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Bad Medicine

Before I went to work this morning I caught the end of a segment on CNBC that had two people debating the FDA and pharmaceutical industry. One of the participants was Dr. Peter Lurie, M.D., Deputy Director, Public Citizen's Health Research Group — and what he said made me almost incoherently angry.

It's several hours later now, so I've calmed down enough to attempt to respond rationally to this arrogant lunatic. (Ah, it would seem I'm still a little worked up about it…) Here's a transcript of the relevant portion of the debate; you can also watch the video:

Michael Tanner
… the current FDA regulations [are] keeping drugs away from people. We talk about Vioxx. Taking Vioxx off the market did help some people but there are thousands of people now who are in pain that don't have access to that drug that was helping them.
Dr. Peter Lurie
Look, they could be taking aspirin. Vioxx was never any better than aspirin. The difference is it killed by FDA estimates, or rather caused heart attacks in, about 160,000 people. I mean, why do we need that risk when it doesn't work any better than aspirin?
Michael Tanner
Well doctors disagree, and that's why they were prescribing it, and doctors are complaining now that they don't have a class of drugs that they need to help some people who couldn't take aspirin for a variety of reasons.
Dr. Peter Lurie
Those doctors are wrong. And if you look for clinical trials that compare Vioxx to aspirin you will not find one in which Vioxx is better, or you will not find a preponderance that show that.
Michael Tanner
Look, you're disagreeing with every academic study that is out there. There is every cost-benefit analysis that's been done on the FDA by economists across the board, left and right, has shown that there is more harm done by FDA regulation than could be benefited by new regulation.
Dr. Peter Lurie
Absolutely not, and the academic literature is absolutely made filthy by the amount of drug industry funded research, including the kinds of stuff that you're busy citing right now.

I go apoplectic at comments like "Vioxx was never any better than aspirin" and "those doctors are wrong" because this is personal, this is family. My sister took Vioxx before it was withdrawn and it has been hell trying to find a suitable alternative. Dr. Lurie's insistence that aspirin is a substitute for Vioxx, even after being reminded that some people can't take aspirin, is a shocking position for a medical doctor to take.

(It's also revealing that Dr. Lurie backpedaled twice during his comments — first about heart attacks and then then about clinical trial data. Did he keep suddenly remembering he's on television, and not safely preaching to his choir?)

Here's an addendum to the earlier article my sister wrote, explaining what happened with the additional medications she's had the "opportunity" to try since Vioxx was pulled:

Running out of options, my doctor gave me a sample of Darvocet to help control the pain. I decided to be cautious with this one and took only half the pill, only to be vomiting it back up within 30 minutes. Several more minutes of dry heaving and I decided that pill wasn't going to work. Next we tried Altram. I felt fine, great in fact — for the first 12 hours. Then I lost the sensation of touch everywhere on my body. I became so dizzy I couldn't stand up, my tongue swelled making speech very difficult, and finally relentless vomiting ensued. My symptoms worsened to the point my aunt had to rush me to the ER were I was given Phenergan and IV fluids and allowed to sleep off the rest of the side effects in the ER.

Now I'm back on Naproxen and my pain grows worse daily. I can only hope that someday, someone will realize the huge mistake of taking Vioxx off the market and return it to those of us who so desperately need it.

There are a lot of pain relief medications, sure. But that doesn't mean they're interchangeable. Some people can't take certain drugs, and the fact that my sister has had to take pain medications for most of her life has given her an unusually long time to develop resistance or an allergy to particular drugs and to whole classes of drugs.

If a new drug provides "the same benefit" through different chemistry, that is an improvement. If a new drug provides "the same benefit" while reducing side effects, that is an improvement. If a new drug provides "the same benefit" through a different form of application (e.g. oral instead of injected, or topical instead of oral), that is an improvement. If a new drug proves "the same benefit" while reducing dosing frequency, that is an improvement.

All the differences between drugs that Dr. Lurie, M.D. is so quick to dismiss are important. This is a matter of life and death, and someone with a title like Deputy Director of the Public Citizen's Health Research Group should behave like he cares about the people he pretends to represent.


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