A comment on Vioxx


Category : General, Medical Rants, Pharma

In response to one of my 2 Vioxx posts yesterday, a reader posed this important comment:

i feel like i’m approaching a dead horse with a stick, but don’t doctors share the responisibility for the “some twenty million Americans” with vioxx prescriptions (those with the ability to safely take aspirin or ibuprofen, that is)? maybe i don’t understand the prescription process – is it that patients are demanding drugs as consumers, and doctors are just the gatekeepers to their consumption? wouldn’t a doctor have the ability (responsibility) to say “what you have would be better treated with tried-and-true x” – rather than filling a prescription for the latest shiny package with the cool name?

One problem with my ranting is that I often skip steps. I am aware of all my previous rants and assume that the reader and I share my approach.

So, here is a more complete explication (I hope).

Given the current system, the pharmaceutical company develops drugs. Those that pass through initial testing enter clinical trials. The pharmaceutical company runs the clinical trials and designs them to show efficacy and define a marketing niche (this is a great oversimplification, but probably close to truth).

In the case of Vioxx and the other Cox-2 inhibitors, their development was spurred by a desire to decrease gastric irritation -a significant problem with standard NSAIDs (ibuprofen, naproxyn, etc.). The drug was marketed as if it was generally more effective.

Advertising influences patients and physicians. In the best of worlds, physicians would have objective data for decision making. In the real world, physicians are influenced in a similar manner as patients.

I did not prescribe the Cox-2 inhibitors because I felt them unnecessary and too costly. However, many physicians did succumb to the hype.

You are correct in criticizing physicians. I still believe that a more objective evaluation process of new drugs would decrease these behavior. But maybe I am just a Polyanna!

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Comments (1)

thanks for clearing that up for me. i’m a newcomer to your blog, so i’m sorry if i was asking a redundant question. i totally agree with you (should have said that in the last comment). i don’t think it’s pollyannaish at all to think that less marketing and more objectivity would be safer. you are essentially confirming what i had thought: some doctors succumb to hype just like the rest of us. but maybe i’m putting too much of the onus on doctors – without sufficiently objective information, this is exactly what we should expect.

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