COX-2 DRUGS OVERSOLD BUT STILL IMPORTANT

All drugs have side-effects

Last week, the New England Journal of Medicine took the unusual step of pre-releasing three articles showing that the increased risk of heart and other vascular disease that had caused Merck to withdraw Vioxx from the market is in fact not limited to Vioxx but instead is a ''class effect,'' meaning that all of the so-called COX-2 inhibitors lead to an increased risk of heart disease. Editorialists called this the ''final nail in the coffin'' for all of these drugs, and depending on the report of the FDA advisory panel, they may well be right.

To a bewildered public, this is understandably confusing, but the issues here are fairly simple. They are a combination of good science, poor FDA oversight and greed. All of these drugs have two actions. Even at low doses they are very effective pain relievers, which is why one or two aspirin will relieve your headache. At higher doses, they also have anti-inflammatory properties, decreasing the heat, swelling and tenderness accompanying diseases such as rheumatoid arthritis.

People with rheumatoid arthritis have to decide daily whether the risks outweigh the benefits. They know that the drugs they take have side effects, but without them they might literally be bedridden. For them, the risk of ulcers, or even a heart attack, might well be worth taking.

However, only about 1% of the population has rheumatoid arthritis, while a huge percentage have other causes of chronic pain such as back problems, neck pain, etc. So, rather than a limited approach directed at people who might need and benefit from these drugs, the makers of the new COX-2 inhibitors spent hundreds of millions of dollars advertising them directly to consumers, creating an enormous demand and reaping billions in profits. And now they are paying the piper.

So what should you do about your lumbago, or whatever? If you don't have rheumatoid arthritis or a similar disease, try simple pain relievers such as acetaminophen first. In doses up to 2,000-3,000 mgs. per day, these drugs are remarkably effective, although the higher doses should be avoided in heavy drinkers. If they aren't effective, try ibuprofen. It is inexpensive and relatively short-acting. Most people have few stomach problems, although if you have a history of stomach disorders you might add a stomach protective agent like ranitidine or omeprazole.

When all of this shakes out, there will still probably be a small group of people with diseases such as rheumatoid arthritis who will do best on the COX-2 inhibitors, and I hope they are kept on the market for those people.....

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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