‘Pay more and suffer more’
by Dr. Lalith Mendis
The treatment of common ailments with expensive drugs with serious side effects when cheaper drugs with less side effects are available is the plight of the patient who does not know any better. This is often seen in the usage of analgesics and non steroidal anti-inflammatory drugs (NSAIDs) in the treatment of headache and musculoskeletal conditions.
The myth is that aspirin is dangerous, so more expensive preparations are necessary.
The truth is that most expensive drugs produce more dangerous side effects than aspirin.
The well kept secret is that many recent and more expensive drugs have been involved in fatal gastro intestinal haemorrhage. The survey done by the Committee on Safety of Medicines in the UK analysing the use of these drugs from 1964 to 1985 elicited that 44 deaths were reported for 381 prescriptions of ibuprofen and 61 deaths for 474 prescriptions of naproxen.
Review of 179 clinical trials on osteoarthritis and more than 400 trials on rheumatoid arthritis have not demonstrated significant differences in efficacy between aspirin and other NSAIDs. (Champion GD; Medical J of Australia 1988;149:201-213). A well designed study by Langman and others showed that 1.5 million non-aspirin NSAIDs recipients would have 3500 episodes of serious gastrointestinal bleeding while 1.5 million aspirin recipients would have only 2800 such episodes. (Lancet 1994; 343:1075-8) Cry out loud aspirin is safer than the expensive new drugs.
After a long time, a study was designed with aspirin where it was proved that No serious gastric effects were seen with aspirin. (Clinical Rheumatology Feb 2002). DG Dispatch (APS 2001) reporting on the 20th scientific sessions of the American Pain Society quotes Dr. Laureen MacEachem who reports that aspirin should be tried first in tension headaches before more complicated medicines.
Fifty percent of migraine improves without drugs by avoiding precipitating factors. Check eyes for accommodation errors and astigmatism (frequent sties). Check out bad reading habits – with slanted head while reclining on the bed, reading in dim light, reading with book too close to the eyes, reading while travelling as hard pressed Medical students do. When you write, keep your document straight as possible.
Usually, stress and breaking rest brings on the migraine aura hunger, nausea. At that stage those who are frequent sufferers of migraine must relax. Sleep with sound and light shut out is helpful. You can induce vomiting (finger in the throat) and reduce the intensity of a migraine attack when drugs have failed.
It is well known that breaking rest, sleepless nights, TV, delaying meals, colas, tea, coffee, peanuts, cadju nuts bring on the migraine attack in those who are predisposed. Application of hot or cold fermentation to the side of the forehead, oil of wintergreen is effective. Psycho-somatic methods have also proven useful.
In the short-term symptomatic treatment of osteoarthritis of the knee, paracetamol was found to be as effective as ibuprofen when the latter was administered in analgesic or anti-inflammatory doses. Furthermore, potent inhibitors of prostaglandin synthesis such as indomethacin may even accelerate the progression of osteoarthritis by reducing vasodilator prostaglandins, thereby diminishing joint perfusion.
The more potent drugs can be actually harmful. GP News & Views July 2001 reports that 22 out of 33 patients with osteoarthritis respond to paracetamol alone. Therefore it is irrational to treat such patients initially with more expensive drugs. In fact they can harm the cartilage.
Other adverse effects
The British Medical Journal reported (14.08.2003) that the use of potent NSAIDs increases the risk of miscarriages. Naproxen, indomethacin, and tolmetin have been implicated in NSAID – induced aseptic meningitis.
The NSAID most commonly implicated has been ibuprofen. (Arch Int Med 1991;15:1309-13). There is also evidence that patients who regularly use paracetamol or non-aspirin NSAIDs are at increased risk of developing end stage renal disease.
Indomethacin and some other NSAIDs were known to increase mortality after heart attacks. Celocoxib was introduced as a drug that will cause less gastric problems. However, the promoters hid the truth of a 15 month trial until a reporter of the Washington Post highlighted the unethicality of the publication.
Celocoxib was found to increase heart risk. (Therapeutic letter 42). This is the result of money driven research with drug manufacturing companies waiting to benefit. Aspirin is an old broom that sweeps well even now.
Aspirin is not a fiend but a friend. There is no medical reason to prescribe newer NSAIDs and not aspirin
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