By Shannon Brownlee Here’s an example of why evidence based medicine is better than the alternative. Long before the drug was approved, Kaiser Permanente pharmacologists were tracking the research on Vioxx. (You remember Vioxx, the pain killer that was pulled from the market in 2004, but not before it killed as many as 60,000 Americans by giving them heart attacks or strokes.) By the time the drug had hit the market, Kaiser pharmacologists had already determined it was no better than ibuprofen and other nonsteroidal anti-inflammatories (NSAIDs) at relieving arthritis pain. Vioxx did have one small advantage: it was a bit better at protecting patients at risk for bleeding from the stomach and intestines (a potential side effect of NSAIDS). But that protective effect was offset by an increased risk of heart attack and stroke. This wasn’t “cookbook” medicine. Kaiser doctors were not forbidden from prescribing Vioxx. Instead, the formulary encouraged them to use the drug only for patients at high risk of a gastrointestinal bleed. The result? In 2003, Kaiser patients were prescribed Vioxx at only 10 percent the rate of non-Kaiser patients in northern California. Kaiser saved $50 million dollars. More importantly, using evidence saved lives.
