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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: Twitter: Dereklowe

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« Boarding Up the Windows | Main | Optioning the Drug Portfolio »

December 21, 2004

No Drug Is An Island

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Posted by Derek

And now there's a warning about the antiinflammatory drug naproxyn. It's all over the news this morning, so you've seen the story already. I can only second what Sydney Smith over at Medpundit says:

"And if drugs like Vioxx and Celebrex cause heart disease and strokes because their biochemistry increases the likelihood of clotting, as many critics have suggested, then why would Naprosyn, which has a biochemistry detrimental to clotting, be riskier than Celebrex? Because the findings have all been based on small and insignificant numbers. The difference between 3% of people having a complication and 2% is clinically meaningless.

It's too bad that we've decided to exaggerate the risks of these drugs. If we keep it up, we won't be able to prescribe anything."

I'm not sure if the numbers are meaningless or not - if the trials are sufficiently large and well-designed, the statistical significance is there. But I am sure that if we breed an expectation of "no side effects, ever", that doctors are, indeed, not going to be able to prescribe anything. I sure won't be able to make anything that for them to prescribe.

If Drug X saves 10,000 lives a year, at the cost of killing 100 people a year who are susceptible to its side effects, what should we do? Look for alternatives, surely. Try to identify (in advance) those at risk, of course. Try to come up with a newer analog with an even better profile, naturally. Oh yeah, and sue the pharmaceutical company until they're flat on the ground. That, too.

Comments (1) + TrackBacks (0) | Category: Toxicology


1. Chui Tey on December 21, 2004 8:22 PM writes...

Californian style disclaimers really do little to protect a patient from drugs which they may be susceptible to, or perhaps one which may have interaction with other drugs or health supplements which they may be taking.

The whole health industry could do with a smartcard which is updated by dispensing pharmacies. This way, a doctor can just scan the smartcard and check whether a drug this person is taking has any known interactions for his condition. For a sick person, the potential interaction is huge, (n) * (n-1), and this is a job that's better computerized.

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