Healthy Skepticism Library item: 712

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Editorial .
Prescription for Confusion
THE NEW YORK TIMES 2004 Dec 28

Full text:

It is no surprise that many people who rely on painkillers to ease their way through the day feel lost at the moment.
Not only have Vioxx, Celebrex and Bextra, the only three drugs in a class thought to be especially safe, been found
to cause heart attacks and strokes in some patients, but an over-the-counter painkiller, Aleve, has, too. It makes one
wonder whether anything out there is really safe.

And that’s just fine. If there is any main lesson to draw from the confusing reports about these and other widely
used drugs, it is that all medicines carry risks as well as benefits. Those risks may not show up in the clinical
trials that are used to decide whether a drug is effective enough and safe enough to be marketed in this country. But
if the drug is used by vast numbers of people for extended periods of time, adverse effects may emerge.

The COX-2 inhibitors – Vioxx, Celebrex and Bextra – were designed for people who suffer ulcers and bleeding when
taking painkillers like aspirin and ibuprofen. But they were so heavily promoted that millions of arthritis sufferers at little risk of gastrointestinal problems took the pills for years in the belief that they were somehow better and safer. Now we know that those drugs were
potential cardiovascular time bombs, especially when used at high doses for long periods. Any patient taking them long-term will need to decide whether the benefits of reduced pain, fewer ulcers and less bleeding are worth the small rise in the risk of heart attack.

In the finger-pointing over who is to blame for letting risky drugs stay on the market, the favorite culprits seem to be the drug companies, for resisting evidence of harm caused by their products, and the Food and Drug Administration, for failing to crack down harder. They
should be joined by a third group, the doctors who prescribe drugs for long periods to patients for whom they are not appropriate.

Many doctors have long been in thrall to drug companies, which bombard them with sales pitches and finance their educational programs. Now that exquisitely calibrated judgments must be made as to which patients can truly benefit from what drugs, doctors will have to reassert
their independence.