Vioxx withdrawn

ARTHRITIS DRUG WITHDRAWN, PEOPLE ARE LOOKING FOR ALTERNATIVES By Neil E. Levin, CCN, DANLA A major pharmaceutical company has announced a worldwide recall of its top arthritis drug due to cardiovascular problems seen in long-term users. Merck has withdrawn Vioxx from the market after a study was halted because users of the drug had 200% as much risk of getting heart attacks than participants taking a placebo. Medical experts are advising patients taking Vioxx to consult with their physicians about a substitute. If you are one of these people, there is no better time than now to discussthe use of natural alternatives to drugs with your doctor. If you can get temporary relief of aches and pains by using natural herbs and foods with minimal side effects rather than with more dangerous prescription drugs, why not? After all, dangerous side effects are one reason why drugs have restrictions on their sale in the first place. You have three basic choices to inhibit inflammation. Here they are, one at a time: PRESCRIPTION COX-2 INHIBITORS COX-2 Inhibitors help to prevent inflammation from developing by blocking the action of a certain chemical called COX-2. These drugs are noted for reducing "risk of clinically important GI (gastrointestinal) events" by some 50-60% versus non-steroidal anti-inflammatory drugs like aspirin and ibuprofen. However, most of the COX-2 Inhibitor drugs are also associated with an increased risk of cardiovascular problems. And there are still a goodly number of GI complaints in the COX-2 groups. Now one of the most prominent COX-2 inhibitor drugs has been pulled off the market for doubling the rate of heart attacks. Over-The-Counter NSAIDs (non-steroidal anti-inflammatory drugs) Doctors reportedly recommend NSAIDs, which are COX inhibitor drugs like aspirin and ibuprofen, more than they prescribe COX-2 inhibitor drugs like Celebrex and Vioxx. But there are also problems with NSAIDs. Gideon Bosker, MD, Assistant Clinical Professor at Yale University School of Medicine, reports on the use of NSAIDs for Osteoarthritis (OA) and Rheumatoid Arthritis (RA): "As every primary care practitioner knows, NSAID-associated GI toxicity has become a public health problem, especially among older patients with OA and RA. Gastrointestinal intolerance has been reported in up to 50% of patients on long-term NSAIDs. "NSAIDs cause irritations in the gastrointestinal tract, leading to bleeding and iron loss. (Bjarnason I, Macpherson AJ. Intestinal toxicity of non-steroidalanti-inflammatory drugs. Pharmacol Ther 1994;62:145-57) Going off drugs like aspirin and ibuprofen often causes a rebound effect that creates a cascade of inflammation in the Cox and Lox enzyme pathways. In one report the levels of these inflammatory markers was over 500% higher even two weeks after going off aspirin and ibuprofen! (Endres S. Oral aspirin and ibuprofen increase cytokin-induced synthesis of IL-1 beta and of tumour necrosis factor-alpha ex vivo. Immunology 1996;87(2): 264-270) Ibuprofen has caused kidney dysfunction and water retention. (Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents, Facts and Comparisons Drug Information. St. Louis,MO: Mar 1993, 251j-1l) There are about 16,000 deaths a year from NSAIDs, and 100,000 people hospitalized with serious complications. NSAIDs are blamed for over half of all liver failures in this country. These serious side effects have caused a demand for the COX-2 inhibitor drugs, which do not inhibit the COX-1 enzyme like some NSAIDs do. Two recent large studies (called CLASS and VIGOR) looked at the relative safety of NSAIDs versus COX-2 drugs. NSAIDs were shown to be associated with significantly more upper G.I. tract complications, including ulcers and bleeding. Partly because of such studies, COX-2 drugs have become a major success story for pharmaceutical companies over the past few years, becoming a multi-billion dollar a year business. Research published in the British Medical Journal found that 21% of adults with asthma are sensitive to aspirin. Aspirin may trigger a deadly reaction; as may ibuprofen, diclofenac and naproxen. The doctors recommend new warning labels on all products containing these drugs. DIETARY SUPPLEMENTS There are dietary supplements that may help control the inflammation associated with osteoarthritis. In some cases these will block the inflammatory COX-2 enzyme while not blocking the beneficial COX-1 enzyme. Some of these supplements will also block the 5-LOX inflammatory enzyme that is not blocked by many of the arthritis symptom relief drugs. SAMe (S-Adenosylmethionine) has been studied for depression, arthritis, and a host of other ills. Pronounced "Sam-ee", this substance was deemed effective enough to be studied in comparison to the COX-2 Inhibitor drug celecoxib (Celebrex), reportedly the least dangerous COX-2 drug in terms of cardiovascular risks. In this study 61 patients were enrolled in a randomized, double-blind, cross-over trial over a 4-month period. The researchers found that "SAMe is equivalent in almost all measures to COX-2 inhibitors (celecoxib) in relieving pain and improving function in subjects with osteoarthritis of the knee." Their functional parameters included depression, pain, impairment of physical activity and knee mobility and strength. The anti-inflammatory effects of aspirin and other drugs can also be achieved more safely with concentrated blends of spices and herbs that have a wide range of benefits. These formulas will block the COX-2 enzyme, which triggers inflammation in tissues as a response to chemical signals. NSAIDs block not only the inflammatory enzyme COX-2, but also the beneficial enzyme COX-1. The natural ingredients do not have this problem, because they block only the inflammatory enzymes. These natural ingredients will prevent the actions of not only the COX-2 inflammatory enzyme, but also of the 5-LOX inflammatory enzyme that the drugs do not usually affect. Look for an herbal formula that uses ingredients that have been shown to be helpful for inflammation and joint health, and also promoting normal cell growth (preventing abnormal growth). It should contain highly concentrated common spices like ginger and turmeric, which have been naturally extracted to contain the therapeutic chemicals in the plants. Other ingredients that will enhance an herbal formula are holy basil, EGCg-rich green tea extract, Boswellia, the antioxidant resveratrol and the enzyme bromelain (which helps digest damaged tissues so the inflammation can subside and you can rebuild). The herbs also serve as antioxidants and mild anticoagulants (bloodthinners). RELATIVE SAFETY The tremendous safety difference between dietary supplements and drugs is staggering. There are over 100,000 deaths a year from drugs versus a handful from all dietary supplements, which are far safer than any other category offered. Our risk of dying from eating dinner is far greater than from taking any dietary supplement. originally published September 30, 2004