This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Drug Therapy, Other  • Viral Infections  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: Dr Shea's suggestion that NIs be withheld from persons with influenza who are at low risk for complications is thought-provoking. The utilitarian approach Dr Shea advises, ie, a collective refusal to mitigate morbidity in individuals solely for the good of society, is a vast departure from most other medical care in the United States. Thus, any recommendation to restrict NIs raises many logistical, legal, and outcome-based questions.

First, what is the cumulative cost to society (in terms of days lost from work and school) each year from withholding NIs among low-risk persons with influenza? Second, how would this cost compare with the theoretical benefit of preserving NI susceptibility among epidemic and pandemic influenza strains? No information is available to predict the clinical efficacy of NIs against a pandemic H5N1 strain, even if the virus is susceptible in vitro. It is also not known whether NI-resistant strains are capable . . . [Full Text of this Article]

David M. Weinstock, MD
weinstod@mskcc.org

Gianna Zucotti, MD, MPH
Memorial Sloan-Kettering Cancer Center
New York, NY

RELATED ARTICLES

Shift Shown in Influenza A Adamantane Resistance
Katherine M. Shea
JAMA. 2006;296(13):1585.
EXTRACT | FULL TEXT  

Shift Shown in Influenza A Adamantane Resistance
Raj C. Shah
JAMA. 2006;296(13):1585-1586.
EXTRACT | FULL TEXT  

Shift Shown in Influenza A Adamantane Resistance—Reply
David K. Shay, Rick A. Bright, Michael Shaw, Nancy J. Cox, and Alexander I. Klimov
JAMA. 2006;296(13):1586-1587.
EXTRACT | FULL TEXT  

Adamantane Resistance Among Influenza A Viruses Isolated Early During the 2005-2006 Influenza Season in the United States
Rick A. Bright, David K. Shay, Bo Shu, Nancy J. Cox, and Alexander I. Klimov
JAMA. 2006;295(8):891-894.
ABSTRACT | FULL TEXT  

Adamantane Resistance in Influenza A
David M. Weinstock and Gianna Zuccotti
JAMA. 2006;295(8):934-936.
EXTRACT | FULL TEXT