Friday 8 April 2005

Pic of the day: It's time to panic! Or perhaps not. Screenshot from the anime Mamotte Shugogetten.

Painkiller panic

In the news: The FDA (Food & Drug Administration) in the USA has banned my current brand of painkillers, Bextra. This should come as no shock, since it is a COX2-inhibitor same as Vioxx which was withdrawn a few months ago. The whole family of painkillers were known to increase the risk of trombosis. I knew this back when I was still taking Vioxx, and it did not cause me to panic then. It still does not cause me to panic. Of course, if I actually get a blood clot or an heart infarct, I'll panic, and by then it is a bit late. But let us put this in perspective.

When these drugs were allowed in the first place, it was not by happenstance. Before being certified for human use, the drugs are tried out on animals and then in clinical tests on real patients. It was only after the drugs had been used for a long time on a large number of patients that the side effects were discovered. This means right away that most people do not develop these side affects. Furthermore, it seems that the side effects are only (or at least mainly) found when people take this medication in large doses for a long time. Some people had to do that, because they suffer from debilitating arthritis pain. Since these drugs were considered the safest available, these patients were taking them constantly.

It is not like people are eating painkillers for candy. When people take this much painkiller, it is because they couldn't live a normal life without it. Of course, you can't live a normal life with heart infarct either, so it makes sense to cut out the COX2 inhibitors. Even so, I believe it was an unwise decision to withdraw them completely from the market. It is not like other painkillers are completely safe, either. In my case for instance, I have had recurring stomach problems for some years. Nothing that has required serious medical treatment, but enough that I would hesitate to use acetylsalicylic acid (Aspirin) or the newer synthetic painkillers that are chemically similar to it, such as ibuprofen and ketoprofen. These drugs not only relieve moderate pain, but also reduce inflammation. For pure pain relief I would take paracetamol, which has no effect on the stomach lining (but can damage the liver if taken in large doses or over long time).

Now the FDA has not just banned Bextra, but also warned against some COX1 painkillers about which there is no new findings of side effects above what has been known for a long time. I have to admit, I agree with the article in Chicago Tribune that implies that the FDA may have exceeded expert advice in order to polish its public image, which took a hit after the Vioxx scandal. (A scandal which was not a scandal, in my opinion, but a matter of disproportional bad press.)

As far as I know, there exists no medication without the risk of side effects. Actually, there exists pretty much nothing in the world without the risk of side effects. Breathing can be dangerous to your health. Common table salt would probably have been forbidden by the FDA if it had been discovered now; it is toxic in quantities easily found in the kitchen by children.

More to the point, tobacco products have been fitted with huge warning labels for some time now, and there are still millions who use them. Even now that much safer nicotine gum is available, I see smokers almost any time I am in town. I also see people happily eating hot dogs, even though the fat in those things are pretty much the worst thing you can give your arteries unless you are a lumberjack or someone with a similar rate of burning calories. Why doesn't the FDA withdraw hot dogs? It's a FOOD and drugs administration, isn't it?

Most relevant of all, we should look at what pain and chronic inflammations do to people. It is not as if pain is good for your health. Chronic pain is linked to lack of sleep, one of the surest ways to not only reduce life quality but also cut valuable days from the lenght of your life. Pain also make people irritable, increasing tension with family and friends. Again, big health risk. Your closest social network is one of the big things to keep you alive. Quarreling raises blood pressure, which causes trombosis and heart infarct too.

In short, we should keep a perspective here. If you have chronic pains, you would want to use a varied medication, shifting from one painkiller to another from time to time. You would also want to use meditation in addition to medication - many relaxation techniques can reduce pain or make it easier to ignore. Compensate for possible side effects by living a healthy life in other ways. And above all: Panic does NOT save lives except in acute danger, and rarely even then.