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Once again the intersection of government, science, and
business has produced a drama of Shakespearian proportion. Our
story begins as a quest to find an arthritis medication that didn’t
irritate the stomach. Traditional arthritis medication had a nasty
habit of causing the stomach to bleed. By slightly changing the
structure of these medicines, scientists found that they could still get
arthritis pain relief without that bothersome stomach bleeding.
Meanwhile government regulators, perhaps flush from industry paid
junkets, approved the advertisement of prescription drugs directly to
the public. But we will get back to this. The pharmaceutical industry
diligently got their new medications (vioxx, bextra, and celebrex)
approved for patients with arthritis who were at high risk of stomach
bleeding from traditional arthritis medications (aleve, motrin).
Now here is where our story turns from A mid summer night's
dream to Romeo and Juliet; comedy to tragedy. It seems that the
market for high risk stomach bleeding arthritis patients wasn’t quite
lucrative enough. The pharmaceutical industry couldn’t manufacture
more of these high risk patients, but they could convince the low risk
patients, through direct advertisement, that they should take these
fancy new pain meds. Just ask your doctor. And unfortunately, we
complied and the government regulators, hoping for industry jobs in
the future, turned a blind eye. Millions of low risk bleeding patients
took these medications and turned themselves into high risk stroke
and heart attack patients.
Unfortunately with all this money flowing though the system
nobody asked the fundamental question. Is the increased risk of
heart attack and stroke with these new medications offset by the
decreased risk of bleeding with the traditional medications in all
populations or just a select population? To my knowledge this
question is still not being researched. I will continue to prescribe
traditional arthritis medications in low risk stomach bleeders and
the new medications in high risk stomach bleeders. But as Hamlet
might say, Cox 1 or Cox 2, that is the question.
John D Riley MD, MPH
hoosier housecalls
April 10, 2005
if you have any other concerns in this matter, feel free to email Dr.
Riley.
business has produced a drama of Shakespearian proportion. Our
story begins as a quest to find an arthritis medication that didn’t
irritate the stomach. Traditional arthritis medication had a nasty
habit of causing the stomach to bleed. By slightly changing the
structure of these medicines, scientists found that they could still get
arthritis pain relief without that bothersome stomach bleeding.
Meanwhile government regulators, perhaps flush from industry paid
junkets, approved the advertisement of prescription drugs directly to
the public. But we will get back to this. The pharmaceutical industry
diligently got their new medications (vioxx, bextra, and celebrex)
approved for patients with arthritis who were at high risk of stomach
bleeding from traditional arthritis medications (aleve, motrin).
Now here is where our story turns from A mid summer night's
dream to Romeo and Juliet; comedy to tragedy. It seems that the
market for high risk stomach bleeding arthritis patients wasn’t quite
lucrative enough. The pharmaceutical industry couldn’t manufacture
more of these high risk patients, but they could convince the low risk
patients, through direct advertisement, that they should take these
fancy new pain meds. Just ask your doctor. And unfortunately, we
complied and the government regulators, hoping for industry jobs in
the future, turned a blind eye. Millions of low risk bleeding patients
took these medications and turned themselves into high risk stroke
and heart attack patients.
Unfortunately with all this money flowing though the system
nobody asked the fundamental question. Is the increased risk of
heart attack and stroke with these new medications offset by the
decreased risk of bleeding with the traditional medications in all
populations or just a select population? To my knowledge this
question is still not being researched. I will continue to prescribe
traditional arthritis medications in low risk stomach bleeders and
the new medications in high risk stomach bleeders. But as Hamlet
might say, Cox 1 or Cox 2, that is the question.
John D Riley MD, MPH
hoosier housecalls
April 10, 2005
if you have any other concerns in this matter, feel free to email Dr.
Riley.
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