it?


Brian: Yes.


Chad: I can’t answer that question but it raises some serious questions for it.


Brian: I think there’s a third category there, Chad, you’ve articulated it. It’s categorizing the class of drugs that we don’t potentially know all the long term side effects, right?


Chad: Without question. Getting released in 1999, now we don’t look at long term stuff. Here is some other interesting —


Brian: Don’t you just find it interesting though? Don’t you just find it interesting that the company that makes it is headquartered in Switzerland? You’ve seen it before, there’s these drug companies that emerge oversees in protected areas that really have no incentive to long term care about the effect of a drug on your body, have zero incentive.


Chad: Exactly.


Brian: Right, why would they make an investment to A, find that out. B, to wait for it when there is billion dollar profits now that are virtually protected from all legislative action, right?


Chad: Right.


Brian: Which amazes me that the FTA would approve such a vendor on a mass of scale based in Switzerland.


Chad: Again, we are going to talk more about the flu, the history of flu, flu shot, all that stuff.


Brian: On our next episode.


Chad: In our next Podcast. There are such fears related to flu. My opinion, what I have seen, I don’t think the average person fears flu because it will kill them, I think they fear flu because it makes them really stinking bad, that’s my opinion. That’s what I have experienced. In some cases it can be life threatening and it sucks. The flu sucks.


Brian: I think Tamiflu has done a great job and Marshall as our brilliant single by the way, young man that operates the show. Marshall, when you think of Tamiflu — part of this podcast I wasn’t thinking not about you, but I was not really thinking that it was just a day and a half. For some reason I was thinking, “I’ll go get Tamiflu and I’m out with the flu.”


Marshall: I thought it treated the symptoms.


Brian: Yes, like immediately.


Marshall: Right.


Brian: You are sick now and in 10 hours you’re going to be all right.


Marshall: Right. You take it and immediately it starts fixing whatever is wrong, getting rid of the virus.


Brian: We have got that somewhere, right? Based on zero factor.


Marshall: Zero factor.


Brian: But we have got it somewhere.


Marshall: From our friends.


Brian: YouTube.


Marshall: YouTube.


Brian: Facebook, something. That’s interesting Chad. What do you think of that? What do you think of that perception? Is that pretty mainstream when someone comes in your clinic?


Chad: I think so. I think that, “Yes, give me that stuff so I feel better.”


Brian: Yes, immediately.


Chad: You take a decongestant and it works right away. It is not the case.


Brian: What do you think in Tamiflu opens up some bigger questions, is how people view their own health care. We live in a fairly fast pace environment, right? Do you see a lot of people to come in the clinic and they are just all about immediate fixes? Is that kind of the generation that we live in, that you see?


Chad: Of course, absolutely. Who doesn’t want to feel better yesterday?


Brian: But generally what are the ramifications that people don’t generally ask, right?


Chad: Correct.


Brian: Why is that do you think? What’s your opinion?


Chad: I think it is a right now the society. If I’m going to categorize older patients, I would say 60s, 70s, 80s year old patients tend to be very compliant the medicine in their era was very paternalistic. Meaning, “I am the doctor, here is your pill, you take this pill, do not ask me questions.”


Brian: Process.


Chad: Right. They will go home and take their pill. Even though that pill makes them every time they stand up they pass out they are not going to question, they are just their doctor is going to do it.


Brian: They come from a generation where the idea of a doctor was very, it was very respected and trusted, right?


Chad: Right.


Brian: They did what he said no matter what he or she said.


Chad: We progress today and our younger patients– We have had some whether in the last couple of days, here in Rose we’re kind of crummy yesterday. Older patients will leave a day early.


Brian: To get to the doctor.


Chad: I have seen it. I had patients they would have an eight o’clock appointment and they would leave six hours early to get there, to mean, “I didn’t want to miss that appointment.” You get a 25 year old and they’ll be like, “I’m not coming.”


Brian: I’m not coming.


Chad: They may not even call to cancel.


Brian: This is Marshall. Marshall is 25 or something like that, this his generation, he screwed it all up. Although I will say this guy is a little different, but.


Chad: They will not even cancel. They’ll be like, “I forgot about it, I have been busy.”


Brian: Yes, not even a courtesy call, nothing.


Chad: That did not make them a bad person, It’s a different paradigm. I think today we are faster paced, we want to be better now, we’re burning the candle on both ends, we do not have time to be sick, “Give me that Tamiflu so I can go.”


Brian: Tamiflu is one of these areas where this Roche company has had a generation of people that aren’t really concerned with a lot of facts. They’re concerned with the possible quick treatment of their flu symptoms.


Chad: Yes, exactly. Tamiflu wasn’t developed for that. It was developed for severe complications to keep people out — I say this, I don’t know that, but this is what the CDC recommends it for, is this category. Now, we’re being marketed just like that commercial we talked about. We’re being marketed very differently. We’re being marketed, “You got the flu, you got to go get your Tamiflu.”


Brian: Yes, of course.


Chad: Have you ever heard of Edward Land?


Brian: No, I haven’t.


Chad: Yes, I hadn’t either. He was a scientist —


Brian: I appreciate you throwing that in, that you hadn’t either.


Chad: A scientist who invented the Polaroid instant camera.


Brian: Okay, of course I have heard. Yes.


Chad: Who hadn’t heard of that guy?


Brian: Those are coming back by the way.


Chad: Marketing is what you do when your product is no good.


Brian: [laughs] Which is 99% of products right?


Chad: Exactly.


Brian: The catch is with these commercials, is if you think about it, it’s true, right? Even if you have a good product. Think about a commercial that would exist for people listening to this podcast were, “Hey, I have the flu and it’s really, really bad and it is coming out of both ends and I am not going to take Tamiflu because it might give me some serious psychiatric side effects. I’m going to stick it out a lot of pain in the next day and a half and I want you to buy nothing. This is what you do.” People would be like, “What is this commercial here?”


Chad: That is right.


Brian: Just stick it out big guy, tough it up.


Chad: That does not sell, big up this drug is going to sell.


Brian: No, it is amazing to me it does not sell. That when we think about a Nike commercial what they just show the shoe being made basically in a waffle maker. Put the rubber in there. The original Nike shoes in a sweat shopper overseas. It certainly does not have any effect that would want to make you buy the product. That is for sure, right?


Chad: That is right.


Brian: It is not different with drugs and it’s the one area when people have to be a little smarter than the marketing guys. Surely you go by a shoe and you might waist a little money but you are cool with your friends. Marshall was a basketball player, so I am sure he wasted a lot of money on sneakers that did not make you jump any higher, right Marshall?


Marshall: That was the only thing that got me off the ground.


Brian: The shoes?


Marshall: The shoes.


Brian: And the only thing that made you dunk a basketball despite being 6’7?


Marshall: Yes, exactly.


Brian: Right, it is totally the shoes, no heights no physical attributes at all. In the same respect you have these strategies that are very affective, that are used in drugs. The problem with that is it’s much different than a shoe because you get the wrong shoe not a big deal, right? You get a buster? No big deal. You get the wrong drug and you can have that, says, “Hey we will save you a day and a half of the flu” but then you have long term psychiatric problems or maybe short term, because maybe you suicide.


Chad: That is right.


Brian: That is pretty sad to think about.


Chad: In a 1998 study, it was shown that the number four cause of death in America was properly prescribed medications.


Brian: Wow.


Chad: Not drug interactions, not overdoses, not allergic reactions, these were properly prescribed medications.


Brian: I bet it’s higher than that Chad.


Chad: It very well could be.


Brian: Yes. I bet it is in the top two.


Chad: It is just what was shown. That was just what was shown.


Brian: Yes. This is rampant in your industry and I think the effect is — I would say although I do not have any evidence and maybe you can enlighten us on your own experience. That when I talked about direct consumer marketing from these drug companies, and Tamiflu being one of those primary case studies that we would use. Based on the evidence that we have here, do you think there is a liability for doctors now not to prescribe something that a patient wants to because that patient will go elsewhere. I hear a lot of people say, I’ve even heard people say about you if I can be honest.


Is, “Chad is not going to get you a Z-pack when you are sick. We had an earlier show where I begged for a ZPack when you’re sick,” we had an earlier show where I begged for a ZPack and you said no. It’s because you believe in the facts. That’s no problem, but I think there is a lot of people that would choose another doctor based on that.


Chad: That is true. There’s no question. I remember I was working in the emergency room so this is my HIPAA compliant story.


Brian: We got a HIPAA compliant button.


Male: HIPAA, Health Insurance Portability and Accountability Act.


Chad: I was working in the emergency room one night and I was pretty cynical at that time. You are in the emergency room and then people will come in with a paper cut that they’ve had for a week and they’ll say, “Why am I not being seeing right now?” And I’m like, “Well, because the guy next to you has no pulse.”


Brian: That is going to be another show is what you’ve seen in the ER. A whole show, maybe two shows.


Chad: We can do that. It’s good stuff.


Brian: Yes, entertaining.


Chad: Fascinating place to work. I love the emergency, I really do, I love the emergency room.


Brian: We should actually talk about the dynamics of an emergency room and how it works. I’m dead serious because, no pun intended dead serious. Because I think the emergency room is one of those places that when I go to emergency room my finger has been cut off and they tell me to wait in the waiting room. I just need a better understanding and how that all works.


Chad: Let us do it. Maybe we will do it really soon.


Brian: Because I’m bleeding and my finger is off and I fell it needs to be put back on now but the doctor is like, “No, we’ve got someone else.” I just want to understand that.


Chad: I get it, we’ll do that soon.


Brian: We’ll do that.


Chad: Yes


Brian: Okay.


Chad: Where were we?


Brian: I do not know. You worked on the ER you saw.


Chad: This is my HIPAA compliant story. This lady, she comes in at the very beginning of the shift, and she came in and she had a cough. She had no fever, she had no other problems, she had a cough. Not that she felt bad because of the cough but she was in her 60s, are clearly affluent, I think she had some social expectations. Like she’s a high highfalutin kind of thing. She came in and she said, “I have this cough.” I did my medical exam, there was absolutely no negative physical findings, everything was completely normal on her. Her vital signs were completely normal. Everything was normal but she had this cough.


She was afraid that she had bronchitis. Maybe she did, maybe she didn’t. I think we even did blood counts, and those kinds of things, which again, were all normal. This qualifies as an upper respiratory type infection. There’s no good scientific evidence to support the use of antibiotics in these kinds of cases. Then you have the potential for all kinds of other things, and so I said, “Everything looks normal to me. We can get you some medicine for your cough. We’ll try to make you more comfortable.” She’s like, “Well, I need an antibiotic,” and I said, “There’s no scientific evidence to support the use of antibiotics in this.”


Brian: How many times have you had that conversation?


Chad: Oh my goodness, till I’m blue in the face. There is a major push by the way to limit the use of antibiotics, governmental agencies like CDC, and those kinds of things. Because we overprescribe antibiotics and it’s leading to the emergence of multidrug-resistant bacteria. This is a potential major problem. We should probably talk about that in a future podcast too.


Brian: Yes, I’d love to. It’s all over the news. I think it’s a great topic.


Chad: We need to minimize and save these antibiotics for when it really matters, and your cough with all due respect doesn’t matter. You’re going to get over this in a few days regardless of what we do. If it progresses and gets serious, now that’s a different story, but now we’re dealing with a different scenario. I politely told her, “There’s no evidence to support the use antibiotics,” and she said, “Well, my doctor would give me an antibiotic.” I literally just had to laugh. I just had to chuckle, and I was like, “Well Ma’am, I’m sorry, but you’re in the emergency room. You’re condition is not a true emergency. We’ll do the best we can to treat you, but if you don’t like your care, and you want the care that your doctor would give you, then perhaps you should have seen your doctor.”


Brian: That’s so nice. Very, passive-aggressive. Very passive-aggressive, but I like it. I like it. Did she buy the hospital and fire you?


Chad: She threw such a stink I was like, “Fine. I’ll give you erythromycin.” Erythromycin is the category of drug that I would have chosen for that kind of case. I ended up giving her erythromycin. The side effect that can come with that is some gastrointestinal upset. The nurse came back and said, “She can’t take erythromycin because it upsets her stomach.” I was like, “Okay, so you’re asking for a –”


Brian: Sounds like a peach of a lady.


Chad: Yes, and I was like, “So you’re asking for a very specific antibiotic, you want what you want.” I don’t think I’ve ever said this to a patient, but I really wanted to say, “If you know what you want, or if you want to be able to prescribe yourself this, then maybe you should go to medical school.”


Brian: I hear you can do it online, it’s fairly easy.


Chad: Yes, just with enough Cheerio box tops. You’re good.


Brian: It baffles me, people who talk about — It’s actually an epidemic, I would call it an epidemic, as an MBA, right? [laughter] Not an MD, but my observation of what expert means in the health industry these days blows me away. You have all these nutritional companies, and network marketing companies that you would be more than qualified to speak to. Given that you have a very good comprehensive understanding of the body, and how things affect people. If you step back and you look at it, it all comes back to where we’ve started with the Tamiflu, and that is people aren’t making buying decisions based on facts.


In fact, they’re making buying decisions from supplement companies, and people that they know that don’t even have a nutrition degree, or any kind of background in nutritional supplements, or medicine at all. I think capitalists, guys like me, guys that are looking for a profit, have taken advantage of that, so you have hospitals that cater to lifestyle. What the heck do we know about medicine, but we’re going to make you feel really good when you come here. [laughs] I think we could name a few.


Chad: I’m all for that.


Brian: Yes, there’s nothing wrong with that, but it can’t be absent of science, but there’s a universe in which both can exist, right?


Chad: That’s right.


Brian: I think that’s what you’re passionate about. Getting down to the science in a manner that makes the patient feel cared for and loved. You have both, you’re doing pretty good buddy.


Chad: I try.


Brian: Yes, look at you. You know, Chad and I knew each other in college. I will say that this guy is extremely smart, always has been. Has had a passion for medicine since I knew him. My gosh, Chad, it’s been a long time since we’ve been in college.


Chad: It’s been a minute.


Brian: It’s been a minute. We’ve been through a lot. We’ve been through it. That’s the end of our show today. We appreciate everyone listening. Stay tuned for the next podcast.


Chad: The flu shot, it’s going to be a good one.


Brian: Flu shot, it’s going to be a great one.


Male: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next weak where we’ll be going Against The Grain.


[Audio ends 00:45:32]