Jewish World Review Dec. 17, 2004 / 5 Teves 5765

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports


Life after Vioxx? — Pharmacetical competition good for patients and the industry


http://www.NewsAndOpinion.com | Your Medicine Men have written often on pain management and related issues especially on what happens when the Drug Enforcement Agency (DEA) decides it doesn't like the way some doctor is practicing, or the Food and Drug Administration (FDA) places bureaucratic business-as-usual over patient welfare.


This week, we add a few more items to the pastiche.


Pain atrophies your brain. Literally. According to a study published in the 23 November issue of the Journal of Neuroscience, people enduring chronic pain (n this study, backaches) have brain mass up to 11 percent smaller than those of people without similar conditions.


A. Vania Apkarian of Northwestern University, the study leader, exclaims that those in chronic pain lose about a large pea's worth of gray matter for each year of suffering.


Possible reasons: stress, hyperactivity of the neurons, exhaustion. Apkarian concedes that some of the gray matter loss may relate to relatively minor brain functions, and notes that no attempt was made to correlate brain size with loss.


But two conclusions seem clear. One is that although a little suffering may be good for the soul, a lot may leave you soul depleted.

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A second conclusion: Thank G-d for the pharmaceutical industry. Every decade, it seems, has its businesses that right-thinking people are supposed to hate: Wall Street, Madison Avenue, investment banking, real estate development, Wal-Mart.


Nowadays, and not for the first time, a major culprit seems to be the pharmaceuticals: their sales and PR practices, their profits, their allegedly dangerous side effects.


Forget for a moment that only one research compound in 5000 ever makes it to the market, and that the FDA can withhold vital medications indefinitely. Those medications save and improve our lives. And when one turns out to be questionable, often there's a substitute ready and waiting.


Last September, Merck & Company pulled Vioxx, a popular anti-arthritis drug, from the market after a study showed that people using the drug for longer than 18 months doubled their risk of heart attack and stroke.


A second study, by the University of Pennsylvania, found that Vioxx users had almost three times the risk as those taking another drug, Celebrex.


The problem relates to cox-2 inhibitors, which block inflammation and are easier on the stomach while simultaneously blocking a substance that prevents heart problems.


The question: Are all cox-2s equally nasty, or are some worse than others? The FDA, which has known of the problem for years, has promised to investigate next year.


Presumably, a number of companies are hard at work looking for substitutes. Such is the nature of pharmaceuticals. When over time, wonder drugs turn out to be not so wonderful, back to the lab. Mistakes, disappointments, occasional disasters, yes. But who could deny the spectacular progress of the last few decades?


To add to the Vioxx vexation the popular antiarthritic medication, Bextra, recently came under fire. Some doctors have been wary of prescribing Pfizer's Bextra, another cox-2 drug, for fear it might cause the same type of heart problems as Vioxx. A study discussed at the American Heart Association's annual meeting in November indicated Bextra more than doubled the risk of heart attack and stroke.


But physicians across the country who specialize in Internal Medicine, Rheumatology, Orthopedic and Neurosurgery assure us that there are other effective pain and arthritic medications they can substitute. Would this be possible without many American pharmaceutical companies competing for safer and more effective products with their research and development dollars?


It is true that here in America, we do provide most of the R&D for the rest of the world. But might not it be better if we were known for our Research and Development than our Reconaissance and Destruction?


The federal government doesn't deny the spectacular progress of the last few decades. In fact, they're fascinated. So fascinated that a Bill, HR 3015, (which we recently discussed) has called for a national registry of all people taking pain medications and any other prescription drugs they're taking. A fine way to gather torrents of data for medical science and for the enforcers.


So you the readers must remain diligent to protect your basic freedoms. All of these media and government hot buttons do interrelate and affect the quality of your life. And our thanks to the readers who spoke out to their legislators on HR 3015. It seems that the bill has momentarily disappeared from the Intelligence and other bills. But be reassured it will return in January when you're not looking or are still sloshed from the holidays!


On that note and in spite of the above - from Drs. Mike and Bob - may you all have the best and safest of holidays.

Editor's Note: Michael Arnold Glueck, M.D., penned this week's commentary.




Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

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