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Burton H. Pollock, M. D. University of Miami, Miami, Fla., April 22, 1968. Dr. Max Tishler, Merck Research Institute, Merck d Co., Inc. Rahway, N.J. Dear Dr. Tishler : I understand that your company is under investigation by the Subcommittee on Monopoly, chaired by Senator Nelson, in reference to the drug, Indocin. In our University Clinic we use Indocin. quite effectively, for pain relief in the milder cases of rheumatoid Nexium Buy Online arthritis. Certain patients, particularly males, have better response to Indocin with less side effects than when given large doses of aspirin or mild narcotics. Business men are able to get pain relief with- out drowsiness. We use Indocin for lowering the dosage of Prednisone. Thus, I think, Indocin is a useful adjunct in the treatment of various arthritics. Sincerely yours, David S. Howell. M.D., Professor of Medicine, Director, Arthritis Division. COMPETITIVE PROBLEMS IN THE DRUG INDUSTRY 33S1 Los Angeles, Calik., April 22, lilGS. Dr. Max Tishlek. Merck Research Laboratories, Merck d Co., Inc. Rahway, N.J. Deyr Dr Tishler: It is my nndorstandiiig that there are to be some congres- sional hearings related to the use of iudomethacin in the treatment of rheuma- S arthritisNve are all cognizant of the difticulties involved m th. <-valuamn- eveu double blind studies-of indomethaciu or any drug in a ^^-^^'^ -^^ ^^^^^^^s rheumatoid arthritis which is characterized by exacerbations, and Se emotional comiH.iient. However. I have found indoiucthacui to be a very use- iufdnig in the treatment of rheumatoid arthritis, particularly Nexium Buy Online m milder cases or in luitients where one is reluctant to use corticosteroids as patients in the older a4 group and in Nexium Buy Online those with diabetes, osteoporosis, etc. Furthermore, in the ?oncom7tant use of iudomethacin with corticosteroids, the dosage of corticoster- oids has been reduced in some patients. . ,^ ^ ^ ?Dt"c ulceraUon has been of major concern to Nexium Buy Online critical, clinical observers. An 4'hses of more than 700 patients treated with Indomethacin at t^o University of Colorado hospital and its clinics indicates that this complication seldom occurs^ These mtientsS previously received other anti-inflammatory and Nexium Buy Online analgesic Jni^s inclSg aspirin, corticosteroids, and phenylbutazone. The '"eidence of m'pttc l?ers d^^ period of therapy was actually less than SS similar ^^^^ of other anti-inflammatory, anti-rheiunatic agents In my explrfence the'^currence of peptic ulceration is not a major obstacle to the clinical use of this drug in patients with rheumatoid arthritis . ^ In my five years experience based on the prac ical "^t,rf/,"fn st ,ff exi^ri- a careful analy.sis of the results in all of our P^tiens treated ^y a staff exi^ri enced in the management of patients with rheumatoid ^^1\"^'; '""'".["''/;" ^ -Hospital, I am of the opinion that Indomethacin benefits some ;^tu f, ^ tn .rheumatoid arthritis. At present no reliable tests are available to predict ^^hlch 81-280 68 pt. 8 19 3382 COMPETITIVE PROBLEMS IN THE DRUG INDUSTRY patients with this chronic disease which is marked by spontaneous remissions and exacerbations, will respond favorable to this drug ^^^^^ remissions
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