John G. Bartlett, MD; Frederick G. Hayden, MD
Potential Financial Conflicts of Interest: Consultancies: F.G. Hayden (Medimmune, Merck & Co., Inc., Roche); Honoraria: F.G. Hayden (Roche); Grants received: F.G. Hayden (Protein Sciences, MedImmune, Merck).
Requests for Single Reprints: John G. Bartlett, MD, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 437, Baltimore, MD 21287; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Bartlett: Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 437, Baltimore, MD 21287.
Dr. Hayden: University of Virginia Health Sciences Center, Charlottesville, VA 22908.
Table. Avian Influenza Infections in Humans, 1997–2005
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Michael L. Rolfsen
October 17, 2005
Ethics of personal stockpiles
In the September 20, 2005 Annals, Bartlett and Hayden, provide an excellent overview of the potential catastrophic results from the next influenza pandemic with the H5N1 virus. The reported overall mortality of 50%, with up to 50 million deaths certainly gives us cause for concern. It is very reasonable to warn and plan for such an eventuality. However, when this fear is coupled with a recommendation for expanding "personal stockpiles of antiviral agents"(1) I am afraid that we may be crossing the line.
According to 2000 data, there are over 779,723 physicians in the USA.(2) With such a devastaing virus potentially facing us, if we were to obtain our own personal stockpile wouldn't we include our own family and some friends? If each physician wrote only a few prescriptions for personal use, we could easily deplete the supply of Oseltamivir prior to any outbreak occuring.
As physicians we have been granted by society the privelege to prescribe drugs for the good of our patients. When there is a known limited supply of an agent and a predicted catastrophic demand, to obtain a personal stockpile either by writing our own prescription or having a colleague do so is unethical. It is tantamount to insider trading which has brought so much disdain to corporate America recently. Lets not do the same to Medicine.
(1)Bartlet JG, Hayden FG. Influenza A (H5N1):Will it be the next pandemic influenza? Are we ready? Ann Intern Med. 2005;143:460-461
(2)Blumenthal D. New Steam from an Old Cauldron-The Physician Supply Debate.NEJM 2004;350:1780-1787
John G. Bartlett
Johns Hopkins University
November 28, 2005
Response from Author
In our editorial we stated that " . . . perhaps even personal stockpiles of antiviral agents makes good sense . . .". Dr. Rolfsen makes a now more obvious point about the problem of drug shortage in the event of widespread procurement of personal stockpiles. This is an issue that has become the subject of some substantial analysis and concern since our editorial was submitted. We agree with Dr. Rolfsen as well as the position statement of the Infectious Diseases Society of America(http.//www.idsociety.org), which advise against personal stockpiling of these drugs. The possible need for personal stockpiles has been mitigated by the recently announced federal goal of obtaining sufficient drugs to treat 25% of the population in the new HHS pandemic plan, although an even higher target should be considered. In the near- term healthcare institution stockpiling remains appropriate, as it targets drug availability to the two groups highest in the NVAC/ACIP prioritization scheme, hospitalized patients and healthcare workers.
Bartlett JG, Hayden FG. Influenza A (H5N1): Will It Be the Next Pandemic Influenza? Are We Ready?. Ann Intern Med. ;143:460–462. doi: 10.7326/0003-4819-143-6-200509200-00011
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Published: Ann Intern Med. 2005;143(6):460-462.
Infectious Disease, Influenza, Pulmonary/Critical Care.
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