Surgery or Drugs?

Whither arthritis treatment now?

This is the second of our articles on the topic of pain control and treatment for osteoarthritis. The first, by Yo'Doc, appeared last week

There is no evidence of a stampede by arthritis patients toward joint replacement now that their favorite pain relievers are gone, but it may simply be a matter of time. Many of us will experience deterioration in our quality of life and will want relief from discomfort.

I'm not sure what is going to happen in England and Canada, where their national healthcare systems just won't allow everyone who wants one to have a new joint put in place. Vioxx et al aren't available now there, either. Perhaps we should wait and see what happens in these two countries. Patients will probably be given older medications, less medication, more physical therapy, and more joint injections. Will their quality of life thus be maintained at a high level?

There are no figures available for the actual rate of occurrence of heart or vascular disease in those who took Vioxx, nor how many died. If you believe the nightly news, it's a lot. If you believe the guys advertising for participants in the lawsuits, it's millions. Let's say that it was exactly as found in the major study - the "relative rate" was twice the rate as in those who did not take Vioxx.

Remembering the truism, "Vioxx was never given to cure a potentially fatal disease", we might say that even a couple of deaths is too many.

Any drug taken by a human is a sharp-edged tool capable of cutting two ways. This includes over the counter, "safe" drugs like aspirin, Tylenol, laxatives, and Sominex. This would seem to indicate a risk associated with such ingestions. Maybe we shouldn't take anything at all. Ever!

OK, if we can't take medicine for arthritis, then let's cut out the offending part and put in a new one. Great idea, no more drugs, no more pain, and we can resume tennis, jogging, etc.

Hold on there! We're talking about operations here. Big, bloody operations, with patients asleep, and at risk for post-operative complications of various types and degrees of severity.

It actually isn't so bad. Good surgeons operating in clean hospitals using tried and true techniques have very low rates of complications and their post-op patients are indeed running about giddily. Plus, the doctors are glad to have the increased business brought about by drugs in disfavor.

The rate of post-operative complications, including heart and vascular problems isn't much greater than the rate of heart and vascular disease in Vioxx users.

Say what?

It is obvious. Choose your poison. Life didn't come with any guarantees. No difference in being hit by a train or a bus.
Gee, this sounds pessimistic, doesn't it?

If you believe that any drug produced and sold to us must have a spotless safety record, then you must be an herbalist (but some herbs can kill), a raving idealist, or a politician elbowing for news space. If you believe that joint replacement surgery is without risk, you are beyond help. Relief doesn't equal cure, and neither equals total absence of risk.

Disclaimer: The author of this column prescribed Vioxx perhaps twice during his career, and has assisted in joint replacement surgery.

For more information on the topic of drug safety here's a link to an opinion piece from the AZ Daily Star.