“If you cannot measure it, you cannot improve it.”

Urban Legends examined the Tamiflu-Rumsfeld connection publicised in 2006:

“Is U.S. Secretary of Defense Donald Rumsfeld personally profiting from fears that a worldwide bird flu pandemic may occur? Yes. Rumsfeld once served as chairman of Gilead Sciences, Inc., the company that holds the patent on the antiviral drug Tamiflu, currently regarded as the world’s best hope for the prevention and treatment of avian influenza. He still owns Gilead stock valued at between $5 million and $25 million.”

Despite the large sums of taxpayers’ money spent stockpiling Tamiflu, in 2012, little has been added to knowledge on the efficacy of this drug:

Trials at the ready: preparing for the next pandemic

BMJ 2012; 344 doi: 10.1136/bmj.e2982 (Published 3 May 2012) Cite this as: BMJ 2012;344:e2982

Researchers have previously struggled to carry out clinical trials on epidemics and the drugs used to treat them.

Ed Yong finds out about the scientists who are changing that by planning ahead…

In 2009 the world squandered a prime opportunity to study a harmful virus. From March a strain of H1N1 influenza virus swept the globe, reaching six continents in three months. It infected between 11% and 21% of all the people on the planet, and gave us the perfect chance to learn more about a virus that has been troubling humanity for centuries. But we failed to make the most of it and, to date, still know surprisingly little about how to treat the pandemic strain.

The problem is that while viruses are fast and adaptable, clinical research is lumbering and cumbersome. Epidemics tend to arrive with little warning, spread quickly, and end abruptly. By contrast, clinical trials can take months to plan. Forms must be designed to record the right data and ethical approval must be sought. By the time would-be researchers can vault over these obstacles the epidemic is history.

This explains why, during the 2009 A/H1N1 influenza pandemic, virtually no patients were enrolled in a randomised controlled trial designed to identify the best ways of treating the infection. Such trials are the gold standard of medicine and the best way of getting rigorous evidence for a treatment’s effectiveness. During the pandemic millions of people were treated with the front line drug oseltamivir (Tamiflu). But the only evidence that oseltamivir actually saved lives came from retrospective observational studies, with all the biases they entail. To this date, serious questions remain about the drug’s effectiveness. “A Tamiflu trial during the last pandemic would have resolved all the controversy over whether it works or not,” says Mike Clarke, Director …

Maybe there’ll be a second chance.

Victorian physicist, Lord Kelvin (1824-1907), is often quoted in the public health arena for his remark, “If you cannot measure it, you cannot improve it.” The comment is used to justify the need for health surveillance and evaluations of prevention and control strategies. It is also used more generally of management and the pseudoscience of accreditation. But actually, you might be able to improve what you can’t or didn’t measure; you just mightn’t be sure of what effect had taken place.

Like the missed opportunity of the 2009 influenza pandemic, the invasion of the health service by managers telling us how to “do more with less” is never subjected to measurement. The NHS might be doing less with more, or more with more, less with less, or even more with less.  But without measurement, most staff and patients have a fair idea of what direction things are moving.

Projected savings are not openly measured against what workstreams and projects delivered. Only the larger budget is considered publically. Despite the miserable theatrics of accountability reviews, managers are careful never to have measures of their achievements that can be subjected to critical scrutiny. When everyone is accountable, no-one is responsible.

“Queen of Mean,” Leona Helmsley, famously denied remarking, “Only the little people pay taxes.”  So it is with accreditation and other forms of obsessive accountability.  A high level of income is associated with freedom from true accountability.  Amidst all the planning and the compulsions to measurement by lesser folk there was planning not to measure pandemic…expenditure…costs or savings.