Hot off the press are wire-service reports that an ongoing trial of Pfizer's Celebrex showed a greater than two-fold increase in risk of myocardial infarction (heart attack) for patients taking the drug versus placebo. Celebrex, like Vioxx, another Cox-2 inhibitor, has been heavily promoted for general use as an analgesic and anti-inflammatory, not just as a niche drug for patients who cannot tolerate standard non-steroidal anti-inflammatory drugs (NSAIDS).
In fact, there has been evidence around for a while that both widely used Cox-2 inhibitors had important rates of adverse effects. A meta-analysis published in 2002 in the Canadian Medical Association Journal warned that both drugs produced statistically insignificant increases in total mortality compared to conventional NSAIDS (whereas, if their main difference with conventional drugs was decreased risk of gastrointestinal side effects, one would expect the Cox-2 inhibitors to yield the same, or lower mortality rates as do regular NSAIDS). ("Statistically insignificant" here means that the differences in mortality could have been produced by chance differences between the patients taking different drugs.) More strikingly, both drugs also produced statistically significant increases in serious adverse events.
If nothing else, maybe this will alert the public to be skeptical of all those expensive "direct to consumer" advertisements now epidemic on US television. Such skepticism would make it easier for physicians to persuade their patients that they don't necessarily need the newest, and most heavily promoted drug for every ailment.
The dilemma of treating patients, based on their contributions to society - During my third-year internal medicine rotation, I was introduced to and helped care for a patient named Casey (name changed to protect privacy). I identif...
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