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December 21, 2004
No Drug Is An Island
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.
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