NYP: Are There Any 'Safe' Drugs?

In the fall, my Vioxx patients fled to Celebrex. Last week they fled to Aleve. This week they don't know what to do.

Now that it was discovered that patients taking naproxen (Aleve) for three years had a 50 percent increased risk of heart disease, my patients want to know if any arthritis drug is safe.

I tell them that all these drugs are probably safe — if taken for the right reasons and if judiciously prescribed.

I tell them that the increased risk of heart disease is due to taking these drugs at high doses over a prolonged period of time. In the case of Celebrex, an enzyme is diminished that prevents clotting. And clotting is associated with heart attacks.

In the case of Aleve (and perhaps all the non-steroidal anti-inflammatory drugs), prolonged use can lead to fluid retention and elevated blood pressure, itself a risk factor to the heart.

A significant issue here is how well the [FDA] patrols drug-safety issues, both before and after a drug is launched. There are certain life-saving drugs that need to be rushed to market....

The largest issue of all is how poorly we physicians keep track of what we prescribe....

Prescribing drugs is a cost/benefit analysis — weighing the risks and benefits of the medication, versus the alternatives (how well the patient would do without it). Perhaps we haven't followed this model carefully enough, but we shouldn't swing from drug dependency to drug panic.

If Celebrex is found to be a greater risk to the heart than it is beneficial to the stomach, we doctors simply need to factor that information into which drugs we prescribe, as the FDA factors it into which drugs are on the market....

Aspirin is an NSAID. It reduces clotting, which why it can sometimes be of help in a heart attack. It is brutal on stomach lining.

These new drugs were developed to be gentler on the stomach lining and to reduce the chances of severe internal bleeding caused by all the NSAIDs.

No drug is to be taken to excess or forever. All the NSAIDs need to be taken with food, as well.

I am someone who cannot tolerate NSAIDs and who has had severe stomach bleeds. I have incapacitating back spasms and routinely do physical work. I use massage, which works, and the relatively new heat wraps, which are better than nothing, but not as good as an NSAID. Every once in a while, I do take a single Aleve and never more than one in 24 hours and never more than once a week and even then, I run risks.

Pain drains energy and joint or muscle pain keeps people from moving, which is sometimes the best treatment. The world is full of people who spend every day toughing out pain and who will try most anything to relieve it, if even for a few hours.

White willow bark was used prior to aspirin and contains the same compound that is irritating. Even Pepto Bismol contains compounds related to aspirin and can cause bleeding in those who are sensitive to it.

The media is now pushing acupuncture for osteo relief. That doesn't help everyone, either. Also, the media is out to get FDA. The left, as well as the right, have been out to get Big Pharma for a long time.

One MD I know gets tired of hearing people complain constantly about the cost of drugs and the side effects. He points out that many of us are only still alive because of these drugs, such as the anti-hypertensives. Still: we all have to research every drug we take and read all the fine print. We have to query our doctors and then we have finally make up our own minds and weigh risks and rewards. We are not guaranteed a pain-free existence and right now I cannot recall a widely used drug that is without side effects.

And, glucosamine-chondroitin

I use it with excellent results, no known side effects.

Barry Sears, author of the Zone Diet books, is coming out with a new one early next year, The Inflamation Zone. Since inflamation is behind so many conditions, it would behoove everyone to read it.

I had furiously inflamed gums a couple of weeks ago, went on my own anti-inflamatory diet and in two days, no pain. High protein, zero high-glycemic carbs (though plenty of greens) ,and plenty of fish oil. It's quite a healthy diet.

I've always believed in prevention rather than cures. The medical profession isn't interested but gee whiz, whenever something goes wrong with me, they are amazed at how quickly I recover without prescription drugs. Ultra-nutrition programs have always pulled me through, but my docs just scratch their heads and say hmmmmmmm. You'd think they'd get a clue!

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