injuryupdate
14-12-2003, 08:37 PM
A recent editorial and paper in the Medical Journal of Australia have slammed the rapid uptake of expensive COX-2 anti-inflammatories by Australian doctors and patients. However, the main concern of these papers is whether the newer drugs (known best by their trade names Celebrex, Vioxx and Mobic) are worth the money. Generally, the newer anti-inflammatories are no more or less effective than older NSAIDs (non-steroidal anti-inflammatory drugs) such as Voltaren. However, their side effect profile is different. There is little dispute that the newer COX-2 medications have lower rates of gastrointestinal complications, such as stomach ulcers, and therefore they are more appropriate medications than traditional NSAIDs for anyone at high risk of an ulcer. The twist in comparative studies has been that older NSAIDs seem to offer a slight protection against heart disease (by thinning the blood) which the newer medications don't match. Ironically the same patients most at risk of gastric bleeding (the elderly using long-term medication) and usually also at risk of heart disease. This issue highlights the perennial problem of the Australian health system. We ideally would like a one-tiered health system where all patients can have their choice of preferred medications. However, with respect to newer drugs, the government is becoming increasingly lumped with a massive bill as more consumers elect for the newer medications. It must drive the Prime Minister crazy as he travels from one meeting discussing the massive blow-out in the PBS to a free-trade meeting with the USA, who argue that the Australian PBS is a protectionist barrier stopping the drug companies from getting full value from their new medications. Read more on anti-inflammatories.