Firms’ deals for flu drug draw fire
Stockpiling stirs concern on access
The Boston-based law firm Ropes & Gray made arrangements this month for hundreds of its employees and their families to obtain the antiviral medicine Tamiflu to protect them from swine flu, a move that the company calls a wise precaution but that public health officials criticized as medically questionable stockpiling.
Hundreds of other companies have also purchased or arranged for Tamiflu, many under a stockpiling program promoted by the drug’s manufacturer, Roche.
But federal and state health officials said that in some cases the practice runs counter to US Centers for Disease Control guidelines that the drug be reserved for seriously ill flu patients and people at risk of dangerous complications.
Providing the drug to healthy people - who may take it inappropriately, such as for a cold or mild case of the flu - could encourage the emergence of a strain of H1N1 resistant to Tamiflu just when the need for effective treatment is greatest, health officials said.
“We are very concerned about resistance,’’ said Bill Hall, a spokesman for the US Department of Health and Human Services. “Prescribing antivirals indiscriminately is not consistent with our guidance. Most people [who get H1N1] don’t become severely ill and don’t need to have antivirals.’’
Some Boston doctors said the practice also raises equity issues, because people not lucky enough to work for a company with a Tamiflu stockpile usually cannot get precautionary prescriptions from their own physicians, who adhere to CDC recommendations and do not want to unnecessarily deplete supplies.
The US Health and Human Services Department and its public health arm, the CDC, recommend Tamiflu, which has been shown to reduce the severity and duration of symptoms, only for swine flu sufferers who are sick enough to be hospitalized and for those who are at high risk of serious complications, such as pregnant women and people with chronic medical conditions, Hall said.
Massachusetts health officials echoed their concerns.
“The widespread and injudicious use of these important medications poses a substantial public health risk,’’ said Dr. Lauren Smith, medical director of the Massachusetts Department of Public Health. “We don’t encourage the widespread prescribing of antibiotics for ‘just in case’ uses.’’
Ropes & Gray, a prestigious national lawfirm with 1,900 employees, defended its Tamiflu access program, and Roche similarly said it had complied with government guidelines when it sold or set aside stores of the drug for nearly 300 US companies.
“There is no higher priority at Ropes & Gray than the health and safety of the firm’s employees,’’ spokesman John Tuerck said in an e-mailed statement. “Like many other professional services firms, we made the optional Tamiflu program available to our employees to combat the duration and severity of flu symptoms.’’
In an Oct. 13 e-mail to all personnel in Washington, Boston, Chicago, New York, San Francisco, and the Silicon Valley, the firm’s head of human resources, Deborah Lemmerman, said Ropes & Gray arranged for physicians to prescribe Tamiflu for employees who want it and for their family members to “allow you to have it on hand should you need it.’’ An accompanying fact sheet tells employees that “more severe outbreaks can potentially result in a shortage of available medication.’’
Ropes & Gray said it had hired New York-based Affiliated Physicians to run the program, meet with employees in 15-minute slots at the firm’s offices, write the prescriptions, and order the medication, which is then mailed to employees’ homes. Employees also had to complete a medical questionnaire. Employees, or their insurance, must pay the $100 to $200 cost of the Tamiflu, the company said, adding that it expects about 5 percent of employees to obtain the medication.
“As with any medication, Tamiflu carries risks and, for that reason, we urge you to discuss these risks with the prescribing physician,’’ the e-mail told Ropes & Gray personnel. The medication can have serious side effects, doctors said, such as nausea and vomiting, and is most effective when taken one to two days after flu symptoms are diagnosed.
The company’s fact sheet told employees to “only take it when you begin to exhibit flu symptoms.’’
Affiliated Physicians would not respond to questions. But in an e-mail, the group’s chief operating officer, Andrew Shulman, pointed to US Health and Human Services Department guidelines that say that “employers may choose to purchase antiviral drugs for stockpiling for several reasons,’’ including “to maintain business continuity’’ and “to ensure early treatment to employees who become ill.’’
But Hall said that the department’s guidelines do not mean that antivirals should be prescribed to healthy employees.
Doctors in Boston who became aware of the Ropes & Gray effort said they are worried such programs may create shortages down the line for flu sufferers who really need the drug. “This is an example of hoarding medications in response to a potential epidemic,’’ said Dr. Ron Katz. an internist.
Like many physicians, he said, he has been asked for the drug by patients who are not sick. “I explain to them that it will be very available in their time of need,’’ he said. “Decisions about whether to take Tamiflu are complex and best left up to the doctor.’’
Dr. Karen Victor, an internist at Beth Israel Deaconess Medical Center, said “the main issue here is really access.’’ The firm “is deciding that Ropes & Gray’s employees’ appearance at work is so important that they will put that above fairness to society,’’ she said.
Roche officials, however, said the drug-maker is not worried about a shortage because the company has significantly increased production and the supply is ample. They, too, said they believe HHS supports stockpiling by employers to ensure that businesses continue to operate during an outbreak. They said Roche does not dictate how companies distribute the drug, and some firms probably are waiting until employees are sick.
David Reddy, head of Roche’s global pandemic task force, said there has been very little resistance to the drug so far among swine flu sufferers.
Still, said Llelwyn Grant, a CDC spokesman, “None of our recommendations include broad dispensing. This is something we would not like to see widely practiced by employers. The bigger thing that concerns me is insuring these folks are given proper counsel about the potential adverse effects and complications associated with antivirals.’’
Liz Kowalczyk can be reached at firstname.lastname@example.org.