Kane
08-28-2006, 02:15 AM
This is from my response to Skrawny about the dangers of NSAID's and pharmacology in general. Readers are directed to Shinomaster's Advil vs. Aspirin article. This is also a response to CNY rider's bull ... meter.
[QUOTE=Skrawny]I'd like to know what is your data, and where you get it.
How many people were killed by AIDS vs NSAIDs? Or are you presuming that all GI bleeders were taking NSAIDs and bled because of them?
Are you referring to the article in the American Journal of Gastroenterology that showed two, fairly biased, observational studies from *SPAIN* in August of '05? That's the only one I know of. It did show a rate of 15.3 deaths per 100,000 users of NSAIDs. The majority of those where using low dose chronic aspirin for coronary disease, 90% of them were older than 60 years of age and 22% had a history of peptic ulcer disease.
Based on the 2006 CIA World Fact Book there were 950,000 people living with HIV/AIDS in 2005 and 14,000 deaths last year.
Yes there may be more people who died of a GI bleed while they happened to be taking NSAIDs, than died of AIDS, but there are a lot more people taking NSAIDs than are infected with HIV.
In my clinical experience NSAIDs are very good at mild to moderate inflammatory pain. It is also the pain reliever of choice for bone pain and pleuritic pain; I have seen patients with terminal metastatic bone pain relieved by NSAIDs who could not get relief with morphine (although it usually takes both NSAIDs and morphine)
I have not seen any clinical trials that have shown NSAIDs reduce rate of healing, please let me know of any.
I certainly have not seen any clinical trials that say fish oil does better with inflammatory pain than NSAIDs.
Nevertheless, your point is well taken. If aspirin were introduced today, with all of risks, it would certainly require a prescription; not so much the other NSAIDs.
Respectfully,
Hello Skrawny et. al.,
The number of GI bleeding deaths in the U.S. for NSAID's was upwards of 17,000 for over the counter and 28,000 total if you include the prescription totals. This does not include Liver failure from Tylenol. Nor the heart attacks from Viox and other Cox 2 inhibitors. JAMA recently published a article the said the number of deaths from the correct diagnosis and the correct prescription was a number that would place medical treatment as the fourth leading cause of death in the U.S. If you include incorrect diagnosis, iatrogenic issues and incorrect prescription that moves 'medicine' into the first leading cause of death in the U.S. This is based upon "Errors in Medicine", Jama, around 1994.
"FISH OILS are much more effective prostaglandin inhibitors because they work in a different manner to create this effect and they do it without any significant side effects if you aren't allergic to fish." This should have read: 'That Fish Oils are better than NSAID'S, because you get prostaglandin inhibition without any significant side effects if you aren't allergic to fish.'
"In my clinical experience NSAIDs are very good at mild to moderate inflammatory pain." Anything that kills so many people is not good. The NSAID that was introduced in 1999 and taken off the market in 2004 caused a 'Pandemic' of deaths that is estimated to be 60,000.
"Or are you presuming that all GI bleeders were taking NSAIDs and bled because of them?" Try the CDC, I think that may be the source for the total number of deaths from Gastro bleeding.
Frankly, the I know very little pharmacology. But, I see a lot of the patient's who have problems with it because they need a safe alternative to a medical approach. Despite my first paragraph I value the contributions of my medical colleagues and I often refer my patients to medical doctors of various specialties even though the medical organizations constantly create political problems for chiropractors year in and year out. The Supreme Court took issue with this and I take issue with this as well. I've seen a lot of patients who told me that they were afraid to see a chiropractor, because their medical doctor told them that they could die if they see a chiropractor. This makes me irritated.
'Medicine' is in a sad state of disarray. The insurance companies have destroyed quality of care except for the most affluent class of people. The best and the brightest do not become medical doctors anymore and the quality of care is only going to get worse over the next twenty years because of this. The drug companies have bought and paid for literature and they control the much of trends in medicine.
I'd like to take the time to look of the literature, but despite frequent consumption of fish oil, I have not commited the names and dates of the journal articles to memory. CNY RIDER please put your bull... meter where the sun don't shine, and get on google to do your own searching. Here's a start for you: Google: "nsaid deaths from gi bleeding in the u.s." Below is a sample taken from this search.
"A statement from a July 1998 issue of The American Journal of Medicine states the following:
“Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.* The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.” 1
And again a year later (June 1999) in the prestigious New England Journal of Medicine there is a similar statement: “It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States.* This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin’s disease.* If deaths from gastrointestinal toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States.* Yet these toxic effects remain mainly a “silent epidemic,” with many physicians and most patients unaware of the magnitude of the problem.* Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS.” 2
What these journal articles are stating is shocking.* Over 100,000 people are hospitalized for GI bleeding and of those 16,500 die every year.* And these values are considered “conservative”.* Also the figures only include prescription NSAIDs used to treat only arthritis and only in the United States.* If prescription and over the counter NSAID-related hospitalizations and death rates were counted for not only arthritis, but for all conditions, and throughout the world, the figures would no doubt be enormous.* Taking those figures and applying them over the many years that this class of drug that has been available since the early 1970s and the numbers would be horrific.* And yet, no study to date has attempted to quantify these figures.* A graph from the same article shows this alarming statistic relative to other causes of deaths.
Figure 1. U.S. Mortality Data for Seven Selected Disorders in 1997.* A total of 16,500 patients with rheumatoid arthritis or osteoarthritis died from the gastrointestinal toxic effects of NSAIDs.* Data are from the National Center for Health Statistics and the Arthritis, Rheumatism, and Aging Medical Information System. 3
Looking at this information from another perspective we can compare yearly estimated NSAID deaths since 1991 with the number of murders committed with firearms each year in the United States and with the number of U.S. Forces killed in Vietnam if that war was being fought in the 1990s instead of 1961-1972.* Although no data shows the exact number of NSAID deaths each year 7,600 deaths were estimated in 1991 and 16,500 deaths were estimated in 1998.* The graph presented here assumes a linear increase in the number of deaths, however the actually numbers are unknown.* Once again the 16,500 NSAID deaths per year is considered conservative and does not include over the counter medications or prescriptions for other conditions other than arthritis."
"Since these medications are marketed and used worldwide we should expect there to be NSAID hospitalizations and deaths worldwide.* Although the available information is limited, there is evidence of this occurring in Germany and Great Britain.
[QUOTE=Skrawny]I'd like to know what is your data, and where you get it.
How many people were killed by AIDS vs NSAIDs? Or are you presuming that all GI bleeders were taking NSAIDs and bled because of them?
Are you referring to the article in the American Journal of Gastroenterology that showed two, fairly biased, observational studies from *SPAIN* in August of '05? That's the only one I know of. It did show a rate of 15.3 deaths per 100,000 users of NSAIDs. The majority of those where using low dose chronic aspirin for coronary disease, 90% of them were older than 60 years of age and 22% had a history of peptic ulcer disease.
Based on the 2006 CIA World Fact Book there were 950,000 people living with HIV/AIDS in 2005 and 14,000 deaths last year.
Yes there may be more people who died of a GI bleed while they happened to be taking NSAIDs, than died of AIDS, but there are a lot more people taking NSAIDs than are infected with HIV.
In my clinical experience NSAIDs are very good at mild to moderate inflammatory pain. It is also the pain reliever of choice for bone pain and pleuritic pain; I have seen patients with terminal metastatic bone pain relieved by NSAIDs who could not get relief with morphine (although it usually takes both NSAIDs and morphine)
I have not seen any clinical trials that have shown NSAIDs reduce rate of healing, please let me know of any.
I certainly have not seen any clinical trials that say fish oil does better with inflammatory pain than NSAIDs.
Nevertheless, your point is well taken. If aspirin were introduced today, with all of risks, it would certainly require a prescription; not so much the other NSAIDs.
Respectfully,
Hello Skrawny et. al.,
The number of GI bleeding deaths in the U.S. for NSAID's was upwards of 17,000 for over the counter and 28,000 total if you include the prescription totals. This does not include Liver failure from Tylenol. Nor the heart attacks from Viox and other Cox 2 inhibitors. JAMA recently published a article the said the number of deaths from the correct diagnosis and the correct prescription was a number that would place medical treatment as the fourth leading cause of death in the U.S. If you include incorrect diagnosis, iatrogenic issues and incorrect prescription that moves 'medicine' into the first leading cause of death in the U.S. This is based upon "Errors in Medicine", Jama, around 1994.
"FISH OILS are much more effective prostaglandin inhibitors because they work in a different manner to create this effect and they do it without any significant side effects if you aren't allergic to fish." This should have read: 'That Fish Oils are better than NSAID'S, because you get prostaglandin inhibition without any significant side effects if you aren't allergic to fish.'
"In my clinical experience NSAIDs are very good at mild to moderate inflammatory pain." Anything that kills so many people is not good. The NSAID that was introduced in 1999 and taken off the market in 2004 caused a 'Pandemic' of deaths that is estimated to be 60,000.
"Or are you presuming that all GI bleeders were taking NSAIDs and bled because of them?" Try the CDC, I think that may be the source for the total number of deaths from Gastro bleeding.
Frankly, the I know very little pharmacology. But, I see a lot of the patient's who have problems with it because they need a safe alternative to a medical approach. Despite my first paragraph I value the contributions of my medical colleagues and I often refer my patients to medical doctors of various specialties even though the medical organizations constantly create political problems for chiropractors year in and year out. The Supreme Court took issue with this and I take issue with this as well. I've seen a lot of patients who told me that they were afraid to see a chiropractor, because their medical doctor told them that they could die if they see a chiropractor. This makes me irritated.
'Medicine' is in a sad state of disarray. The insurance companies have destroyed quality of care except for the most affluent class of people. The best and the brightest do not become medical doctors anymore and the quality of care is only going to get worse over the next twenty years because of this. The drug companies have bought and paid for literature and they control the much of trends in medicine.
I'd like to take the time to look of the literature, but despite frequent consumption of fish oil, I have not commited the names and dates of the journal articles to memory. CNY RIDER please put your bull... meter where the sun don't shine, and get on google to do your own searching. Here's a start for you: Google: "nsaid deaths from gi bleeding in the u.s." Below is a sample taken from this search.
"A statement from a July 1998 issue of The American Journal of Medicine states the following:
“Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.* The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.” 1
And again a year later (June 1999) in the prestigious New England Journal of Medicine there is a similar statement: “It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States.* This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin’s disease.* If deaths from gastrointestinal toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States.* Yet these toxic effects remain mainly a “silent epidemic,” with many physicians and most patients unaware of the magnitude of the problem.* Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS.” 2
What these journal articles are stating is shocking.* Over 100,000 people are hospitalized for GI bleeding and of those 16,500 die every year.* And these values are considered “conservative”.* Also the figures only include prescription NSAIDs used to treat only arthritis and only in the United States.* If prescription and over the counter NSAID-related hospitalizations and death rates were counted for not only arthritis, but for all conditions, and throughout the world, the figures would no doubt be enormous.* Taking those figures and applying them over the many years that this class of drug that has been available since the early 1970s and the numbers would be horrific.* And yet, no study to date has attempted to quantify these figures.* A graph from the same article shows this alarming statistic relative to other causes of deaths.
Figure 1. U.S. Mortality Data for Seven Selected Disorders in 1997.* A total of 16,500 patients with rheumatoid arthritis or osteoarthritis died from the gastrointestinal toxic effects of NSAIDs.* Data are from the National Center for Health Statistics and the Arthritis, Rheumatism, and Aging Medical Information System. 3
Looking at this information from another perspective we can compare yearly estimated NSAID deaths since 1991 with the number of murders committed with firearms each year in the United States and with the number of U.S. Forces killed in Vietnam if that war was being fought in the 1990s instead of 1961-1972.* Although no data shows the exact number of NSAID deaths each year 7,600 deaths were estimated in 1991 and 16,500 deaths were estimated in 1998.* The graph presented here assumes a linear increase in the number of deaths, however the actually numbers are unknown.* Once again the 16,500 NSAID deaths per year is considered conservative and does not include over the counter medications or prescriptions for other conditions other than arthritis."
"Since these medications are marketed and used worldwide we should expect there to be NSAID hospitalizations and deaths worldwide.* Although the available information is limited, there is evidence of this occurring in Germany and Great Britain.