The Sordid History of Cox-2 Inhibitors

The reportage surrounding the Cox-2 inhibitor drugs -- Vioxx, Celebrex and now Arcoxia -- can be a bit confusing. The bottom line, as articulated by MSNBC's Robert Bazell, is this: "Will the drive for profits once again trump sound science and proper medical practice?"

Bazell goes on to give a great historical rundown of Cox-2 inhibitors:

In one of the most sordid chapters in pharmaceutical-company history, the manufacturers got tens of millions of Americans to take the drugs for pain relief, even though they cost hundreds of times more than other drugs that work just as well. Plus, these pricey pills turned out to have scary side effects. [...]

About 20 million people in the United States suffer from osteoarthritis, pain at the joints that often comes with age. Another 4 million have rheumatoid arthritis, an autoimmune disease. For years, the major treatment for the pain and inflammation of arthritis was aspirin, which works quite well for many people. In some, however, continued use of large amounts of aspirin causes bleeding ulcers that can require hospitalization and can even be fatal.

In the 1970s drug companies developed a series of aspirinlike drugs called nonsteroidal anti-inflamatories or NSAIDs, including ibuprofen (sold as
Motrin and Advil) and naproxen (sold as Aleve). Even with these drugs, an estimated one half of 1 percent of the people who take them end up hospitalized with bleeding ulcers and about one in five of those die from them, mostly people who are elderly and infirm.

The hope of the Cox-2 inhibitors, developed in the 1980s, was that they would relieve the pain and inflammation of arthritis without causing the stomach problems. Although drug-company public-relations representatives, eager reporters and some doctors hailed the Cox-2
inhibitors as “super aspirin,” it is critical to note that no one — not the companies, not the FDA — ever said they did a better job of controlling pain or inflammation than aspirin or any other NSAID. They were just supposed to be gentler on the stomach.

Thanks to "two of the most expensive marketing campaigns in pharmaceutical history," three out of every five Americans with arthritis were taking Vioxx or Celebrex by the late 1990's, when research started to link these unnecessary, expensive drugs with increased risks of heart disease.

In 2004, facing a firestorm of criticism, Merck yanked Vioxx from the market. The FDA did not intervene, and permitted Celebrex to stay on the market -- which is part of the reason why people are now so suspicious that the FDA won't give Arcoxia, the latest Cox-2 inhibitor, the rigorous review it deserves.

Second Opinion: Return of the killer painkillers? [MSNBC]