The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

Editor, – The article 'The vascular effects of COX-2 selective inhibitors' (Aust Prescr 2004;27:142-5) is now out of date. The COX-2 selective inhibitors including rofecoxib, celecoxib, meloxicam and diclofenac (diclofenac is about as selective as celecoxib) have never been shown to have an overall advantage over less selective anti-inflammatory drugs for any patient group.1 There has never been a good justification for prescribing any of these drugs outside of a trial. The huge ongoing death toll could have been avoided in 1999-2001 but regulators, companies, patients' groups and educators have all done too little too late and many have pulled in the wrong direction. Our organisation, Healthy Skepticism, is one of the few who did warn against COX-2 selective inhibitors but we did not have the resources to get our message across.2,3

The root cause of this disaster is a vicious cycle of misleading drug promotion and inappropriate prescribing. We call for a Royal Commission to investigate major reforms that could avoid similar disasters in the future and dramatically improve medical research and health care.4 The first step forward is to understand and accept that a major easily avoidable disaster has occurred. We urge Australian Prescriber to become part of the solution by publishing an article accurately summarising all the relevant evidence about COX-2 selective inhibitors.

Peter R. Mansfield
General practitioner and Research Fellow
Department of General Practice
University of Adelaide

Agnes Vitry
Senior Lecturer
School of Pharmacy and Medical Sciences
University of South Australia


  1. Mansfield PR, Vitry AI, Wright JM. Withdraw all COX-2-seletive drugs. Med J Aust 2005;182:197 [cited 2005 Mar 14]
  2. Mansfield PR. Healthy Scepticism about Pfizer and Searle's promotion of celecoxib in Australia. Healthy Skepticism International News March/April 2000 Vol 18 No 3/4 [cited 2005 Mar 14].
  3. James MJ, Cleland LG. Applying a research ethics committee approach to a medical practice controversy: the case of the selective COX-2 inhibitor rofecoxib. J Med Ethics 2004;30:182-4.
  4. Sweet M. Doctors and drug companies are locked in 'vicious circle'. Br Med J 2004;329:998.