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Posted by mddah02 on 19 Feb 2013 at 20:34 GMT

Dr Sasich makes important points. The widespread access to etoricoxib is of concern. We have heard stories of its ready availability without prescription in India. This may also be the case elsewhere. We agree the FDA made the right decision in not approving etoricoxib. It is also not available in Canada, but is available in most other major markets. In England in 2011, it was dispensed more often than celecoxib.

The FDA is absolute mine of information on drug effects and the financial press recognises its value. Anyone examining drug-associated risks, including in low and middle income countries, stands to learn from its repository - challenging as it is to get the information to the surface

But we can’t leave everything to the FDA or indeed any regulatory agency. Doctors pharmacists and consumers can make up their minds about which NSAIDs to use. The information is available. Patients at risk of cardiovascular events should not take diclofenac – there are equally effective safer alternatives.

Humans are not the only species who suffer. Certain districts in India and Nepal are being declared ‘diclofenac-free zones’ to stop farmers feeding high doses to cattle. Diclofenac kills vultures that feed on the carcasses because they ingest sufficient amounts to cause renal failure. Their populations have declined dramatically. We think diclofenac-control zones for humans may be a good idea too.

Patricia McGettigan
William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom

David Henry
Institute for Clinical Evaluative Sciences, Toronto, Canada

No competing interests declared.