Wonder Drugs & Patient Ethics

Pharmaceutical companies are churning out "wonder drugs" at a breakneck pace, and patients are clamoring to get them. Too often, the release of these drugs is followed, soon after, by class action lawsuits by the same patients that were, at the time of the release, demanding that they receive them.

Much has been written about the activities of these pharmaceutical companies, and whether or not they behave in an ethical and appropriate manner when dealing with the safety of their patients. Virtually nothing has been written about the ethics of the patients who involve themselves in this litigation.

Many people remember the uproar that saw Celebrex and Vioxx withdrawn from the marketplace, and are aware that there is massive litigation being conducted in both Canada and the United States. What the litigants seem to avoid mentioning is that, when these drugs were introduced, they were the only alternative for millions of people with osteo-athritis and rheumatic disease who simply couldn't take the NSAID (non-steroidal anti-inflammatories) drugs that represented, at that time, the front-line treatment for their conditions.

NSAIDs carry their own huge risks. Risks of stomach ulcers, kidney damage and inflammation of the liver. Celebrex and Vioxx, by comparison, are what are known as COX-2 inhibitors, designed to control inflammation without the secondary damage associated with NSAIDS.

Many of the patients who ended up taking these COX-2 inhibitors had already endured years of treatment with NSAIDs, that resulted in significant enough damage to their bodies that they could no longer take them at all. The introduction of Celebrex and Vioxx was a huge relief to these people. Faced with the alternative of no treatment at all, many of them wanted access to these drugs, and they wanted access immediately.

I faced a difficult decision when Enbrel, a class of drug called an Anti TNF-Alpha Inhibitor, became available for the treatment of Ankylosing Spondylitis, one of the rheumatic diseases that used to be treated with NSAIDs.

The drug is very new. The manufacturers acknowledge that it may present some unknown health risks with prolonged use, one of which is the possibility of developing cancer. The very fact that it works by altering how one's immune system works mitigates against it being perfectly safe. In truth, one suspects that the drug manufacturer has no idea what the effects of taking it for twenty or thirty years might be, because they're not sure exactly how or why it works, and it simply hasn't been around that long.

But, it does work. It eliminates inflammation in certain types of inflammatory arthritis, such as Ankylosing Spondylitis, Crohn's Disease, and Psoriatic Arthritis. It virtually eliminates the pain associated with a very painful disease, and it increases mobility in largely immobile patients.

Like every patient faced with a new "wonder drug" therapy, I had to make a risk/reward assessment. Was I prepared to gamble on the odds that the cure would kill me, some years down the line, in exchange for a relatively pain free and more mobile lifestyle in middle age?

For me, the decision was an easy one. I chose an increased quality of life now over a possibly-decreased life expectancy. It just made sense to me as, I'm sure, it made sense to tens of thousands of others came to the same conclusion. And, like others who made the same decision, I wasn't prepared to endure ten or fifteen years of pain, before starting on it, just to make sure it was safe.

The question is "How will other patients react if-or when-the side-effects of drugs like Enbrel start to show themselves?"

Like the litigants in the current class action suits, will they sue the pharmaceutical company that created and marketed the drug, and the doctor who prescribed it, or will they behave in an ethical way, remembering the first day that they woke up pain-free?