We have forgotten. Prior to 1938, the year penicillin was synthesized, there was a very small pharmacy industry. Contrast this with 1997, where the pharmacy companies' stocks are almost universally a good investment, and their advertisements appear in all forms of the media.
We have also forgotten the many examples of the pharmacy industry's wares causing unintended consequences. Remember the stories of diethylstilbestrol (DES) and cancer and reproductive tract defects, swine flu vaccine and Guillain-Barre syndrome, or aspirin and Reyes syndrome?
Another story of unintended consequences associated with drugs is currently unfolding. The class of drugs is familiar to all of us: non-steroidal anti-inflammatory drugs (NSAIDs). Much has been written with regards to NSAIDs and their caustic effects on the gastrointestinal tract.1-7 Toxicity and the extant of damage caused tends to vary widely when comparing the many NSAIDs; they are not all equal. The unintended consequences of NSAIDs are not limited to the GI tract: this is just the most widely written about and experienced side effect.
Researchers estimate that 8-10% of the overall incidence of end-stage renal disease (ESRD) is attributable to acetaminophen. The risk was dose dependent with measurable increases of risk beginning at 105-365 pills per year or greater than 1,000 pills per lifetime. Aspirin did not increase the risk of ESRD, however, other NSAIDs (non-aspirin, non-acetaminophen) sharply increased ESRD risk in persons who consumed 5,000 or more pills during their lifetime.8 These are doses easily achieved with over-the-counter products. Only recently have negative side effects on the central nervous system been appreciated. Cases of aseptic meningitis, psychosis, and cognitive dysfunction have been reported.9 These side effects are more commonly seen in the elderly.
A mechanism of action of NSAIDs is to inhibit prostaglandin synthesis. Prostaglandins are involved in pain and inflammation mechanisms, but this is not their only function. Prostaglandins are also involved in thermoregulation and melatonin synthesis.10 This directly impacts body temperature, sleep, and may affect circadian rhythm.
A recent double blind study found that normal circadian decrease in body temperature during the nighttime hours was attenuated by the administration of aspirin or ibuprofen.11 Daytime body temperature was not affected by these same NSAIDs. In addition, melatonin was suppressed by the administration of these NSAIDs during the nighttime hours. This confirmed earlier reports of suppression of melatonin synthesis10 and alteration of normal sleep patterns in healthy individuals.12,13 These effects were not found in all study subjects; there were wide variations.
Gastrointestinal damage, kidney damage, cognitive disturbances, alteration of sleep and circadian rhythms -- all are unintended consequences directly attributable to NSAIDs. But wait ... there's more.
The first-line treatment for osteoarthritis, from the medical perspective, is NSAIDs. These drugs are recommended for chronic use either as an over-the-counter or prescription item. Here is the sad irony. Human articular cartilage is continually remodelled during growth and development and during adult life. The remodelling involves, in part, the synthesis of glycosaminoglycans (GAG), the principal macromolecule of the extracellular matrix. Normal synthesis and breakdown of these molecules is mediated by chondrocytes.14-16 Changes in the metabolic activity of these cells has been postulated to be a factor in the development of cartilage lesions characteristic of osteoarthritis.17-19 If the synthesis of GAG is reduced, this may eventually lead to deterioration, which is part of the osteoarthritic process. Conversely, the ability to accelerate the synthesis of GAG should aid in repair and regeneration.
A study of the effect on GAG synthesis in human articular cartilage using NSAIDs was undertaken (this was an in vitro experiment).20 The following table rates the various NSAIDs as to those that stimulate GAG synthesis, have no significant effect, and those that have significant inhibitory effects.
| NSAID (generic name) | NSAID (trade name) | effect on GAG synthesis |
| aceclofenac | (European drug) | stimulate |
| tenidap | Enable | stimulate |
| tolmetin | Tolectin | stimulate |
| diclofenac | Voltaren | neutral |
| piroxicam | Feldene | neutral |
| tiaprofenic acid | (European drug) | neutral |
| aspirin | * * * | neutral |
| naproxen | Naprosyn, Aleve | inhibition |
| ibuprofen | Advil, Motrin | inhibition |
| indomethacin | Indocin | inhibition |
These distinct categories discount the individual variabilities that were present. For example:
Given the damage wrought by the class of non-steroidal anti-inflammatory drugs, it is astounding how large an audience they have captured. Documented side effects to the gastrointestinal tract, liver, kidneys, central nervous system, endocrine system, and articular cartilage should strike a note of warning to all. Yet, NSAIDs are the most frequently prescribed medications worldwide.21 Remarkably, some chiropractors recommend these drugs, even for chronic use. Perhaps, in addition to your favorite NSAID, the use of alcohol and cigarettes should be considered.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
