Dear Editor,

It was Oliver Wendell Holmes, Jr. who wrote that “certainty generally is illusion and repose is not the destiny of man.” How true?



The author of this article1 on NSAIDs makes a point about calcium channel blockers, as a class, having been found to have had some serious side effects in the earlier smaller studies, later having been cleared as safe by the ALLHAT study.2 The truth is otherwise. ALLHAT study has only used amlodipine and not other classes of calcium channel blockers.3 Even the earlier smaller studies did not fault amlodipine as much as they did other calcium channel blockers. The Lancet editorial, many years ago, entitled “Calcium Channel Caution,” showed the true colour of calcium channel blockers, as a class.4 One can not, therefore, conclude that ALLHAT study has cleared all calcium channel blockers as safe.



It is very difficult to depend on the FDA and the drug manufacturers to supply all the details of drug trials. I think major journals must take upon themselves the responsibility to get at the truth in their post drug release assessments from multiple sources. Journals should scientifically critique the drug releases.5 After all, the real face of a drug is seen only after the drug is released for free distribution. All the pre-release studies have only limited scientific value. NSAIDs are no exception. The truth about NSAIDs is slowly emerging only now, after they have been in use for years!



Yours ever,

Bmhegde



References:



1) author

2) ALLHAT study Group: anti-hypertensive treatment. JAMA 2002; 288: 2981-2197.

3) Williams B. Drug treatment of hypertension. BMJ 2003; 326: 61-62.

4) Editorial. Calcium Antagonist Caution. Lancet 1991; 337: 885-886.

5) De Angelis C, Drazen JM, Freizelle FA, et. al. Clinical trials registration. Lancet 2004; 364: 911-912