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    Wednesday, June 05, 2002

    Good Drugs, Bad Press: Two arthritis drugs, Vioxx and Celebrex have come under fire this week, for several reasons. The makers of Celebrex evidently fudged their research, got it published in a well-respected journal (JAMA), then circulated reprints of the study widely to promote their drug. Both Vioxx and Celebrex are agressively advertised to consumers as new and improved arthritis medication, and both cost a lot more than the older arthritits medications which are also just as effective. The result is that a lot of people take these drugs when they could get along with the cheaper, older drugs just as well. So why do doctors prescribe them at such high rates? It would appear that we have succumbed to the two-pronged assault engineered by the drug makers. We were given evidence that the drugs were easier on the stomach, although probably not any better for inflammation than the older drugs. Our patients were influenced into thinking that the drugs were better because they were newer via a slick ad campaign. No one wants to end up causing a bleeding or perforated ulcer while treating a nonfatal condition like arthritis, so it was easy to succumb to patient requests for the drugs they had seen touted on television. They seemed safer. The British Medical Journal now reveals evidence that the incidence of bleeding and perforation aren't that different between these drugs and the older ones after all. We were bamboozled.

    The Washington Post article, however, takes the issue a step further than necessary or even warranted. It gives too much credence to all the other bad news reports about the drugs:

    "Last year, research indicated that Vioxx patients ran four times more risk of heart attack than patients taking aspirin or ibuprofen. Last summer, a study published in the British journal The Lancet associated Vioxx with kidney failure. In March of this year, the FDA reported that five people taking Vioxx had been hospitalized with aseptic meningitis, an inflammation of the membranes covering the brain and spinal cord. And just last week came a report showing that Vioxx and Celebrex slowed the healing of bone fractures in lab animals."

    All of the nonsteroidal anti-inflammatory drugs used to treat arthritis, including all of the older, cheaper ones, are capable of causing kidney failure. Considering the number of people who take Vioxx, it is almost impossible to pin the incredibly small number of five cases of meningitis to the drug. The study on delayed bone healing was performed on rats, not people. (Although it's probably true that anti-inflammatories delay healing in general. Inflammation serves a purpose in nature, and one of those purposes is to get all the body's healing mechanisms flowing to the site of injury.)

    The drugs shouldn't be completely condemned outright. The fact remains that there are a lot of people out there who get nausea and stomach discomfort when using the older and cheaper arthritis medicines who don’t get those symptoms on Vioxx and Celebrex. There are also, people who have failed to respond to the older medicines and have found relief with one of these two medications. Unfortunately, media reports like this one convince them the drugs are too dangerous to take, which isn't true. They just aren't as superior as we were led to believe.
     

    posted by Sydney on 6/05/2002 06:02:00 AM 0 comments

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