Jump to content


Getting an "Insecure Connection" warning for Exisle? No worry

Details in this thread

Vioxx, Celebrex and Heart Attacks

Medicine 2004 Drug reactions

  • Please log in to reply
19 replies to this topic

#1 mjtian

mjtian
  • Islander
  • 897 posts

Posted 20 December 2004 - 08:26 PM

As a student of the medical profession, I am sickened by the countless advertisements by local/regional lawyers seeking law suits against the pharmaceutical companies.  Indeed, the companies used advertisements to lure the consumers to their products, but so does all other companies in the United States.    

In addition, with regard to the most recent study on Pfizer's Celebrex, is more of a laughing matter.  Like all drugs, this group of drugs also pose side effects.  Every pill that we take is not natural and hence may have certain levels of toxicity.  Take, Tylenol for example, if you take more that 4 grams (8 500mg pills) per day you can develop liver toxicity and generally, physicians do a pretty good job of warning their patients of the side effects.  In this particular study, the patients were given an extremely high dose of Celebrex for an extended period of time.  Furthermore, this select group of patient were stricken with Cancer, which does not represent the general population as a whole.  Furthermore, do we completely understand cancer today?  NO!  

Indeed, the Cox II family of drugs, Vioxx, Bextra, Celebrex, do not offer better pain relief than the cheaper over-the-counter Motrin or Ibuprofen.  However, this group of drugs is very important for those patients that have severe gastrointestinal problems such as history of gastric ulcers or bleeding.

As I sit here and watching the CNBC special on Merck and Vioxx, I found it absurd that one of the widows claim that Vioxx killed her husband who admittedly did not seek medical care as he thought he was in perfect health.  Furthermore, he took the medicine for exactly one month and the picture of the decease clearly showed that he was obese.  I am not here to speculate or protect the pharmaceutical companies, however, I urge all of us here to be a little more observant and not take such stories so superficially.

Edited by mjtian, 21 December 2004 - 10:15 AM.

"I have missed more than 9000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot... and missed. And I have failed over and over and over again in my life. And that is why... I succeed" -Michael Jordan

#2 DWF

DWF

    Dr. Who 1963-89, 1996, 2005-

  • Islander
  • 48,287 posts

Posted 20 December 2004 - 08:37 PM

And it seems like despite the risk Celebrex probably won't be recalled.

http://story.news.ya...ealth_pfizer_dc

Quote

Some analysts are betting Pfizer Inc. won't have to withdraw its arthritis drug Celebrex but they do expect sales to fall after a study of the drug in cancer patients showed it increased the risk of heart attacks.

Pfizer has said it has no plans to withdraw Celebrex, which had annual sales of nearly $2 billion last year. The U.S. Food and Drug Administration, which on Friday urged doctors to consider prescribing alternatives to Celebrex, plans to make additional announcements about the drug over the next few days.

Several analysts believe Celebrex is mostly safe when used at the typical levels of 100 milligrams or 200 milligrams. The trial of patients with tumors known as adenomas took either 400 milligrams or 800 milligrams of the drug. Previous trials of Celebrex in arthritis and Alzheimer's have not shown an increase in heart risk.

Two-thirds of patients in the cancer trial took the drug for two years, some up to four years. Merck & Co. Inc.'s recently withdrawn arthritis drug Vioxx, which is similar to Celebrex, showed it doubled the risk of heart attack and stroke, but the risk only emerged after patients had been taking the drug for 18 months or more.

"We do not believe there will be a withdrawal at this point," said Winton Gibbons, an analyst at William Blair & Co. "Our read of the data so far suggests that high dosing is the primary risk driver, with duration of therapy possibly exacerbating the risk."

Pfizer's shares fell 11.2 percent on Friday after it said a trial sponsored by the National Cancer Institute showed patients with adenomas that grow from glandular tissue had more than twice the risk of heart attacks than those taking a placebo. On Monday they fell an additional 5.7 percent to $24.29 on the New York Stock Exchange.

"We believe the product will be able to stay on the market because the studies only show a safety problem in high risk cancer patients," said David Moskowitz, an analyst at Friedman, Billings, Ramsey.

The FDA has asked Pfizer to temporarily stop advertising Celebrex. The drug has been one of the most heavily advertised in pharmaceutical history.

:(
The longest-running science fiction series: decadent, degenerate and rotten to the core. Power-mad conspirators, Daleks, Sontarans... Cybermen! They're still in the nursery compared to us. Fifty years of absolute fandom. That's what it takes to be really critical.

"Don't mistake a few fans bitching on the Internet for any kind of trend." - Keith R.A. DeCandido

#3 Nikcara

Nikcara

    confused little imp

  • Islander
  • 3,500 posts

Posted 20 December 2004 - 08:43 PM

I think our medical system in general needs a massive overhaul.

For one thing, I hate the commercials for drugs.  Patients shouldn't come into offices demanding a certain medication (happens all the time) when they may or may not need them.  Related to this, doctors need more continuing education that ISN'T sponsored by drug companies.  It seems most doctors learn about new medications by all the stuff drug companies send them - heck, I have Viagra calanders, Alergra sugar and flour set of jars, Vioxx clock, countless pens, and perhaps a dozen other things in my house from drug companies advertising to health care providers and I'm not even a doctor.  Now, I understand that there would be no point in researching new medication if doctors never perscribed them because they didn't know about the new drugs....but there has to be a better way of learning about them.  Plus, if drug companies could stop making so much stuff to give health care providers they could decrease the price of medication.

Moreover, there needs to be more independent studies going on.  Most research is done by the drug companies and they are going to skew their data - not out of being evil or greedy or such things, but when you are researching a drug that is yours, you want it to work.  The researchers themselves are biased when they start looking, so even if they are trying to be impartial they often downplay the bad areas.  It's very hard to be impartial in science when it's your project and it's your drug up for judgment.

Anywho, it's time for me to stop ranting.
We have fourty million reasons for failure, but not a single excuse  -- Rudyard Kipling

Develop compassion for your enemies, that is genuine compassion.  Limited compassion cannot produce this altruism.  -- H. H. the Dalai Lama

#4 mjtian

mjtian
  • Islander
  • 897 posts

Posted 20 December 2004 - 08:57 PM

I agree that the big pharma try extremely hard to push their products.  As someone that spends a bit of time on the wards, I am aware of the "drug reps" that brings food, pens, clocks, offer fancy dinners residents/students.  Although I never attended one of those dinners, I know friends that have and I will be foolish to think that those events have absolutely no effects on us when we prescribe medications to our patients.  Is it ethical?  NO!!!  It is wrong?  Thats up for debate.  

We live in a capitolism society, a free market.  One of my friends in highschool whose family owned a grocery store, constantly have free tickets to sports events given to them by beer distributers.  It is therefore, foolish to think that Pharmaceutical industry are the only companies that are trying to push their products!

Pharmaceutical companies are in the business to cure/help people.  I think it is irresponsible to allow trial lawyers to pray on the victims of these unfortunate events and hurt the U.S. consumers as a whole.
"I have missed more than 9000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot... and missed. And I have failed over and over and over again in my life. And that is why... I succeed" -Michael Jordan

#5 Rhea

Rhea

  • Islander
  • 16,433 posts

Posted 20 December 2004 - 09:31 PM

mjtian, on Dec 20 2004, 05:26 PM, said:

As a student of the medical profession, I am sickened by the countless advertisements by local/regional lawyers seeking law suits against the pharmaceutical companies.  Indeed, the companies used advertisements to lure the consumers to their products, but so does all other companies in the United States.   

In addition, with regard to the most recent study on Pfizer's Celebrex, is more of a laughing matter.  Like all drugs, this group of drugs also pose side effects.  Every pill that we take is not natural and hence may have certain levels of toxicity.  Take, Tylenol for example, if you take more that 4 grams (8 500mg pills) per day you can develop liver toxicity and generally, physicians do a pretty good job of warning their patients of the side effects.  In this particular study, the patients were given an extremely high dose of Celebrex for an extended period of time.  Furthermore, this select group of patient were stricken with Cancer, which does not represent the general population as a whole.  Furthermore, do we completely understand cancer today?  NO!  

Indeed, the Cox II family of drugs, Vioxx, Bextra, Celebrex, do not offer better pain relief than the cheaper over-the-counter Motrin or Ibuprofen.  However, this group of drugs is very important for those patients that have severe gastrointestinal problems such as history of gastric ulcers or bleeding.

As I sit here and watching the CNBC special on Merck and Vioxx, I found it absurd that one of the widows claim that Vioxx killed her husband who admittedly did not seek medical care as he thought he was in perfect health.  Furthermore, he took the medicine for exactly one month and the picture of the decease clearly showed that he was obese.  I am not here to speculate or protect the pharmaceutical companies, however, I urge all of us here to be a little more observant and not take such stories so superficially.

<{POST_SNAPBACK}>


I agree with you.  I have been taking Celebrex and Vioxx for years with no side effects (and I can't take ANY of the non-Cox-2's - tried 'em all). And given that there were TWO studies with contradictory results, both very small studies - I think the jury's still out.

Besides, ALL antiiflammatory drugs have side effects. The non-Cox-2's can kill your liver. The Cox-2's can kill your kidneys. It all depends on how badly you need the effects of the drugs.

Edited by Rhea, 20 December 2004 - 09:34 PM.

The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#6 mjtian

mjtian
  • Islander
  • 897 posts

Posted 20 December 2004 - 10:20 PM

Another example of the price we are paying for the irrational responses to these studies:  cnn


I think the media should be a little more careful in their response to these studies and not shocking the public in order to gain ratings!!!  There are people that need these drugs everyday!!!

Edited by mjtian, 21 December 2004 - 10:12 AM.

"I have missed more than 9000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot... and missed. And I have failed over and over and over again in my life. And that is why... I succeed" -Michael Jordan

#7 Bouree57

Bouree57
  • Islander
  • 578 posts

Posted 22 December 2004 - 04:40 AM

mjtian, on Dec 20 2004, 08:26 PM, said:

I am not here to speculate or protect the pharmaceutical companies, however, I urge all of us here to be a little more observant and not take such stories so superficially.
It hard for some of us to not take these studies seriously when we are caring for elderly parents especially with those that already have heart problems. My mom has very severe arthritis and a pacemaker. Luckily she was only on Vioxx 2 years (mainly because the health insurance company got very touchy about paying such a high price for it.) So in February of this year, her doctor switched her to Celebrex 200 mg. So I can help but be concerned. What worries me most is they may think its only for long term high doses, but they may not truly understand the situation yet.

Rhea, on Dec 20 2004, 09:31 PM, said:

I agree with you.  I have been taking Celebrex and Vioxx for years with no side effects (and I can't take ANY of the non-Cox-2's - tried 'em all). And given that there were TWO studies with contradictory results, both very small studies - I think the jury's still out.

Besides, ALL antiiflammatory drugs have side effects. The non-Cox-2's can kill your liver. The Cox-2's can kill your kidneys. It all depends on how badly you need the effects of the drugs.
There is not a drug on the market that doesn't have some side effects but doctors monitor patients on most drugs of this nature to prevent them from causing irreversible damage. They don't do that for over the counter drugs which taken at high doses can cause greater harm. Bottomline, if you are in severe pain, you are better off with prescribed medicine monitored by a doctor.

-- B
My words but a whisper, your deafness a shout!
I may make you feel but I can't make you think.
(from Thick as a Brick, Jethro Tull)

He who made kittens put snakes in the grass.
He's a lover of life but a player of pawns.
(from Bungle in the Jungle--War Child, JT)

#8 Broph

Broph
  • Islander
  • 6,671 posts

Posted 22 December 2004 - 08:12 AM

Nikcara, on Dec 21 2004, 01:43 AM, said:

For one thing, I hate the commercials for drugs. 

Yeah, but how else are we going to find out which diseases come with hot chicks and puppies. I'm still trying to get that disease!

A friend of mine was on Celebrex for awhile, but his doctor heard 1) a slight murmer and 2) a lot of chatting about side effects of Celebrex and heart disease. When was this? 2 years ago.

Folks - this isn't a big surprise for a lot of people. Yes - some people who had heart attacks or died had other problems (my friend is pretty thin and gets some exercise regularly) - but there are side-effects of drugs that we don't know about.

Ambulance-chasers aren't helping matters. Like someone else said - there are risks with every medicine - you just have to decide if the risks are worth the benefits - and don't complain when the results of those risks appear.

#9 Nonny

Nonny

    Scourge of Pretentious Bad Latin

  • Islander
  • 31,142 posts

Posted 22 December 2004 - 08:51 AM

Broph, on Dec 22 2004, 05:12 AM, said:

Nikcara, on Dec 21 2004, 01:43 AM, said:

For one thing, I hate the commercials for drugs. 
Yeah, but how else are we going to find out which diseases come with hot chicks and puppies.

<{POST_SNAPBACK}>

:lol:  :lol:  :lol:

Seriously, next time I see my primary care physician, a really nice guy who really does care, I think I'm going to have to break the shocking news to him that I'm not expecting to live forever.  He's trying to medicate me for something I'd rather not be medicated for, due to serious side effects.  Some of us just can't handle the side effects.  :pout:  :pout:  :pout:

Nonny
Posted Image


The once and future Nonny

"Give a man a gun and he can rob a bank, give a man a bank and he can rob the world." Can anyone tell me who I am quoting?  I found this with no attribution.

Fatal miscarriages are forever.

Stupid is stupid, this I believe. And ignorance is the worst kind of stupid, since ignorance is a choice.  Suzanne Brockmann

All things must be examined, debated, investigated without exception and without regard for anyone's feelings. Diderot

#10 Cardie

Cardie

    I'm a very *good* tailor

  • Administrator
  • 22,632 posts

Posted 22 December 2004 - 09:18 AM

Several years ago I injured my shoulder, and the doctor prescribed Vioxx while I was going through physical therapy.  The pain wasn't that excruciating, and I told him that I'm very drug sensitive and the side effects sounded worse than the condition the drug was supposed to help.

What worries me is that doctors get used to prescribing these meds when the patient doesn't really need to be that strongly medicated, partly because they are compromised by drug company advertising and freebies.  I took the occasional tylenol for my shoulder but mostly just put up with a few twinges.

Of course, now that I have a back problem and the Vioxx helped me walk without limping, they discover the problems with all these drugs.  So I'm back to putting up with twinges.

Cardie
Nothing succeeds like excess.

#11 Spectacles

Spectacles
  • Awaiting Authorisation
  • 9,632 posts

Posted 22 December 2004 - 10:25 AM

Yeah, I'm irked that I finally found an over-the-counter medication that works to manage my arthritis and back pain--Aleve. (My doctor would probably put me on Percoset, but I told her I didn't want to take anything Rush Limbaugh takes. That stuff apparently addles you permanently. ;) ) For the past four months, I've been taking it once in the morning and once in the evening--and I've felt all young and bouncy again, like the people in the Celebrex commercials--but without the cost, or so I thought. Turns out Aleve may carry as much risk as Vioxx.

Damn. Oh well; I'd rather die relatively pain-free in my 50s than be a miserable old woman, so they'll have to pry my bottle of Aleve from my cold, dead fingers.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#12 Rhea

Rhea

  • Islander
  • 16,433 posts

Posted 22 December 2004 - 01:26 PM

Spectacles, on Dec 22 2004, 07:25 AM, said:

Damn. Oh well; I'd rather die relatively pain-free in my 50s than be a miserable old woman, so they'll have to pry my bottle of Aleve from my cold, dead fingers.

<{POST_SNAPBACK}>



Took the words right out of my mouth. And both my primary care doc AND my surgeon monitor me regularly for side effects. My GP is religious about keeping an up-to-date list of my medications. They check with me every time I see them to make sure I haven't changed meds (I take asthma and allergy meds as well as the arthrities-type stuff).

But nobody should be taking ANY of these antiinflammatory meds without being regularly checked by their doctor anyway.
The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#13 mjtian

mjtian
  • Islander
  • 897 posts

Posted 22 December 2004 - 05:10 PM

"But nobody should be taking ANY of these antiinflammatory meds without being regularly checked by their doctor anyway"

I agree, as physicians we are here to help and monitor the patient's overall well being.  To think that we consciously prescribe certain medications based on the free pens and meals is absurd.  An average primary physican earns over $130.000 a year, a couple of pens will not and should not determine our decisions.  Perhaps, subconsciously, some of us do make that mistake and it is unfortunate and unethical.  From my experience, most attendings at my medical school are not big fans of pharm reps!!!  Although the "poor" residents and medical students like myself pay more attention to the little gadgets.  We are constantly reminded, however, by the physicians of the reality and honestly, most of the times I just take their stuff and not even listen to what the pharm reps are saying.
"I have missed more than 9000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot... and missed. And I have failed over and over and over again in my life. And that is why... I succeed" -Michael Jordan

#14 FnlPrblm

FnlPrblm
  • Administrator
  • 12,503 posts

Posted 23 December 2004 - 05:23 AM

In short, EXCESS in anything will kill you.  Too much running, drinking, partying, sexual activities, being on the computer, sleeping, staying awake, taking meds...so on, all killers when odeed. :p  Just use common sense, a little bit of logic, follow the advice of most others and you should live a fairly decently long life.
"It is an old maxim of mine that when you have excluded the impossible, whatever remains, however improbable, must be the truth." --- Sir Arthur Conan Doyle The Adventures of Sherlock Holmes: The Beryl Coronet

The Boscombe Valley Mystery: "There is nothing more deceptive than an obvious fact."

"Nothing astonishes men so much as common sense and plain dealing." --- Ralph Waldo Emerson 'Art,' 1841

"Such welcome and unwelcome things at once, 'Tis hard to reconcile." --- Macbeth IV.III.138-9


LauraBertram.net

"Once in one's life, for one mortal moment, one must make a grab for immortality; if not, one has not lived." -- Sylvester Stallone

Time to eat all your words, swallow your pride, open your eyes...Sowing the Seeds of Love - Tears4Fears

#15 Bouree57

Bouree57
  • Islander
  • 578 posts

Posted 28 December 2004 - 05:27 AM

Spectacles, on Dec 22 2004, 10:25 AM, said:

Yeah, I'm irked that I finally found an over-the-counter medication that works to manage my arthritis and back pain--Aleve. (My doctor would probably put me on Percoset, but I told her I didn't want to take anything Rush Limbaugh takes. That stuff apparently addles you permanently. ;) ) For the past four months, I've been taking it once in the morning and once in the evening--and I've felt all young and bouncy again, like the people in the Celebrex commercials--but without the cost, or so I thought. Turns out Aleve may carry as much risk as Vioxx.

Damn. Oh well; I'd rather die relatively pain-free in my 50s than be a miserable old woman, so they'll have to pry my bottle of Aleve from my cold, dead fingers.
The report I saw said high doses of Aleve carry a greater risk than Vioxx or Celebrex. I took my mom's Aleve away from her.

-- B
My words but a whisper, your deafness a shout!
I may make you feel but I can't make you think.
(from Thick as a Brick, Jethro Tull)

He who made kittens put snakes in the grass.
He's a lover of life but a player of pawns.
(from Bungle in the Jungle--War Child, JT)

#16 Godeskian

Godeskian

    You'll be seein' rainbooms

  • Islander
  • 26,839 posts

Posted 28 December 2004 - 06:32 AM

FnlPrblm, on Dec 23 2004, 11:23 AM, said:

In short, EXCESS in anything will kill you.  Too much running, drinking, partying, sexual activities, being on the computer, sleeping, staying awake, taking meds...so on,

When they get round to doing tests regarding the highlighted bit, I'd like to pre-emptively volunteer  :angel:

Defy Gravity!


The Doctor: The universe is big. It's vast and complicated and ridiculous and sometimes, very rarely, impossible things just happen and we call them miracles... and that's a theory. Nine hundred years and I've never seen one yet, but this will do me.


#17 WildChildCait

WildChildCait

    And from the ashes of fire, she is reborn

  • Islander
  • 3,416 posts

Posted 28 December 2004 - 06:35 AM

Heck, i was in hospital for an eye operation a week and a half ago.
When i came to, it HURT and i asked for medication. Could not have any, as i'd make myself sick. So i worked through it, as id woken up earlier than expected, yadda yadda....two hours later i was up int eh ward, and pain was down from a hefty 8 on the scale of 10, to a 2-3. Usually i don't take a painkiller for anythign less than a 4, i hate taking medication...so When the lady came around wiht painkillers 2 hours after that and i was on a steady 2 level, i refused them. The doctor would have preferrred i stay on every 5 hour doses of 400 mg painkillers...I never took any.

Painkillers are overprescribed, and underprescribed.
This habit of taking 2 or more the instance anyone has a headache and 1 will suffice contributes to it.
RIP Ruby Medallion: 31-10-1999/21-05-2007
one gender-reassigned, world travelling, world class snake.

FKA Chaddee, amongst other things.
http://scentedalchemy.webs.com Custom handmade bath and body products

#18 Godeskian

Godeskian

    You'll be seein' rainbooms

  • Islander
  • 26,839 posts

Posted 28 December 2004 - 07:06 AM

I'm not a huge fan of suffering needleslly, but at the same time, i agree with Chaddee that people seem sometimes to be a little to quick to reach for painkillers.

What's more, taking painkilelrs may actually hide a growing problem and elt it get worse before it's resolved. I had this with my teeth last march.

Defy Gravity!


The Doctor: The universe is big. It's vast and complicated and ridiculous and sometimes, very rarely, impossible things just happen and we call them miracles... and that's a theory. Nine hundred years and I've never seen one yet, but this will do me.


#19 Chakotay

Chakotay

    For gosh sakes let me out of here!

  • Islander
  • 6,657 posts

Posted 28 December 2004 - 07:16 AM

It's gotten too easy to pop a pill for the small stuff these days, and ignore the underlying cause. Toothache, headaches, indigestion et al.

There's also the issue that there's big bucks to be made by firms creating prescription drugs. They test, sure, but who's going to wait around for 20-30 years doing proper long-term trials? No one.  They look for the immediate problems and if there aren't any, it's marketed.  

Once a few million people are taking it, then they have a really decent sample to check for the more subtle problems side-effects, like combining it with stuff no one thought of in the lab, or lifestyle impacts. Unfortunate for the unwitting guinea-pigs, however.
  No plan survives first contact with the enemy - military axiom.

#20 Rhea

Rhea

  • Islander
  • 16,433 posts

Posted 29 December 2004 - 02:38 PM

FnlPrblm, on Dec 23 2004, 02:23 AM, said:

In short, EXCESS in anything will kill you.  Too much running, drinking, partying, sexual activities, being on the computer, sleeping, staying awake, taking meds...so on, all killers when odeed. :p  Just use common sense, a little bit of logic, follow the advice of most others and you should live a fairly decently long life.

<{POST_SNAPBACK}>


Absolutely. And it doesn't hurt to actually READ what dosages the people in the studies are taking. In case of the Celebrex studies, the patients were taking AT LEAST double the normal dosage.
The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH



Also tagged with one or more of these keywords: Medicine, 2004, Drug reactions

0 user(s) are browsing this forum

0 members, 0 guests, 0 anonymous users