Double Crossed Nearly 30 percent of insured senior women in the U.S. take five or more prescribed medications. Sad, but not really surprising. That statistic was one of the findings of a recent study that also reported this benchmark: For the first time, more than half of all insured Americans take prescription drugs. An Associated Press article notes that "experts" chalk up this ever-increasing drug use to worsening public health, better drugs for chronic conditions, and doctors who are more aggressive with treatments (which is a nice way of saying that doctors can just match up a symptom with a drug and send you on your way with a prescription. Or two. Or three…) Almost as an afterthought, the AP piece adds that Big Pharma's "relentless advertising" also plays a role. Good call, although I would have put advertising at the TOP of that list. But drug advertising - relentless as it is - accounts for only part of the drug industry's scorched-earth sales strategy. You want to make some REAL money? Develop a crossover drug. Could a popular painkilling drug help prevent Alzheimer's disease (AD)? Sounds like a long shot, but it might work. Or so goes the thinking. Observational studies have suggested that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of Alzheimer's. So in 2001, researchers launched an ambitious study and gave it a catchy name: ADAPT - the Alzheimer's Disease Anti- inflammatory Prevention Trial. ADAPT tested the daily use of two NSAID pain killers: naproxen (better known by the brand name Aleve), and the prescription anti-inflammatory Celebrex. Researchers enrolled more than 2,000 elderly subjects, each with a family history of AD. I'll spare you the details and we'll go straight to the nutshell: These two NSAIDs proved to be a bust as an AD preventive. In fact, subjects in the naproxen group actually scored lower on cognitive function tests than subjects in the placebo group. And to top off this fiasco, the trial had to be abruptly stopped after about three and a half years when another study found that Celebrex increased heart attack risk. And that begs the question: Was this trial safe to begin with? Researchers have known for years that many people will experience adverse reactions with extended daily NSAID use. For instance, here's a quote from a 1998 Archives of Internal Medicine article: "Nonsteroidal anti-inflammatory drugs (NSAIDs) cause substantial morbidity and mortality from upper gastrointestinal tract disease." No gray areas there. So why even begin such a trial? It would be like discovering evidence that dropping a brick on your foot every day seems to prevent Alzheimer's. And if your long-term study proved this to be true, you might celebrate the confirmation of a breakthrough therapy, but you would also have to reluctantly report that a high percentage of intervention subjects were in constant pain and no longer able to walk. (In which case they would probably end up taking a few daily NSAIDs.) This is a good place to note that the ADAPT study is silent on the topic of adverse events, even though three and a half years is a very long time to be taking these drugs on a daily basis. In fact, the Aleve web site (aleve.com) confirms that NSAIDs may cause stomach bleeding, and adds this ominous warning: "Long term continuous use may increase the risk of heart attack or stroke." I'd rather drop a brick on my foot. But in spite of the risks and in spite of the disappointing ADAPT results, I'm certain we'll see more studies like this - conducted with different NSAID drugs, different dosages, different age groups, etc. Because there's just too much money to be made if NSAIDs can cross over to become the miracle Alzheimer's cure of the 21st Century. Sources:
"Study: Over Half of Americans on chronic Medicines" Linda A. Johnson, Associated Press, 5/13/08, ap.org
"Cognitive Function Over Time in the Alzheimer's Disease Anti-Inflammatory Prevention Trial (ADAPT)" Archives of Neurology, Early release article, 5/12/08, archneur.ama-assn.org
"Celebrex, Naproxen Won't Prevent Mental Decline" Amanda Gardner, HealthDay News, 5/12/08, washingtonpost.com
"Risk of Hospitalization for Upper Gastrointestinal Tract Bleeding Associated with Ketorolac, Other Nonsteroidal Anti-Inflammatory drugs, Calcium Antagonists, and other Antihypertensive Drugs" Archives of Internal Medicine, Vol. 158, No. 1, 1/12/98, ncbi.nlm.nih.gov | 
