Society
Put away those painkillers
Published 21 November 2005
Observations on viruses
If, as is feared, the avian flu virus H5N1 mutates and mingles genetically with the more serious human influenza A virus, enhancing its capacity for human-to-human transmission, we face the possibility of a terrible pandemic. With a 50 per cent mortality rate reported from sporadic cases of bird flu in south-east Asia, we can assume the new mutant will be at least equally lethal.
What are the prospects for prevention and treatment? They are not reassuring. There is no vaccine for human use, because we do not yet know what form the virus threat will take. In any case, flu viruses are so innovative that they manage to thwart vaccination measures by keeping a step or two ahead through rapid genetic change. There are anti-viral agents, but the H5N1 virus is already resistant to two of these, and shows a cocky tendency to become resistant to the only potentially useful agent for humans, oseltamavir, even as it is used during treatment.
The Edinburgh Royal Colleges of Physicians and Surgeons have issued an update on avian influenza which makes brief mention of a highly significant observation. In the 1997 Hong Kong H5N1 outbreak, mortality was observed - in the form of "Reye's syndrome" - particularly when afflicted people had taken aspirin or non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and related medications).
Reye's syndrome is a rare but devastating illness of multi-organ failure in the face of overwhelming infection: the immune system cannot cope. The syndrome has caused deaths during viral infections, especially of chicken pox and influenza, in children who have taken aspirin. For this reason, aspirin is not recommended at all for children under 16 in the UK, whether they are suffering from infections or not.
Yet this observation connecting deaths with avian flu and aspirin deserves more than a passing mention (and does not even figure in the key points at the end of the Royal Colleges paper). Inflammation is suppressed by aspirin and NSAIDs, which are sold as flu and cold remedies and act to quell the cytokine storm that is the cause of the unpleasant symptomatology of flu. But these symptoms are manifestations of the body's fight against the infection and there is good evidence that these drugs can interfere with the valiant rearguard action of the immune system, if the infectious attack is virulent enough. For instance, I have seen several cases of dog bites in otherwise healthy people progress to the horrifying necrotising fasciitis, and in each case the patient had taken NSAIDs to treat the pain from the wound. Other reports in the literature support this observation - that where immune barriers are fragile, NSAIDs can readily break them down, especially with secondary infection of skin and soft tissue in viral illnesses. The aspirin-related mortality in humans with avian flu is another instance of this effect.
Perhaps, then, more important than what medicine we take for bird flu is what we do not take. With a virgin virus to which we have no historic or herd immunity, we need to help rather than hinder our innate defences. I for one shall steel myself to endure the aches and fever without the help of aspirin or ibuprofen or the like, if it enhances my chance of survival. Doctors' leaders should remember the lesson of "masterly inactivity": in this instance, it may be life-saving to withhold treatment.
Post this article to
We want to encourage people to comment on our content and to exchange views with other readers and hope this will be done on a courteous basis. However, if you encounter posts which are offensive please let us know by emailing comments@newstatesman.co.uk and we will take swift action where necessary.
