In this part of the test, there are two texts about different aspects of healthcare.

Choose the answer (A, B,

C or D) which you think fits best according to the text.

Does Tamiflu really work?

Paragraph 1
The British Medical Journal (BMJ) was dominated in 2009 by a cluster of articles on oseltamivir
(Tamiflu). Between them the articles conclude that the evidence that oseltamivir reduces complications in
otherwise healthy people with pandemic influenza is now uncertain and that we need a radical change in
the rules on access to trial data.

Paragraph 2
The use of meta-analysis is governed by the Cochrane review protocol. Cochrane Reviews investigate the
effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They are
designed to facilitate the choices that doctors, patients, policy makers and others face in health care. Most
Cochrane Reviews are based on randomized controlled trials, but other types of evidence may also be
taken into account, if appropriate.

Paragraph 3
If the data collected in a review are of sufficient quality and similar enough, they are summarised
statistically in a meta-analysis, which generally provides a better overall estimate of a clinical effect than
the results from individual studies. Reviews aim to be relatively easy to understand for non-experts
(although a certain amount of technical detail is always necessary). To achieve this, Cochrane Review
Groups like to work with “consumers”, for example patients, who also contribute by pointing out issues
that are important for people receiving certain interventions. Additionally, the Cochrane Library contains
glossaries to explain technical terms.

Paragraph 4
Briefly, in updating their Cochrane review, published in late 2009. Tom Jefferson and colleagues failed to
verify claims, based on an analysis of 10 drug company trials, that oseltamivir reduced the risk of
complications in healthy adults with influenza. These claims have formed a key part of decisions to
stockpile the drug and make it widely available.

Paragraph 5
Only after questions were put by the BMJ and Channel 4 News has the manufacturer Roche committed to
making “full study reports” available on a password protected site. Some questions remain about who did
what in the Roche trials, how patients were recruited, and why some neuropsychiatric adverse events
were not reported. A response from Roche was published in the BMJ letters pages and their full point by
point response is published online.

Paragraph 6
Should the BMJ be publishing the Cochrane review given that a more complete analysis of the evidence
may be possible in the next few months? Yes, because Cochrane reviews are by their nature interim rather
than definitive. They exist in the present tense, always to be superseded by the next update. They are
based on the best information available to the reviewers at the time they complete their review. The
Cochrane reviewers have told the BMJ that they will update their review to incorporate eight unpublished
Roche trials when they are provided with individual patient data.

Paragraph 7
Where does this leave oseltamivir, on which governments around the world have spent billions of
pounds? The papers in last years journal relate only to its use in healthy adults with influenza. But they
say nothing about its use in patients judged to be at high risk of complications- pregnant women, children
under 5, and those with underlying medical conditions; and uncertainty over its role in reducing
complications in healthy adults still leaves it as a useful drug for reducing the duration of symptoms.
However, as Peter Doshi points out on this outcome it has yet to be compared in head to head trials with
nonsteroidal inflammatory drugs or paracetamol. And given the drug’s known side effects, the risk
benefit profile shifts considerably if we are talking only in terms of symptom relief.

Paragraph 8
We don’t know yet whether this episode will turn out to be a decisive battle or merely a skirmish in the
fight for greater transparency in drug evaluation. But it is a legitimate scientific concern that data used to
support important health policy strategies are held only by a commercial organisation and have not been
subject to full external scrutiny and review. It can’t be right that the public should have to rely on
detective work by academics and journalists to patch together the evidence for such a widely prescribed
drug. Individual patient data from all trials of drugs should be readily available for scientific scrutiny.

QUESTIONS
Q1. A cluster of articles on oseltamivir in the British Medical Journal conclude__________
a. complication are reduced in healthy people by oseltamivir
b. the efficacy of Tamiflu in now in doubt
c. complications from pandemic influenza are currently uncertain
d. a series of articles supporting Tamiflu

Q2. Cochrane Reviews are designed to __________

a. set randomized controlled trials to specific values
b. compile literature meta-analysis
c. peer review articles
d. influence doctors choice of prescription

Q3. According to the article, which one of the following statements about
Tamiflu is FALSE?
a. The use of randomized controls is suspect
b. The efficacy of Tamiflu is certain
c. Oseltamivir induces complications in healthy people
d. Cochrane reviews are useful when examining the efficacy of Tamiflu

Q4. According to the article, Cochrane Review Groups __________

a. like to work for “consumers”.
b. are being overhauled.
c. use language suitable for expert to expert communication.
d. evaluate a clinical effect better than individual studies.

Q5. Which would make the best heading for paragraph 4?

a. Analysis of 10 drug company trials
b. The stockpiling of Oseltamivir
c. Risk of complications in healthy adults
d. Tamiflu claims fail verification
Q6. According to the article, which one of the following statements about Roche is TRUE?
a. Full study reports were made freely available on the internet
b. Patients were recruited through a double-blind trial
c. The identities and roles of researcher in the Roche trials are not fully accounted for
d. Not all neuropsychiatric adverse events were reported

Q7. Cochrane reviews should __________

a. use a more complete analysis
b. not be published until final data is available
c. be considered interim rather than definitive advice
d. be superseded by a more reliable method of reporting results

Q8. Which would make the best heading for paragraph 7?

a. Risk-benefit profile of Tamiflu
b. Studies limited to healthy adults
c. High risk of complications
d. Oseltamivir only for high risk patients

Answer Key:
1. b
2. b
3. b
4. d
5. d
6. a
7. c
8. a