The Finch Formerly Known As Gold

22 June 2005

Fear is the drug

Last fall in Vent #407, I found myself in the unusual position of defending a drug company:

Merck, on balance, was right to pull Vioxx from the shelves; while the publicity is bad, it would have been much worse had they waited for the FDA to order a recall. Still, it should be remembered — but probably won't be, at least among the general public — that just about anything you put into your mouth, be it a $3 Vioxx tab, a two-cent aspirin, or a Kellogg's Pop-Tart, has a measurable risk factor, and the only way to avoid risk completely is to drop dead.

One reason the general public won't remember this, you can be sure, is medical scaremongering, as described by Dr. Sanity, who encountered it in regard to hormone-replacement therapy:

I suspect there is considerable individual physiological variability associated with the number of estrogen receptors and such, which probably determines how sensitive one is to estrogen depletion. But it is an individual thing, and each individual should decide for themselves whether the risk is worth it or not. Everything in life is a trade-off, after all. It is only in a culture where litigation thrives that miracle drugs like HRT, or anti-inflammatory agents (e.g., Vioxx, Celebrex, Ibuprofen etc.) are damned because they have side effects. EVERY SINGLE DRUG HAS SIDE EFFECTS.

Emphasis in the original.

How much risk was the good Doctor facing?

Why, I asked, couldn't I get back on HRT? Oh, I was told, the risks are too great. Well, I went to the original literature and read the articles — and lo and behold, it was exactly as Dr. Purdie suggested above. For example, when you are talking about a 20 in 1000 chance of developing breast cancer (which is the risk WITHOUT EITHER HRT OR ERT) doubling — you get 40 in 1000 (that's the actual risk of HRT; if you use ERT, the risk goes from 20 in 1000 to 25 in 1000). Let me tell you, that risk seemed pretty darn good to me in exchange for being able to sleep and function as a normal human being again.

"Dr. Purdie" is Professor David Purdie of Hull-York Medical School, who took the British medical journal Lancet to task for hyping the two-percentage-point increase in risk, which they characterized as a doubling of the risk, which is mathematically correct, but which, says Purdie, is "unbalanced and inflammatory."

Similar numbers exist with NSAIDs: in a clinical trial with Vioxx, 3.5 percent of patients suffered "cardiovascular events" — but so did 1.9 percent of patients who were given a placebo. Yet the press reacted as though Merck had hacked together some form of snake oil containing two parts arsenic, one part raw sewage, and just a hint of eye of newt, and I don't mean Gingrich.

Repeat: EVERY SINGLE DRUG HAS SIDE EFFECTS. If this seems astonishing to you, you should perhaps steer clear of Walgreen's.

(Found at The Cotillion.)

Posted at 6:21 AM to TANSTAAFL

"eye of newt" eh?

Sounds like double toil and trouble to me...

Posted by: paulsmos at 9:32 AM on 22 June 2005