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Educational Forum

The Tamiflu fiasco and lessons learnt

Yogendra Kumar Gupta, Meenakshi Meenu, Prafull Mohan

ABSTRACT
Oseltamivir (Tamiflu), a neuraminidase inhibitor, was approved for seasonal flu
by US Food and Drug Administration in 1999. A number of randomized controlled
trials, systematic reviews, and meta-analysis emphasized a favorable efficacy and
safety profile. Majority of them were funded by Roche, which also first marketed
and promoted this drug. In 2005 and 2009, the looming fear of pandemic flu
led to recommendation by prominent regulatory bodies such as World Health
Organization (WHO), Centers for Disease Control and Prevention, European Medicines
Agency and others for its use in treatment and prophylaxis of influenza, and its
stockpiling as a measure to tide over the crisis. Serious Adverse Events, especially
neuropsychiatric events associated with Tamiflu started getting reported leading to
a cascade of questions on clinical utility of this drug. A recent Cochrane review and
related articles have questioned the risk-benefit ratio of the drug, besides raising
doubts about the regulatory decision of approving it. The recommendations for
stockpiling the said drug as given by various international organizations viz WHO
have also been put to scrutiny. Although many reviewers have labeled the Tamiflu
saga as a costly mistake, the episode leaves us with some important lessons. This
article takes a comprehensive relook on the subject, and we proceed to suggest some
ways and means to avoid a similar situation in the future.

Department of Pharmacology,
AIIMS, Ansari Nagar, New Delhi,
India
Received: 08-07-2014
Revised: 11-10-2014
Accepted: 19-12-2014
Correspondence to:
Dr. Yogendra Kumar Gupta,
E-mail: [email protected]

KEY WORDS: Cochrane review, flu pandemic, H1N1, roche, stockpiling, Tamiflu

Introduction
In 1999, the US Food and Drug Administration (US
FDA) approved oseltamivir, a new drug in a class called
Neuraminidase inhibitors proposed to be effective in seasonal
flu, through its seemingly routine regulatory process. Roche,
a pharmaceutical company launched oseltamivir in the global
market with Tamiflu as its brand name. After US FDA approval,
European Medicines Agency (EMA) soon followed suit. The
chronology of its clinical development is given in Table 1.[1-5]
Serious adverse events were first reported during
post-marketing surveillance from Japan, UK, and subsequently
from other places although most of the published articles did not
report them. A recent Cochrane review and a series of articles
Access this article online
Website: www.ijp-online.com
DOI: 10.4103/0253-7613.150308

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in British Medical Journal (BMJ) have revealed the truth behind

oseltamivir success story, which incidentally is one of the highest
revenue earners for Roche. It is inexplicable that despite the lack
of scientifically robust data on efficacy and safety of Oseltamivir,
reputed organizations like World Health Organization (WHO),
Centers for Disease Control and Prevention (CDC), EMA, US FDA
not only recommended the drug in question for treatment and
prophylaxis of influenza but its stockpiling as well.
This fiasco essentially provides us with an opportunity to
articulate tangible lessons so as to guard against such scientific
transgressions in the future. There is a need to consider
changes in the process of introduction of a new drug in the
public health care system and to bring greater accountability
and transparency in the way we practice science.
About flu and oseltamivir
Seasonal flu is a contagious viral infection which usually
follows a mild course. Occasionally, complications such as
pneumonia, bronchitis, otitis media, myocarditis, pericarditis,
neurologic complications (viz confusion, convulsion, psychosis,
neuritis, transverse myelitis, and encephalomyelitis), and
dehydration occur.[6,7] The cause may be secondary bacterial
illness or natural course of viral illness.

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Table 1:
Chronology of clinical development of oseltamivir
Timeline

Regulatory landmark

October 1999

US FDA approved the oseltamivir for treatment

of influenza in adults[1]
US FDA approved the oseltamivir for prophylaxis
of influenza in patients 13 years and older[1]
US FDA extended use of oseltamivir for treatment
of patients 1-year and older, symptomatic for not
more than 2 days[1]
Oseltamivir was approved for the treatment of
influenza in adults and adolescents in Japan[1]
Oseltamivirs use as treatment of influenza was
extended to include children more than 40 kg
in Japan[1]
EMA approved oseltamivir for treatment of
influenza in patients 1-year and older[1]
EMA approved the oseltamivir for prophylaxis of
influenza in patients 13 years and older[1]
Japan expanded use of oseltamivir as prophylaxis
of influenza in adults and adolescents[1]
Oseltamivir approved for influenza in India[2]
WHO prequalified a generic version of oseltamivir
Antiflu under its prequalification program[3]
India approved the oseltamivir for the treatment
of children 6-12 months of age during a
pandemic influenza outbreak[4]
US FDA approved the oseltamivir for treatment
of infants 2 weeks or older, symptomatic for not
more than 2 days[5]

November 2000
December 2000

December 2000
December 2001

June 2002

July 2004
October 2005
May 2009
June 2010

December 2012

US FDA=US food and drug administration, EMA=European medicines agency,

WHO=World health organization

Oseltamivir, a sialic acid analog, restrains viral population

to one generation, decreases viral load, and so contains the
infection and its outcomes.[8]
Oseltamivir is taken orally and is absorbed from the
GIT. Its active moiety is formed in the liver by the action of
enzyme carboxyl esterase. Its half-life is 610 h with good
oral bioavailability. The side effects include nausea, diarrhea,
insomnia, abdominal pain, and headache.[8]
Oseltamivir Success-ground Reality
During the 1990s, Roche sponsored 40 clinical trials on
oseltamivir. One such trial that formed a strong argument in
favor of oseltamivir was a Randomized Controlled Trial (RCT)
published in the year 2000 in The Journal of the American
Medical Association.[9] In this RCT conducted on otherwise
healthy patients (patients with no comorbidities), the authors
concluded that early initiation (within 36 h) of treatment
reduced illness duration by 30% and severity by 40%. It also
significantly reduced the frequency of secondary complications
of influenza. The authors went on to suggest the possibility that
early initiation of antiviral drug might decrease the frequency of
complications in high risk population and potentially cut down
hospitalization rates although the study itself was not designed
to address these issues. Authors offered no reasoning behind
these promising assumptions. In the same article, they accepted
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Indian Journal of Pharmacology | February 2015 | Vol 47 | Issue 1

few limitations in their study. No formalized criteria were used

to define secondary complications of influenza, e.g., bronchitis,
sinusitis, and functional definitions based on clinical practice,
were used.
Another study, which was momentous in oseltamivir
success, was published in The Lancet in the year 2000. This
study was also carried out in otherwise healthy patients. In
this RCT, Nicholson et al. elaborated the benefits of oseltamivir
in terms of alleviation of symptoms, decreased viral load and
improvement in health and activity. They also noted a shortening
of the duration of illness. They, however, did not report any
adverse effects associated with oseltamivir.[10]
In 2003, Kaiser et al . published a meta-analysis on
oseltamivir and concluded oseltamivir treatment of influenza
illness reduces lower respiratory tract complications,
antibiotics uses, and hospitalization in healthy and at risk
adults.[11] This much-cited article was also supported by
Roche and apparently formed a robust scientific argument
for stockpiling the drug in later years. Such stockpiling
was one of the components of contingency plans of various
governments in reducing disease burden during a possible
flu pandemic.[12]
A WHO funded systematic review by Jonathan Hsu et al.,
pooled 74 observational studies. Authors concluded that the
oral oseltamivir might reduce mortality, hospitalization, and
duration of symptoms as compared to no treatment. The
quality of evidence available for such an inference was low to
very low. Authors conceded that the mortality was assessed
in high-risk patients, and therefore, generalizability of this
inference was limited. The overall evidence was compromised
due to confounding factors and multiple biases.[13]
Roche funded another meta-analysis of individual
participant data collected during an influenza pandemic,
H1N1pdm09. This study reported that the oseltamivir was
effective in reducing mortality (evaluated as the primary
outcome) across the spectrum of severity on early initiation
of therapy in adults, pregnant women, and critically ill adult
patients. Investigators did not report any benefit in pediatric
patients, although they attributed this finding to lower case
fatality proportion and high viral load in children and proposed
that the prescribed dose might not be therapeutically effective.
Authors concluded that the greatest likelihood of reduced
mortality was attributable to treatment initiation within 2 days
of symptoms onset. However, delayed treatment was still found
to be effective in severely ill patients. Authors claimed that the
strength of this study was a potential reduction in confounding
factors, adjustment for treatment propensity, and coherence
with ecological data. Authors further argued that conducting
an RCT during a pandemic is a difficult task, and this study
presents an exhaustive retrospective observational study.
They retrospectively vindicated the prepandemic stockpiling
by various governments.[14]
What Went Wrong?
The Japanese Saga
Independent events of abnormal behavior and disturbance
of consciousness and few deaths after oseltamivir intake were
reported in Japan. Japanese authorities initiated cohort studies

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in children. The initial studies were inconclusive except for a

small increase in abnormal behavior on the 1st day after drug
intake. However, an independent analysis of the data showed
the oseltamivir to be associated with an increased risk of
abnormal behavior by over 50% and significant occurrence of an
unconscious state of mind on the 1st day after drug intake. Thus,
Japan, which was once the biggest consumer of oseltamivir in
the world, introduced a package insert warning against giving
the drug to children and overall restricted use of this drug.[15] In
2007, Roche reviewed its data and did not report any increased
risk of neuropsychiatric events.[16] But, global accumulation of
adverse events on databases led to the updating of label warning
against rare adverse events, e.g., hallucination, self-injury,
abnormal behavior.[17]
The British Experience
A symptomatic case in a local school in UK in 2009 led
to an order by the Health Protection Agency (HPA) to initiate
7 days prophylaxis of oseltamivir to all the kids in the school.
The general consensus of opinion at HPA was Prophylactic
oseltamivir reduces the risk of contacts becoming symptomatic,
shedding the virus, and infecting others. There is also scientific
evidence that treating symptomatic people with oseltamivir
can reduce infectiousness. The professional experience of
the treating physicians concluded that the likely benefits did
not outweigh likely risks. This led to disagreement among
Birmingham NHS Primary care trust.[18,19]
The Cochrane Review
The Cochrane Collaboration published their analysis of
Neuraminidase inhibitors in 1999, 2003, 2006, 2009, 2010,
2012, and 2014. Reviews of Cochrane collaboration did not raise
any major issues over safety and efficacy of oseltamivir till 2009.
In 2009, Dr. Hayashi, a Japanese pediatrician questioned the
Cochrane team regarding the results of their review pointing
out the fact that the conclusion of the study was not based
on their own data analysis. Cochrane team had derived their
report from a meta-analysis done by Kaiser et al. According to
Hayashi, Kaiser et al. had based their review on 10 RCTs. Of
these, only 2 RCTs (Nicholson 2000 and Treanor 2000) were
published as articles in peer-reviewed journals. Other 8 RCTs
were either presented as proceedings of the congress (5 RCTs),
as abstracts in meetings and conferences (01 RCT each) or were
available as data on file of the sponsor (01 RCT).[20]
In view of the emerging safety issues and Dr. Hayashis
specific objections, Cochrane collaboration decided to
undertake a complete analysis of the clinical trial data set.
However, they had difficulties in accessing the data, and it was
not before protracted efforts lasting from 2009 to 2013 that
they could gain access to all the materials. They needed full data
set to formulate exhaustive and scientifically robust evidence.
Cochrane had correspondence with WHO, US FDA, CDC, EMA,
and European center for disease prevention and control. And it
came as another surprise as none of them possessed full data.[21]
On April 10, 2014 Cochrane team published their revised
review on oseltamivir after details of all the trials were revealed
by Roche. Cochrane team based their review on clinical study
reports from sponsors as well as minutes of proceedings of
regulatory meetings.[22] This review comes as an eye-opener for
the scientific community. The questions they have asked and the

issues they have raised appear to be justified in the context of

their tremendous importance for public health.
Revelations of Cochrane Review
Risk Benefit Ratio
Benefit-paltry or substantial?
Oseltamivir reduced the time to first alleviation of symptoms
by 16.8 h (95% confidence interval 8.425.1 h P < 0.001) and
by 29 h (95% confidence interval 1247 h, P < 0.001) in healthy
children.[23] The benefit of oseltamivir in asthmatic patients was
insignificant. Pneumonia, hospitalization, and virus transmission
were the major concerns with the disease for which benefits
have been claimed in various studies. However, Cochrane review
failed to establish any definitive benefit on these parameters.
Adverse effect profile-conveniently concealed
There had been no mention of adverse effects associated
with the use of this drug in the published trials. Post-marketing
surveillance had uncovered adverse effects like raised
liver enzymes, hepatitis, neuropsychiatric events, cardiac
arrhythmia, skin hypersensitivity reactions including toxic
epidermal necrolysis, Stevens-Johnson syndrome and erythema
multiforme, metabolic side effects and renal events.[24] In some
cases, increased QTc prolongation was seen in ECG in the
treatment group compared with placebo during on-treatment
periods. The most important serious adverse events which
raised concerns were neuropsychiatric events such as
depressed mood, behavior disturbance, panic attack, suicidal
ideation, delusion, delirium, convulsion, and encephalitis. These
were reported more frequently in children than in adults and
generally occurred within 48 h of drug intake.[25]
Harms Underplayed, and Benefits Overplayed?
Majority of the published studies described advantages
with oseltamivir. According to Jonathan Hsu et al., oseltamivir
decreased the risk of mortality in high-risk population (Odds
ratio = 0.23, 95% confidence interval - 0.130.43) and
hospitalization (Odds ratio = 0.75, 95% confidence
interval - 0.660.89) compared with no treatment.[13] Rationality
and importance of these data create a doubt when analyzed in
the context of the case fatality rate of influenza. The estimated
case fatality rate of influenza is 0.150.25%, with most deaths
in middle-aged adults with underlying diseases.[26]
Cochrane review states that oseltamivir showed significant
benefit in cases where pneumonia was nonverified or
self-verified. The studies in which standard definition and
diagnostic criteria were applied, statistical analysis of study
reports concluded that the benefit was insignificant. Similar
conclusions were obtained with other secondary illnesses of
influenza-like otitis media, sinusitis, and bronchitis. Reporting of
other complications was also passive. Oseltamivir was found to
be ineffective in asthmatic children. Thus, according to Cochrane
team oseltamivir does not appear to be effective in cases where
it may found a better application. In a similar vein, a systematic
review of systematic reviews, published in PLOS One in April
2013 concluded that oseltamivir did not provide any treatment
benefit in elderly and at risk groups and it did not affect rate
of hospitalization or mortality. To sum it up, cumulative risks
prevail over small benefits of oseltamivir for prophylaxis and
treatment of influenza in healthy humans.[27]
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Though a large number of RCTs and meta-analyses

had been conducted on oseltamivir, these failed to report
important adverse events such as neuropsychiatric adverse
effects. These were later revealed by independent clinicians,
post-marketing studies and led to label change warning.
Finally, sound evidence was provided by a systematic review
conducted by Cochrane Collaboration, published in BMJ in
April 2014. In this systematic review, the magnitude of risk
difference of neuropsychiatric events during the combined
on-treatment and off-treatment periods was 1.06% (0.07
2.76%) and two pivotal treatment trials showed significant
association of oseltamivir dose (75 mg [standard dose]
and 150 mg [high dose] twice daily) with neuropsychiatric
events (P = 0.038).[24]
There was no significant difference in the rate of admission
to the hospital in the treatment and placebo arms. Drug was
given to symptomatic patients only, missing out on large no
of asymptomatic patients who were a major source of viral
transmission. Thus, any inference that the drug reduced
transmission of the virus from infected individuals to healthy
contacts appears to be incomplete. Further studies are needed
to reach such a conclusion.
In other words, benefits had been overplayed, and harms
had been underplayed in the reporting of the trials.[23]
Other Issues Raised by Cochrane Team
In the context of evidence-based medicine, an RCT is
considered as the gold standard.[28] In the case of oseltamivir,
RCTs had lacked precision, and most of them provided
low-quality evidence. The study designs were poor for most of
the trials. Dummy placebo containing dehydrocholic acid and
dibasic calcium phosphate dihydrate had been used, which
caused mainly gastrointestinal symptoms.[23] For documentation
of complications, non-specific forms had been used and
reporting itself was passive. Diagnosis had been confirmed on
the basis of clinical judgment of physicians without a detailed
definition, diagnostic criteria, and confirmatory investigations.
Reporting of the adverse effects had been selective so was
reporting of trial data. Thus, there was reporting, publication,
and survivor bias.
Some of the glaring shortcomings brought out by the
Cochrane review team are:
Why was there no reporting of neuropsychiatric events
during the trial? Was it due to small scale trial?
Why was large-scale trial not commanded from the
pharmaceutical industry when it was obviously a case
of enormous public health importance and would have
huge commercial impact on industrys revenues?
Why had there been no study on relapse cases?
Why was the adverse events profile studied till the
treatment lasted? Why was no analysis done after the
patients stopped treatment even though it was known
that side-effects could present even after stopping the
treatment.
Drug was widely used for H1N1 strain of virus in 2009
though before that strain was virtually unknown. Hence,
the drugs efficacy was never before tested on the
strain. Why was a scientifically sound observational
study not done after this experiment by independent
investigators?
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A Chain Reaction of Failure

Cochrane study group have raised questions on the data
retrieving and analyzing processes of many of the worlds
eminent regulatory bodies. And they have fallen short of
expectations, an instance of propagation of failure based on
which decisions of enormous capital value had been taken.
They have highlighted inherent defects in the methods utilized
for regulatory processes which are likely to bias the results of
trials, systematic reviews, and meta-analysis.
World Health Organization has not clarified oseltamivirs
status as an essential medicine.[29] WHO set aside questions raised
regarding the management of A/H1N1 pandemic flu as Conspiracy
Theories.[30] Interruption of transmission which theoretically will
allow time for intervention by vaccine was the strongest rationale
behind using oseltamivir according to WHO. But, WHO never had a
complete set of trial data to prove or disprove its theory.[16]
US Food and Drug Administrations Lack of a Strong Stance
Marketing practices of Roche were false or misleading as
declared by US FDA in Nov 2000 because of Roches extravagant
advertisement claiming significant reduction in secondary
bacterial infections in flu cases.[31] According to Jefferson,
its methods were invisible and appeared to have ignored the
evidence of psychiatric harms from the trials it had full access
to. It observed 75 cases of adverse events during a safety review
and noted 12 child death cases in its adverse events database.
US FDA accepted that the oseltamivir has not been shown to
prevent serious bacterial infections.[32]
Centers for Disease Control and Prevention
Early initiation of treatment (within 48 h) with neuraminidase
inhibitors may reduce complications (e.g. otitis media in young
children, pneumonia, and respiratory failure) and death, and
decrease the duration of hospitalization. It also recommends
treatment with oseltamivir in patients who are more likely to
develop complications of influenza.[33] However, it does not
provide any credible evidence for its continued advocation of
oseltamivir in the treatment and prophylaxis of influenza.
European Medicines Agency denied not having full set of
data. It made cautious statements when confronted by BMJ
over cases of neuropsychiatric events in UK as having assessed
all data provided by Roche or no available data showed an
increased risk of neuropsychiatric events.[34]
Indian Scenario
Jan 2006, an Indian firm Hetero-Drugs was granted
sublicense by Roche for producing oseltamivir to assist in
stockpiling the drug.[35]
Considering the social and demographic factors of India,
government initiated plans to tackle a pandemic influenza by
stockpiling oseltamivir.[36] Cipla obtained regulatory approval
for its generic drug Antiflu when WHO prequalified it,[3] and
acquired compulsory licensing to manufacture its product.[37]
Antiflu was introduced in the market in the late 2009 during
H1N1 pandemic flu.
The question is which data did WHO look at to reach its
decision? Did regulatory authority of India perform their own
data analysis before it authorized the drug to be marketed in
the country or look at the data of post-marketing surveillance
later on? It appears incredible that no scientifically sound

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observational study had been conducted to assess the efficacy

and safety issues, e.g. incidence of SAEs like neuropsychiatric
events in postmarketing surveillance which had been reported
in other parts of the world. Should the Government consider
large-scale study to credit or discredit controversy surrounding
oseltamivir? It is obviously a matter of national importance
considering the huge sum of public money.
Oseltamivir Is It a Case of Multisystem Failure?
Approval by US US FDA and EMA appears to be a judgment
based medicine rather than evidence-based medicine. It
appears that the regulatory authorities took their decision
under the pressure of providing a pharmaceutical solution to
a pandemic disease.
Stockpiling by the countries was based on assumptions
and not hard data. None of the studies were done during a
pandemic. Access to full methods and results was not available
to regulatory authority. There is always a high degree of control
over the trial if it is conducted by manufacturer, and it creates
conflict of interest.[38]
Oseltamivir Windfall for Pharma Company
Roche has been benefitted with oseltamivir by more than
18 billion $ since its launch in 1999. Its sales were increased by
84% by oseltamivir during US flu season in 2013. UK stockpiled
the drug worth 710 million $ for 40 million treatments. US spent
1.3 billion $ on stockpiling oseltamivir for 65 million dosages.[39]
India also increased its stock by 10 fold.[40]
What May Be the Way Forward?
While oseltamivir has been identified as a classical
case of multiple, linearly aligned errors and omissions;
wherein manipulated evidence, selective disclosures, and a
favorably timed pandemic disease have ensured windfall for
pharmaceutical companies. We need to devise ways and means
so that wasteful exercises such as this can be minimized, and
patients are not made to consume medicines of questionable
risk-benefit ratio.
Pharmaceutical Company
Pharmaceutical companies need to share full data of clinical
trials and place the same in the public domain. They can go
ahead and publish their study results in the manner they like,
but the study should be verifiable with full data. There should
be an independent expert committee to look into the matter
of reporting bias and poor design of the study associated with
the trials funded by pharmaceutical companies.
Government and Funding Agency
Inadequacy of present resources, e.g. time allocation, funding
configuration, are major limitations for scrutinizing clinical study
report by systematic reviewers. A detailed rational evidence
formulation is an essential prerequisite for evidence-based
medicine. It is the cornerstone of modern science. But, it is
capital intensive like pure science for a long-term benefit of
society. It is the responsibility of the government to develop a
realistic attitude toward a genuine problem.
Regulatory Policies
There should be change in the policy of the regulatory
authorities. In all studies where humans are a part of the trial,

all the data should be made available in the public domain if

demanded. It should not be the prerogative of sponsors. The
inconsistencies among major regulatory bodies have been a
prime feature of oseltamivir fiasco. They need a new think-tank
to come up with a solution for this conflicting situation.
A central regulatory body which will work out the discrepancy
and integrate their analysis might be a step toward finding a
solution. EMA has already taken the lead and changed its policy
vis--vis data availability.[41] A concerted public awareness
initiative should also be undertaken to underscore the scientific
imperatives behind drug development and the inherent
inefficiency of the entire process. There needs to be wider
social understanding of the fact that modern evidence-based
medicine is unlikely to throw up quick fix solution to emerging
public health problems irrespective of their seriousness. A case
in point is the emerging epidemic of Ebola that in spite of its high
infectivity and mortality, is still away from a reliable, effective,
and safe therapeutic solution.
What should India do?
A good start has been made in India by making the registry
of any clinical trial mandatory at Clinical Trials Registry India.
This needs to be taken further by placing all the trial data
in open access public domain. There should be mandatory
seamless integration of ethical approval, regulatory approval,
trial registry, availability of trial data, and post-trial publication
in scientific journals in such a manner, and hence that all these
steps are mutually identifiable and accessible.
The government should look at the advisory from
international regulatory bodies and health organizations
into our perspective before its acceptance and subsequent
application. The oseltamivir fiasco proves that India needs to
build appropriate capacity so that emerging scientific evidence
is analyzed in-house keeping in mind the countrys peculiar
social and economic context and the reliance on international
guidelines to formulate national policies is reduced.
It might be a better move for the government to improve
its manufacturing capacity by involving Pharma central public
sector enterprises. They work on a no profit no loss basis
compared to for profit motive of private pharmaceutical
companies. Pharma CPSEs can be entrusted with such tasks
of medical and national importance. Compulsory licensing
can be provided to them. However, this will entail tremendous
capacity building at the end of Pharma CPSEs as currently they
are neither mandated nor geared up for such an onerous task.
Further, to safeguard against possible future rise in demand,
raw material can be stockpiled rather than the finished product.
Government needs to take a dynamic approach in its endeavors
to reduce its wasteful exercises and to save hard earned public
money.
In consideration of future redundancy, it is a necessary
step for India to expeditiously upscale its manufacturing and
marketing practices.
Conclusion
A cocktail of pandemic panic, publicity propaganda,
and scientific misconduct turned a new medicine with only
modest efficacy into a blockbuster. It appears that the multiple
regulatory checks and balances gave way as science lost
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Gupta, et al.: Tamiflu fiasco

its primacy and pharmaceutical enterprise lost no time in

making the most of it. This reminds one of Prof R. P. Feynmans
statements after Challenger space shuttle disaster.
Reality must take precedence over public relations as
nature cant be fooled
- Prof R. P. Feynman
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Cite this article as: Gupta YK, Meenu M, Mohan P. The Tamiflu fiasco and
lessons learnt. Indian J Pharmacol 2015;47:11-6.
Source of Support: Nil, Conflict of Interest: None declared