The NSAIDS – Over the Counter but Not Harmless

Skimming the newspaper one morning my eye stopped in the obituaries, on a picture of a woman who looked about my age. The death notice said she had died of ‘complications of rheumatoid arthritis.’

Complications of RA? I didn’t know there were any, but I knew there were plenty associated with the drugs we used to control the disease.

In my rheumatologist’s office later that day I learned that this person was a patient of my doctor and in fact had an appointment scheduled for the next day. Neither the doctor nor her staff was aware that she had died.

As gently as I could I pieced the story together: The dead woman had developed a cold while taking Enbrel. She had been taken off the drug but it was too late for her immune system to recover enough to fight off the infection. In the Western world in the 21st century no one expects to die from an infection, but that day, at age 50, this patient lay in a coffin in a funeral home.

I had always adored my rheumatologist, an irrepressible optimist, although I knew from the first that she totally discounted the down side to prescription drugs. They were all good to her. All the time. Despite our friendship, I silently wondered if she might be a legal drug pusher.

So I shouldn’t have been surprised when she continued to urge me to take a biologic, as though she had no first hand evidence that these drugs were deadly, as though this patient had not died in her care from the drug she wanted me to take.

Ten years ago David Fox, a prominent rheumatologist, wrote, “The treatment of RA remains insufficiently effective and distressingly toxic for many patients.”

Since then, nothing has changed. It’s important to remember than any drug is an intrusion into the miraculous, finely coordinated microscopic balance of our bodies. The effect of that intrusion can vary according to our own unique biology. Some of us may have a relatively high tolerance for a toxin and others will not. Any drug should be taken with caution and with an awareness that any unusual symptoms we develop could be a drug reaction.

The medical profession usually handles a drug side effect with another drug to counter the unwanted symptoms. Drug interactions are almost never studied, so combining drugs is a walk into risk. The more drugs a person takes, the more side effects s/he can expect, the more unlikely a healthy outcome, and the more likely catastrophe.

Here’s the first installment in a summary of drugs commonly taken for Rheumatoid Arthritis.

NSAIDs: Non Steroidal Anti Inflammatory Drugs.

This class of drugs includes over the counter medications like aspirin, ibuprofen (Advil), naproxen sodium (Aleve) and a large variety of prescription pills that, as far as I’ve been able to tell, offer no advantage but a much heftier price tag.

[Tylenol (acetaminophen) works differently from aspirin and is not classified as an NSAID. It is the leading cause of liver failure and should be taken with special care and only according to directions.]

If you are running into trouble with NSAIDS, and especially aspirin, you may have ringing in the ears (tinnitus), nausea or vomiting, rapid breathing, double vision, and feeling faint. Symptoms can become life threatening suddenly and without advance notice.

Taking NSAIDS regularly can result in the slow and invisible blood loss picked up in occult blood tests on stool samples. It may account for the anemia that so often accompanies RA.

The market for NSAIDS is huge and staggeringly profitable. Their deadly danger, generally unknown to customers, was described in the July, 1998, issue of The American Journal of Medicine:

“Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for NSAID-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.”*

Read this, too, from the New England Journal of Medicine:

If deaths from the … toxic effects from NSAIDS were tabulated separately, they would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain 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.”**

Did you catch that? The estimated 16,500 deaths due to NSAIDS were all in hospitals. It doesn’t even include the over-the-counter painkillers we take at home.

And then there is this:

“Medicines … provide their benefits by interfering in some way with the chemical makeup of the body’s cells. … Every one has unplanned and unpredictable side effects .… There is a thin line between a drug working as a medicine and when it becomes a poison, … a ‘medical misadventure,’ … a ‘drug induced disorder,’ … an ‘adverse drug reaction’.”

[Or a complication of Rheumatoid Arthritis.]

Melody Petersen: Our Daily Meds, p.298

*Singh Gurkirpal, MD, “Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy”, The American Journal of Medicine, July 27, 1998, p. 31S.

**Wolfe M. MD, Lichtenstein D. MD, and Singh Gurkirpal, MD, “Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs”, The New England Journal of Medicine, June 17, 1999, Vol. 340, No. 24, pp. 1888-1889.

2 comments to The NSAIDS – Over the Counter but Not Harmless

  • Heather

    I am on Embrel, I am getting a bad chest cold and this post scared the hell out of me. I haven’t taken my dose this week because all 5 of my family members came down with the nastiest flu I have ever seen. I, of course, am recovering the slowest. But I have to say that Embrel has been a miracle drug for me. And me not taking it for two weeks, all my limbs are re-swollen and I am totally flared everywhere. It’s like Awakenings at the END of the movie. I am scared to get more sick now, but I have to say, I miss being able to run up the stairs or walk without leaning on everything. The possibility of death from a chest cold makes me think that I better get used to the fact that even though I am 42, I should just not take a biologic and use a cane.

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