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Coxibs and their aftermath: an (opinionated) commentary, based on some historical viewpoints

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Five historical viewpoints are presented, each foreshadowing to some degree that it was only a matter of time before we would (re)learn that imbalanced anti-prostanoid therapy was a potentially lethal strategy. Positive outcomes from this coxib debacle might be more willingness to (i) acknowledge our lack of understanding concerning normal homeostatic mechanisms involving the autopharmacology and pleiotropic functions of prostanoids and acyclic eicosanoids (leukotrienes, lipoxins, resolvins, etc.); (ii) revisit the question of salicylate versus aspirin for therapies not requiring anti-thrombotic prophylaxis; (iii) re-examine some leads provided by natural/alternate therapies for inflammatory disorders; and (iv) reconsider the downside of over-reliance upon the present patent system as the main shield and driver of drug innovation.

Affiliations: 1: Therapeutics Research Unit, Department of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia


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