Public Nuisances

It is a fact of American journalism that it is almost always in a state of agitation. Its practitioners should, with a few notable exceptions, be on medication at all times. For the newsrooms of America, I would prescribe one of the many fine tranquilizers produced by our leading pharmaceutical companies.

An example of the agitation afflicting my unsedated colleagues is the enormous pother they have created over another of the pharmaceutical companies’ wonders, painkillers.

One, Vioxx — when taken in very high dosages and for a long period of time — is suspected of causing cardiovascular problems for a small number of patients. Two others, Celebrex and Aleve, might when taken in huge doses and for a long time cause similar problems.

The makers of Vioxx imprudently hauled it off the market — an invitation for the trial lawyers to pounce. The makers of Celebrex and Aleve have acted more prudently. They understand that the danger posed by their medications is slight and that tens of thousands of Americans with chronic pain face dreadful misery without these medications.

Yet the agitation of the journalists continues and moves from unwarranted alarm about a painkiller to Great Expectations about another, newer painkiller, one that sounds grisly to me, something called Prialt. It is made from poison found in the South Pacific cone snail. Yes, I said poison.

A similar painkiller that has scientists and journalists giddy in anticipation is made from fluids found in tree frogs. Of the snail-venom-laced painkiller, Richard L. Rauck of Wake Forest University and the Carolina Pain Institute exclaims, "This drug is very exciting because it’s a very potent analgesic but isn’t a narcotic." Very exciting indeed — wait until it is discovered that Prialt’s baseline risk for cardiovascular disease over a period of time is not less than 1 percent but actually 1.5 percent.

Then the trial lawyers will be ringing up the snail venom users. The press will be echoing with charges that Prialt’s producer knew all along that the stuff was deadly. And forget not the case that will be made by the animal rights activists when they discover the impending depletion in the world’s South Pacific cone snail population.

The increase in baseline risk that I mention as a possibility in Prialt’s future is not a product of my imagination. It was precisely this shift in Vioxx’s baseline threat that transformed it into a matter of hysteria in the press. In the study that indicted Vioxx, the number of cardiovascular events per 1,000 was 15 for the group using Vioxx in large dosages and for 18 months. The number of cardiovascular events per 1,000 was 7.5 for the group using a placebo.

Rather than bringing in the Feds and the trial lawyers, I think such findings should leave it to doctors and patients to decide whether they wanted a slight increase in danger or enduring pain.

Instead, we now have journalistic hysteria over the Giant Pharmaceuticals and their alleged reckless pursuit of profit. The trial lawyers’ pursuit of profit will get little attention. Witnesses will turn up who will insist that they recognized the painkiller’s dangers all along. They will claim Vioxx’s producer did, too.

Let me say it now. I seriously doubt that in litigious America any pharmaceutical company would risk putting a drug on the market knowing it was dangerous. All medications have side effects, some quite serious. The important question is over the severity and frequency of the side effects.

My guess is that Vioxx’s severity and frequency are within the bounds of the tolerable. The suffering of patients no longer allowed to use Vioxx has gotten little attention in the news stories. Certainly suffering can lead to death.

The Wall Street Journal points out ironically that it might be a good thing that a growing list of painkillers is being attacked in the press. Suffering Americans need painkillers. As the list of painkillers with side effects lengthens, the public may be moved to a sensible conclusion.

Powerful medications have side effects. The afflicted and their doctors can decide what is best for them — in the case of Vioxx, more pain or a slight increase in the chance of cardiovascular disease. The answer to the current hysteria over painkillers is more information and more consumer freedom — nothing more.

This column was original published in 2004.