E-DRUG: Many NSAID users who bleed ...... (cont'd)

[Alec Walker <amwalker@episun1.harvard.edu>]

E-drug: Many NSAID users who bleed ...... (cont'd)
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Dear Colleagues:

There are bizarre patterns of NSAID use that I have come across in
two settings, which extend Herxheimer's point.

Looking at a large HMO in the US, I and others noted that a history of
presumed dyspepsia, as indicated by past use of H2 blockers was
positively associated with future NSAID use.(1) Some years later,
colleagues working in Rome identified precisely the same phenmenon in
Italy.(2)

My view (not very original) is that there are potent forces that relate
to physican and patient perception of the utlity of drug therapy that
overwhelm the output of the drug safety community. This is why
regulation needs to remain an key part of strategies to influence
patterns of drug use.

Regards,

Alec Walker
Harvard School of Public Health
+1 617 432 4565

1. Walker AM et al. The influence of prior prescription of H2 blockers
on the use of NSAIDS. J Clin Res Pharmacoepidemiol 1991;5:255-363

2. Traversa G et al. L'uso dei farmaci antiinfiammatori non steroidei
nella populazione di Roma. Giornale Ital Fam Clin 1994;8:31-37
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