Question special

Thank you panelists for the insightful discussion so far! As a budding internist, my impression from listening to the sound bites in the aftermath of the Vioxx scandal has been that COX-2 selective inhibitors are particularly dangerous to cardiovascular health. Is there something worrisome about the underlying biology of selective COX-2 inhibition, or should the real take home point be that we should carefully consider the adverse cardiovascular effects of all NSAIDs before prescribing?

Furthermore, given that approximately 50% of the patients discontinued the study drugs by 18 months, how should we counsel patients who may be willing to take celecoxib for longer periods and are worried about the cardiovascular effects?