Bleeding Deaths From Basic Pain Relievers Overstated, Investigation Finds
Bleeding Deaths From Basic Pain Relievers Overstated, Investigation Finds [Milwaukee Journal Sentinel]
From Milwaukee Journal Sentinel (WI) (May 30, 2012)
May 30--One of the main arguments for putting older people with chronic, non-cancer pain on narcotic painkillers is the concern that an alternative treatment -- over-the-counter pain relievers -- can cause serious internal bleeding.
But the number that is the basis for the concern -- 16,500 deaths each year from gastrointestinal bleeding caused by the drugs -- is vastly overstated, a Journal Sentinel investigation found.
Even the researcher who first estimated the number in 1999 says it is wrong.
"That is an old number," said Gurkirpal Singh, an adjunct clinical professor of medicine at Stanford University. "That’s history."
Singh said his initial calculation of 16,500 annual deaths was based on early 1990s data.
The U.S. Centers for Disease Control and Prevention says the actual number of deaths in 2008, the most recent year available, is about 3,400, based on a review of death certificates. And that number includes all gastrointestinal bleeding deaths, not just those caused by pain relievers.
Singh noted that lower doses of the nonprescription drugs are used today. And they are often taken with proton pump inhibitors such as Prilosec and Prevacid, which reduce acid in the stomach and result in less bleeding.
Nevertheless, opioid proponents continue to cite the 16,500 number.
It was brought up at the American Geriatrics Society’s annual meeting in 2009, when the group announced its new guidelines recommending opioids and said the nonprescription drugs, such as ibuprofen (Advil) and naproxen (Aleve), should be used rarely.
It is used in a presentation on the group’s website as part of a continuing medical education activity funded by opioid maker Janssen Pharmaceuticals. That presentation was created by James Katz of George Washington University, who at the time was a paid consultant for opioid-maker UCB Pharma.
Katz declined to comment.
Of the 10 experts on the panel that created the 2009 guidelines, Katz and four others were paid consultants or speakers for opioid companies at the time. A sixth panel member, the chairman, was listed as a paid speaker for an opioid company the year after the guidelines came out.
Lewis Nelson, an emergency medicine and medical toxicology specialist in New York, said the 16,500 deaths attributed to the so-called nonsteroidal anti-inflammatory drugs does not seem possible.
"I could count 100 opioid-related problems for every nonsteroidal recognizable problem I see," Nelson said. "I literally don’t see nonsteroidal problems, and I see tons of opioid-related problems."
Byron Cryer, a gastroenterologist at the University of Texas Southwest in Dallas, said it is wrong to overstate the risks of the nonprescription drugs.
"Anybody proposing an alternative therapy is going to peddle a worse-case scenario," said Cryer.
A paper in the American Journal of Therapeutics estimated the number of deaths tied to gastrointestinal bleeding caused by the drugs at 3,200 a year.
That paper was published in 2004 -- five years before the American Geriatrics Society issued its new guidelines.
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Posted: May 2012