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patients this is the most eflfective remedy of its type on the market. Probably aspirin would Where To Buy Nexium Online do just as good a job if patients could take 30 a.spirin a day, but in my experience most patients cannot take 12 aspirin a day on a regular basis whereas many can take Indocin. It is ridiculous to argue Where To Buy Nexium Online that Indocin is no better than aspirin when many patients cannot take aspirin. With respect to the recent questions that have been raised by the CCC trials of Indocin, I would like to say that under the circumstances of these trials the types of patients u.sed w^ould Where To Buy Nexium Online not very well demonstrate the effect of Indocin. Due to the nature of the disease, rheumatoid arthritis, Indocin is most effective in patients who have not developed joint deformities and secondary complications of the disseasedue to anatomical damage. If this study had been confineatients without deformity and with most of their symptoms being due to the pure inflam- matory' effects of arthritis there would be in my mind, absolutely no question but that Indocin would have been shown to be an extremely effective drug for re- lief of inflammatory symptoms due to rheumatoid arthritis. For physicians who are thoroughly and professionally acquainted with the nature of "rheumatoid arthritis it is not necessary to do the "double blind" studies in order to tell whether a drug is effective or not. It certainly is necessarj- to do this type of study in order to tell whether one drug is more effective than another drug in a similar type of patient. In conclusion, I would like to state that the recent questioning of the value of Indocin in rheumatoid arthritis merely illustrates the ignorance of the i)eople askin;; the (inestion and the lack of familiarity with the nature of the disNi.se, rheumatoid arthritis, and the proper precautions to be evaluated in judging therapeutic eflScacy. 3378 COMPETITIVE PROBLEMS IN THE DRUG INDUSTRY It would be a great disservice to the public at this time to raise any question which could lead to the withdrawal of Indocin for treatment of patients with rheumatoid arthritis. The drugs we have to use in treating rheumatoid arthritis are not as good as we would like to have but there are some patients who desperately need each and every one of them. Arthub Dobkin, M.D. Akron, Ohio, April 22, 1968. Dr. Max Tishlek, Merck Research Laboratories, Merck d Co., Inc., Rahway, N.J. Dear Dr. Tishleb: I am one of a few physicians in this metropolitan area who have been interested in and practicing Rhemnatology for a number of years. I have used one of your drugs, Indocin, ever since it was released several years ago. In my exx)erience with this drug, I find that it has a useful place in the therapy of arthritis. I fully realize that it has no curative effects, never- theless, I have found "Indocin" to be beneficial in a selected and limited number of arthritis patients. It has been effective in relieving the symptoms of a number of patients with Rheimiatoid Arthritis, Gouty Arthritis, as well as Osteoarthritis and Rheumatoid Spondylitis. "Indocin", like many Where To Buy Nexium Online other medications now used in Arthritis, Where To Buy Nexium Online none of which are curative, will therefore have a place in the treatment of the Rhemniatic Diseases in selected cases at least until such time as newer and more effective medications are available. Mayo Clinic, Rochester, Minn., April 22, 1968. Max Tishler, Ph. D., President, Merck Sharp d Dohme Research Laboratories, Rahway, N.J. Dear Dr. Tishler : It is my understanding that a congressional hearing is soon to be held in which the efiicacy of indomethacin may be challenged. I do not know the basis for tiiis contest but Where To Buy Nexium Online if the opportunity presents itself, I would be pleased to have you convey my opinion that indomethacin has served a use- ful function therapeutically. The record clearly shows that it has been adequately tested on an experimental basis pr^ior to its introduction for clinical usage and that widespread clinical trial has indicated an acceptable risk of occasional intolerance on the part of certain patients. It should be noted, however, that all knovtTi anti-inflammatory drugs seem to have a tendency to gastrointestinal bleeding but that this does not seem to be an overriding interference to the use of anti-inflammatory drugs in general. As a matter of fact, the public interest would not be served by the elimination of anti-inflammatory drugs. I feel further that the medical profession Where To Buy Nexium Online has been amply instructed in the proper usage of indomethacin. The challenge to indomethacin Where To Buy Nexium Online on any basis with which I am familiar is in my opinion imwarranted and probably prejudicial. Sincerely yours, H. F. POLLEY, M.D. Veterans' Where To Buy Nexium Online Administration Center, Los Angeles, Calif., April 22, 1968. Dr. Max Tishler, President, The Merck Foundation, Merck d Co., Rahway, N.J. Dear Dr. Tishler : It is my understanding that there will be a congressional hearing soon to consider, among other things, the current controversy that has been brought forth regarding the antirheumatic eflScacy of indomethacin. I would assume that this is somehow related to the results of more recent double- blind evaluations with indomethacin in rheuma.toid arthritis (RA) . It is my opinion that while double-blind studies are obviously useful in evaluating new agents, they are also extremely difficult, particularly in such a capricious disease as RA. To this point, I might add that there are few (if any) double-blind trials with other antirheumatic agents that are entirely satisfactory. COMPETITIVE PROBLEMS IN THE DRUG INDUSTRY 3379 Even more Where To Buy Nexium Online appalling are the apparent expectations of many investiRiitors con- ducting short-term studies In RA that indoniethacin would provide ohjective functional improvement. This is a clinical misconctption since all antirheumatic agents are at best palliative. By providLng effective relief of joint pain and inflammation, drugs allow patients to undertake tlieraiK'utic exercise and other supportive measures. These provide objective improvement. Yet, such measures receive scant mention and do not appear to be an integral part of the reported double-blind studies of indomethacin in RA.
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