Stretching the Stockpile

Urine

Scientists are understandably scrambling to find ways of stretching national stockpiles. During World War II, scientists discovered how to extend precious penicillin supplies by co-administering a drug called probenicid that acts upon the kidney to inhibit the secretion of drugs like penicillin. By slowing the body’s ability to rid itself of the penicillin through the urine, smaller doses of the antibiotic could be given less frequently, preserving the valuable drug for others. Roche discovered that the same was true for Tamiflu in 2002.²⁴⁹⁴

Roche found that probenicid doubled the time that Tamiflu spent circulating in the human bloodstream, effectively halving the dose necessary to treat someone with the flu. Since probenicid is relatively safe, cheap, and plentiful, joint administration could double the number of people treated by current global Tamiflu stores. “This is wonderful,” exclaimed David Fedson, former medical director of French vaccine giant Aventis Pasteur. “It is extremely important for global public health because it implies that the stockpiles now being ordered by more than 40 countries could be extended, perhaps in dramatic fashion.”²⁴⁹⁵

Roche has known this for years; have they considered the option? “It doesn’t seem so,” said a Roche spokesperson. “It is an interesting idea,” she added, “but we can’t really say anything.”²⁴⁹⁶ When the science journal Nature asked the WHO and the FDA about the idea, they also declined to comment. Fedson, like many scientists, finds the apparent lack of attention given to this option “stupefying.”²⁴⁹⁷

The probenicid option would seem the more appetizing choice compared to the creative (though erroneous) solution developed by internist Grattan Woodson, M.D. Tamiflu is normally given as a ten-pill course, two pills a day for five days. If a family of five is privileged enough to have a single pack of ten pills, how could one possibly make such a Sophie’s Choice? Enter Woodson’s “Tamiflu Re-Administration Strategy.” Assuming that Tamiflu was excreted unchanged by the kidneys, he figured that if each family member were to take two pills and then drink his or her own urine for five days, the entire family could, in theory, be saved. Do try this at home, said Woodson, but only under medical supervision to ensure proper hydration. Woodson listed in his book ways to improve palatability—chilled, preferably, and flavored with citrus.²⁴⁹⁸ Unfortunately (or perhaps fortunately) this strategy won’t work. Tamiflu is altered by the liver such that urinated Tamiflu would not be readily re-absorbed by the intestine.