In your recent column on Ralph Nader, “Unsafe at Any Dose?” [June 2009, p. 8], you cited rheumatology drugs pulled from the market. Frankly, I think that both Vioxx and Bextra got the bum’s rush on that one because, as we all know, over-the-counter drugs like Advil/Motrin have exactly the same level of toxicity and risk and I have heard no proposals to either pull those drugs or sue the manufacturers. Rheumatologists have often spent too much time worrying about toxicity, paralyzed in their treatment plans. This leads to use of inadequate doses of drugs (allopurinol is probably the best example of that) or inappropriate non-use (again, the endemic maltreatment of gout is really a national medical shame).
I should also mention a horse trainer whom I met recently who takes “horse-bute” for his back pain so there is a market for phenylbutazone. It was a great drug for some patients.
Bruce N. Cronstein, MD
Paul R. Esserman Professor of Medicine
Director, Clinical and Translational Science Institute
New York University School of Medicine
New York, N.Y.
My attention was grabbed by the photo of the partial front end of a 1965 Chevrolet Corvair in The Rheumatologist [June 2009, p. 8]. Most rheumatologists are too young and won’t know Corvair; they might think you are “old school.” The color is evening orchid.
We are approximately contemporaries, so I am old enough to have purchased a new 1965 Corvair when I started medical school, and I still own it 160,000 miles later. There were seven Corvair owners in my Stanford Medical School class of 65 students, so more than 10% had Corvairs. One of them is now a master of the American College of Rheumatology.
Ralph Nader was wrong about the Corvair. Your Corvair comments would not pass the referees in a scientific publication. Sure, there were some elements of truth, but his major premise about the wheels tucking under and striking the roadway is bogus. I looked at my owner’s manual, and it is true that the tire pressures are not emphasized. There is no black box warning. Nonetheless I was aware of the tire pressure differential from the very first day. There are fans of the early (1960–1963) models, the ones identified by Nader as dangerous, but I have never ridden in or driven one. In GM’s defense, swing axle rear suspensions were usual for performance cars at that time, including VW Beetle, Mercedes-Benz “gullwing” 300SL and Porsche 356. From an automotive engineering aspect, I have to believe that the late model Corvair (1965–1969) rear suspension was superior. It is similar, and probably equal, to the contemporary Corvette independent rear suspension. The late model Corvair has been praised for both its handing and styling and was not a target of Unsafe at Any Speed.