By Peter C Gøtzsche
The name non-steroidal, anti-inflammatory drugs (NSAIDs) suggests that NSAIDs reduce inflammation like corticosteroids do, but this is not correct. In a meta-analysis of the placebo-controlled trials, they did not reduce the swelling of finger joints measured by jeweller rings in patients with rheumatoid arthritis. And in a placebo-controlled trial in 173 patients with acute ankle distortions, they did not reduce the oedema. In this trial, the patients were also randomised to a group that was instructed to immobilize the foot and was given crutches and to a group that was instructed to walk as normally as possible despite the pain. Mobilisation quickly reduced the oedema. After 2-4 days, the difference in volume between the healthy and the injured foot was 42 mL when the patients were mobilised compared to using crutches (P = 0.01). In contrast, there was no significant effect of naproxen (P = 0.42; difference 11 ml compared with placebo, which could simply be due to more mobilisation because of less pain). Thus, mobilisation was anti-inflammatory, which naproxen wasn’t, and it also led to much faster recovery, 44% versus 16% had recovered after 2-4 days (P = 0.0006). I have spared the internal company report of our study, which is where these data are. The company resisted to have these embarrassing data published. It is rare to name drugs after what they are not (non-steroidal), but this was a carefully planned marketing trick that has worked very well for the drug companies while it has killed hundreds of thousands of patients who didn’t really need such a drug but could have done well on paracetamol or no treatment.