A month ago I wrote a blog called "Don't Trust Your Doctor." That blog made a lot of doctors upset, so I guess today's blog will make some of those doctors even more mad.
In "Don't Trust Your Doctor" I used an example of a friend of mine, who isn't a doctor, and who stopped using Vioxx many years ago, based on the early reporting about cardiovascular side effects. But many docs kept prescribing Vioxx as if this was candy, resulting in a still evolving medical catastrophe.
Today, the Wall Street Journal on their front page takes the same approach I took in my blog.
In an article on page one titled "How the New England Journal Missed Warning Signs on Vioxx" they use an example of a non-doctor concerned about Vioxx, very early on: "In August 2001, a Seattle pharmacist called a radio show on which Jeffrey Drazen, the top editor of the New England Journal of Medicine, was appearing. On the air, the pharmacist, Jennifer Hrachovec, begged Dr. Drazen to update an article in the journal that touted the benefits of the painkiller Vioxx while playing down its heart risks."
The article goes on to describe the role of the New England Journal of Medicine in the Vioxx debacle. Please note that this journal is the most-cited medical publication in the world, and its November 2000 article on Vioxx was a major marketing tool for Merck. In fact, "the journal sold more than 900,000 reprints of the article, bringing in at least $697,000 in revenue. Merck says it bought most of the reprints."
There was only a problem with the article. "The article said 0.4% of the Vioxx patients had suffered heart attacks, compared to 0.1% for the naproxen group. It offered several reasons why that wasn't as worrisome as it seemed, including a theory that the difference stemmed from naproxen's supposed protective effect on the heart."
Later, however, "Merck submitted data from the Vigor study to the FDA because it wanted to add the favorable information about stomach side effects to Vioxx's label. But the data it gave to the agency, posted on the FDA's Web site in February 2001, did not square with the data in the New England Journal article. Merck said Vioxx takers had 20 heart attacks, which translated into 0.5% of the total, not 0.4% as the article said. The higher figure undermined an assertion in the article that only those who were already at high risk of a heart attack showed an increased risk after taking Vioxx. That's because the extra heart attacks were all in the low-risk group."
So let's step back for a second. It appears as if the New England Journal of Medicin was hoodwinked by Merck, and didn't do much to check the facts. But even if they hadn't been hoodwinked, there was early data showing that four times as many patients on Vioxx suffered heart attacks as patients on a well known older drug.
And here's my point. Tons of doctors did prescribe Vioxx as if this was candy. David Graham from the FDA claims that Vioxx has killed about 60,000 patients. And if you have a doctor who prescribed Vioxx like candy to his patients, he had an obligation to stay on top of scientific data. He certainly seems to have had time to see all those sales reps, so why didn't he take some of that time to do his own reading? And then he would have known, already back in 2001, that there might be an issue with Vioxx, even if the full problem hadn't yet been revealed. Of course he could have just believed the "explanation" in the NEJM, but he could also have used common sense which would have made him more reluctant to prescribe Vioxx to overweight, hypertensive, elderly patients, who were at increased risk for heart attacks.
A cursory review or recent Vioxx lawsuits indicate that many doctors had no such worries on their little minds.
The problem I have is that many doctors now blame the big bad drug company. That's like the Little Red Riding Hood blaming the Wolf. Doctors know that drug companies are in business to make money, and will rarely tell them the whole story. Doctors know the drug companies select the best data to present to them and doctors know that except for bagels, pizza and drug samples, sales reps rarely have something of value to offer.
And if the doctor buys the fairy tale that the Wolf is grandma and the drug company will "teach them about new drugs," then the doctor deserves to be eaten alive, because his patients are paying the price with their lives.
Finally, to those of you who's mommies never read the Little Red Riding Hood, you can find the story here.
And as an additional bonus, for all of you who did read that story, here's a new, more interesting version:
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LITTLE RED RIDING HOOD (The Politically Correct Version)
There once was a young person named Little Red Riding Hood who lived on the edge of a large forest full of endangered owls and rare plants that would probably provide a cure for cancer if only someone took the time to study them.
Red Riding Hood lived with a nurture giver whom she sometimes referred to as "Mother," although she didn't mean to imply by this term that she would have thought less of that person if a close biological link did not in fact exist. Nor did she intend to denigrate the equal value of nontraditional households, and she was sorry if this was the impression conveyed.
One day her mother asked her to take a basket of organically grown fruit and mineral water to her grandmother's house.
"But mother, won't this be stealing work from the unionized people who have struggled for years to earn the right to carry all packages between various people in the woods?"
Red Riding Hood's mother assured her that she had called the union boss and gotten a special compassionate mission exemption form.
"But mother, aren't you oppressing me by ordering me to do this?"
Red Riding Hood's mother pointed out that it was impossible for women to oppress each other, since all women were equally oppressed until all women were free.
"But mother, then shouldn't you have my brother carry the basket, since he's an oppressor, and should learn what it's like to be oppressed?"
Red Riding Hood's mother explained that her brother was attending a special rally for animal rights, and besides, this wasn't stereotypical women's work, but an empowering deed that would help engender a feeling of community.
"But won't I be oppressing Grandma, by implying that she's sick and hence unable to independently further her own selfhood?"
But Red Riding Hood's mother explained that her grandmother wasn't actually sick or incapacitated or mentally handicapped in any way, although that was not to imply that any of these conditions were inferior to what some people called "health." Thus Red Riding Hood felt that she could get behind the idea of delivering the basket to her grandmother, and so she set off.
Many people believed that the forest was a foreboding and dangerous place, but Red Riding Hood knew that this was an irrational fear based on cultural paradigms instilled by a patriarchal society that regarded the natural world as an exploitable resource, and hence believed that natural predators were in fact intolerable competitors.
Other people avoided the woods for fear of thieves and deviants, but Red Riding Hood felt that in a truly classless society all marginalized peoples would be able to "come out" of the woods and be accepted as valid lifestyle role models.
On her way to Grandma's house, Red Riding Hood passed a woodchopper, and wandered off the path, in order to examine some flowers. She was startled to find herself standing before a Wolf, who asked her what was in her basket. Red Riding Hood's teacher had warned her never to talk to strangers, but she was confident in taking control of her own budding sexuality, and chose to dialogue with the Wolf.
She replied, "I am taking my Grandmother some healthful snacks in a gesture of solidarity."
The Wolf said, "You know, my dear, it isn't safe for a little girl to walk through these woods alone."
Red Riding Hood said, "I find your sexist remark offensive in the extreme, but I will ignore it because of your traditional status as an outcast from society, the stress of which has caused you to develop an alternative and yet entirely valid world view. Now, if you'll excuse me, I would prefer to be on my way."
Red Riding Hood returned to the main path, and proceeded towards her Grandmother's house. But because his status outside society had freed him from slavish adherence to linear, Western-style thought, the Wolf knew of a quicker route to Grandma's house.
He burst into the house and ate Grandma, a course of action affirmative of his nature as a predator. Then, unhampered by rigid, traditionalist gender role notions, he put on Grandma's nightclothes, crawled under the bedclothes, and awaited developments.
Red Riding Hood entered the cottage and said, "Grandma, I have brought you some cruelty-free snacks to salute you in your role of wise and nurturing matriarch."
The Wolf said softly, "Come closer, child, so that I might see you."
Red Riding Hood said, "Goddess[es]! Grandma, what big eyes you have!"
"You forget that I am optically challenged."
"And Grandma, what an enormous, what a fine nose you have."
"Naturally, I could have had it fixed to help my acting career, but I didn't give in to such societal pressures, my child."
"And Grandma, what very big, sharp teeth you have!"
The Wolf could not take any more of these speciesist slurs, and, in a reaction appropriate for his accustomed milieu, he leaped out of bed, grabbed Little Red Riding Hood, and opened his jaws so wide that she could see her poor Grandmother cowering in his belly.
"Aren't you forgetting something?" Red Riding Hood bravely shouted. "You must request my permission before proceeding to a new level of intimacy!"
The Wolf was so startled by this statement that he loosened his grasp on her. At the same time, the woodchopper burst into the cottage, brandishing an axe.
"Hands off!" cried the woodchopper.
"And what do you think you're doing?" cried Little Red Riding Hood. "If I let you help me now, I would be expressing a lack of confidence in my own abilities, which would lead to poor self-esteem and lower achievement scores on college entrance exams."
"Last chance, sister! Get your hands off that endangered species! This is an FBI sting!" screamed the woodchopper, and when Little Red Riding Hood nonetheless made a sudden motion, he swung the axe and sliced off her head.
"Thank goodness you got here in time," said the Wolf. "The brat and her grandmother lured me in here. I thought I was a goner."
"No, I think I'm the real victim, here," said the woodchopper. "I've been dealing with my anger ever since I saw her picking those protected flowers earlier. And now I'm going to have such a trauma. Do you have any aspirin?"
"Sure," said the Wolf.
"Thanks."
"I feel your pain," said the Wolf, and he patted the woodchopper on his firm, well padded back, gave a little belch, and said "Do you have any Maalox?"
This Politically Correct version is found online from many sites as of 09/26/2005. There is a similar version but of lesser quality and the Maalox version is probably refined from it. For an example of the original version, see http://philip.greenspun.com/zoo/red-riding-hood as of 20050926, which is credited from "Politically Correct Bedtime Stories" by James Finn Garner.
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