Make a quick survey of any clinic and you will almost invariably find that pain is one of the most common reasons for people to visit a doctor. It is a subjective matter and doctors depend on patients to tell them whether they experience pain, how severe it may be and if it is gets better with time. Doctors can make independent judgments and objective measures of how tall we are our weight, blood pressure and so on, but they are helpless when it comes to managing pain! Doctors know that all pain killers carry degrees of risk, and would be happy not to be forced to deal with such complaints. Doctors do not prescribe any medicine for pain unless a patient complains of severe and persistent debility.
The Role of Vioxx
Most patients try pain killers off the shelf before they ask a doctor for help. Analgesics and NSAIDs (Non-Steroidal Anti-Inflammatory Agents) form first lines of defense and the common brands that we can buy on our own for pain relief, use active ingredients based on these classes. It is standard practice to try Cox-2 Inhibitors such as Vioxx in patients who report inadequate relief from products that they can buy and try on their own for pain relief. However not even the President can buy a Cox-Inhibitor tablet without a prescription. Doctors assess the risks of side-effects before prescribing medicines such as Vioxx. Osteo-arthritis, rheumatoid arthritis and heavy menstruation are the main medical conditions in which pain reported by patients is severe enough to justify use of a Cox-2 Inhibitor.
Side-effects of Vioxx
Allergic reaction, gastric irritation, heart, kidney and liver damage are some of the serious side-effects that were known to be possible with Vioxx treatment when the FDA first permitted Merck to market the medicine in 1999. Doctors consider patient history before they decide to prescribe any Cox-2 Inhibitor including Vioxx. Patients on medicines such as Vioxx should be monitored regularly, so that dosage can be adjusted or treatment changed if early signs of side-effects come to light. The prevalence of such side-effects is rare: most patients can take medicines such as Vioxx safely.
A new puzzle
Medicines on the market continue to be tested in the interests of continuing patient safety. A recent trial to compare gastric irritation with Vioxx as compared to an NSAID, showed Vioxx in favorable light. However it also showed that some people, who took Vioxx for over 18 months at a stretch, developed cardiac conditions. Merck reported the results to the FDA and voluntarily took the medicine off the market. The relationship between long-term Vioxx therapy and heart condition is not known as yet. The FDA believes that the risks of Vioxx use are rare. We could still find Vioxx back on the market, perhaps with new label warnings and modified dosage. It is not unlike NASA’s suspension of space flights after an adverse event, with subsequent resumption after understanding and dealing with relevant issues.
The Vioxx lawsuit
A higher court may reverse the August 2005 verdict in Texas. Attorneys may establish that the patient in question had a history of cardiac difficulties and that the dosage prescribed was not followed accurately. Merck believes that it has a scientific defense. Media reports of cascading litigation and its effect on Merck could prove to be exaggerated. There is significant evidence of the benefits of all Cox-2 Inhibitors, and their contribution to managing chronic pain. Large numbers of patients need medicines such as Vioxx to remain mobile and to feel well enough to go about their lives, and can take the treatment without undue risk.
Some Vioxx lessons
There are major technical and legal issues that remain unresolved with respect to Vioxx and other similar medicines. However the following 5 guidelines can be of universal benefit:
1. Be circumspect about reporting pain to a doctor. Grin and bear it if you can and know that no treatment is entirely free of risk!
2. Follow prescriptions precisely. Do not attempt a repeat purchase against an old prescription or administer your medicine to someone else.
3. Read the information leaflet that comes with your medication and clear doubts with your doctor beforehand.
4. Never take medication without your doctor’s prior information.
5. Never hide symptoms and medical history from your doctor.