Another lesson from the Vioxx case

There is yet another lesson to be learned from the Vioxx debacle: drug representative sales pitches to American physicians and direct advertising to the public result in inappropriate over-use of newer, more expensive, less thoroughly clinically tested, and potentially more dangerous drugs. A recent article in the traditional Archives of Internal Medicine concluded that Vioxx and Celebrex were prescribed to millions of people who either didn’t need them, or who were unlikely to benefit from these more costly medications.

The Cox-2 class of drug was developed in response to the rather common side effect of the first generation non-steroidal anti-inflammatories of gastrointestinal bleeding. However, they should only have been prescribed for those patients at the highest risk for GI bleeding. The older NSAIDs and even plain old aspirin are just as effective, and much less costly, than these new “superdrugs.” Only 2 percent of the study group fulfilled the criteria for a definite Cox-2 inhibitor drug prescription. Twenty-five percent of the group could rationally have been prescribed either a Cox-2 drug or an older NSAID. But the other 75 percent should have been given NSAIDs or aspirin. So why did Vioxx and Celebrex capture 61 percent of the market within two years of their introduction? Aggressive marketing, and an especially aggressive budget for direct-to-consumer marketing, those drug commercials we all have been seeing.

Now this is serious business. A drug company introduces a new drug. It is appropriate for perhaps at most 25 percent of the people who need to take anti-inflammatories, in our opinion, even fewer, because anti-inflammatories make the underlying arthritis process worse. Yet aggressive marketing is hugely successful, brings in billions a year for the drug company and its shareholders, and in the process, millions of people’s health are placed unnecessarily in jeopardy. This looks like the drug company’s main purpose is to make the most possible money. They did quite a job on this in the case of Vioxx. But look what happened. Perhaps thousands of people had heart attacks who should not have had them. How many people did these prescribing habits kill? There are many things that are terribly wrong with our health care system. This is surely one of them. The lack of ethics by pharmaceutical companies, the media wedded to traditional drug-based medicine, which hypes and idolizes each “miracle drug,” and a brain-washed physician and general populace that has been trained to believe that drugs are good, and new drugs are even better.

Here’s my advice. Drugs are palliative, and at best are two-edged swords that can both harm and help you. Do not necessarily believe what you read in the papers or see on TV. Don’t jump on any new drug bandwagons. There are no real miracle drugs. Ignore television drug advertising directed at the consumer, and never ask your physician if a new drug is for you. He’ll be all too happy to try it out on you even when you’re not really a good candidate for the drug. If you must take drugs, stick with the ones that have stood the test of time and are tried and true, or at least the negative effects have been well delineated. The Vioxx disaster cost many people their lives and their health. This event holds the potential for being a huge cultural spark that gets our attention, and makes us start asking the right questions, some hard questions, about why things are the way they are and how they need to change.

Reprinted with permission. A newsletter from Caring Medical & Rehabilitation Services, S.C., 715 Lake St., Suite 600, Oak Park, IL 60301. Phone: (708) 848-7789, Fax: (708) 848-7763,

From the March 30-April 5, 2005 issue

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