E-DRUG: Cox-2, NSAIDS, cardiovascular risk: the seduction of common sense
-------------------------------------------------------------------------
[In a rare move JAMA has made available pre-publication versions of two
meta-analyses and an accompanying editorial for free as full text. The
hard-hitting editorial by David Graham is below. The two meta-analyses
are at http://jama.ama-assn.org/cgi/content/full/296.13.jrv60015v1 and
http://jama.ama-assn.org/cgi/content/full/296.13.jrv60011v1
(abstracts below). The NYT has coverage at
http://www.nytimes.com/aponline/us/AP-Safest-Painkillers.html?_r=1&oref=slogin
- any comments on this advice: "''If something has helped you in the
past and you haven't experienced an adverse reaction with it, stay with
that drug,'' advises Larry Sasich, a pharmacy school instructor and
consultant to Public Citizen's Health Research Group."? Or on Graham's
suggestion that patients at risk of GI problems use naproxen plus a PPI
as first-line or that those at risk of cardiac problems (or all elderly
patients?) use naproxen in the first instance? The FDA NSAID guide is at
http://www.fda.gov/cder/drug/infopage/COX2/NSAIDmedguide.pdf.
Copied as fair use. Andy
[Also note that the last study raises serious questions about the safety
of diclofenac, which is present on many essential drug lists. Should
it be replaced by naproxen (+PPI?) for patients at risk? WB]