Perspectives on drug withdrawals

Physicians are the ultimate decision-makers in the use of prescription drugs, but we depend on the integrity of pharmaceutical companies. We spend much of our time modifying risk factors for vascular disease, but in the past few years, 2 major classes of drugs have proven to be contributors to vascular disease. The first to fall were the menopausal replacement hormones, and now we are dealing with the fallout related to COX-2 inhibitors.1

When the COX-2 drugs arrived on the scene, I actually stopped prescribing older nonsteroidal anti-inflammatory drugs, because of the risk of upper gastrointestinal bleeding. I began to have doubts about the COX-2 inhibitors when some patients experienced gastric or intestinal problems anyway, and others seemed to experience rather severe hypertension.

The drug representatives showered me with so many samples that I seldom had to write a prescription. One rep gave me an entire case, which lasted for months. I tended to favour whichever COX-2 inhibitor was in my sample cupboard, but they are a hard sell now that 2 of them have been banned. Patients read newspapers too, but surely we physicians deserve to get bad news about drugs from the manufacturers well before it hits the papers.

My fear now is that those of my patients who received COX-2 inhibitors and who now have vascular disease may question my treatment, just as my menopausal patients have questioned replacement hormone therapy. Patients are surprisingly forgiving, but there is undoubtedly a limit to their understanding.

So goes the art and practice of medicine. Sometimes when I reach for my prescription pad, I treat it like a loaded weapon, to be used with extreme caution if at all.