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3 - Principle of Primacy of Patient Welfare

Published online by Cambridge University Press:  25 February 2010

By
John Spandorfer
Edited by
John Spandorfer ,
Charles A. Pohl ,
Susan L. Rattner  and
Thomas J. Nasca
John Spandorfer
Affiliation:
Associate Professor of Medicine, Jefferson Medical College
John Spandorfer
Affiliation:
Jefferson Medical College, Philadelphia
Charles A. Pohl
Affiliation:
Jefferson Medical College, Philadelphia
Susan L. Rattner
Affiliation:
Jefferson Medical College, Philadelphia
Thomas J. Nasca
Affiliation:
Jefferson Medical College, Philadelphia
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Summary

PATIENT WELFARE – ADULT PRIMARY CARE

A family physician recommends that an eighty-two-year-old woman with a history of coronary disease take the non-steroidal anti-inflammatory (NSAID) drug celecoxib (Celebrex) for osteoarthritis. The physician chooses celecoxib over a non-Cox 2 inhibitor because of his concern about NSAID-induced gastropathy. Celecoxib requires prior authorization and the physician is aware that the insurance company only allows use of this drug when a patient has tried and is intolerant of other NSAIDs. The physician forwards a note to the insurance company indicating this to be the case, despite the fact that the patient has not tried other NSAIDs.

A Perspective from a General Internist

Clinical Background

Each year, the use of NSAIDs, including aspirin, accounts for a significant amount of gastrointestinal complications, mainly gastric ulcers and gastritis. These complications lead to an estimated 7,600 deaths and over 70,000 hospitalizations in the United States. Factors listed in Table 3.1 have been shown to increase the risk of NSAID-induced gastropathy.

The average duration of NSAID use before the onset of GI symptoms is twelve weeks. The longer the duration of NSAID use, the higher the risk of gastropathy.

There is an approximate 1 percent absolute risk reduction for symptomatic ulcer disease when using celecoxib compared to other non-COX-2 inhibiting NSAIDs over a one-month duration.

Type
Chapter
Information
Professionalism in Medicine
A Case-Based Guide for Medical Students
 , pp. 115 - 153
Publisher: Cambridge University Press
Print publication year: 2009

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