The history of the development and marketing of non-steroidal anti-inflammatory drugs is both fascinating and frightening. It offers a strange combination of stunning commercial successes and dramatic calamities, the latest concerning the recently withdrawn drug rofecoxib (Vioxx).1

In the 1960s research showed that salicylates were good for pain relief in rheumatoid arthritis, but as with steroids, their use was limited by toxicity.2 So the major pharmaceutical companies developed non-salicylate, non-steroidal anti-inflammatory drugs (NSAIDs). Over the subsequent 40 years we have seen a procession of new agents come and go, each one being heralded as either more efficacious or less toxic than its competitors. As new NSAIDs appeared, the indications steadily broadened from inflammatory diseases to almost any painful condition. Each time a new drug was launched the market expanded, resulting in annual estimated sales of more than $20bn (£11.1bn; €16.1bn) worldwide.2

The first big problem with a new NSAID occurred in the 1980s with benoxaprofen (Opren).3 This drug, developed by Eli Lilly, was marketed on the basis of a unique mode of action. But it soon became clear that its use was associated also with novel adverse events, including photosensitivity and hepatotoxicity. …