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Patients can self-monitor warfarin

I am concerned that the latest problems with cox-2 inhibitors represent 'regulator panic'. There has always been difficulty in differentiating between heartburn and ischaemic heart pain.

Inferior ischaemia in particular can give rise to epigastric pain. There is therefore a risk that doctors might have preferentially prescribed coxibs to patients at high risk of MI and stroke. I wonder whether this confounding factor has been excluded from the analysis?

The fiasco over third-generation Pills should lead us to have more caution with population research. We were told it was these pills that caused an increase in thromboembolic disease.

Now we know there is a doubling of risk for patients with a BMI of 30 and smoking and a quadrupling of risk with a BMI of 35.

Doctors have been prescribing the Pill to an increasingly obese population. Research into these risk factors was put back many years due to the regulator's response and as a direct consequence doctors have prescribed the Pill to women who have died.

I believe patients taking coxibs should be warned of a possible connection but heavy-handed withdrawal of drugs should be avoided until the evidence is properly considered.

Dr Mark Burgin


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