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Are rates of gastrointestinal bleeding higher following the introduction of COX-2 inhibitors?

The introduction of selective COX-2 inhibitors has provided a valuable treatment alternative for the management of pain and inflammation. Although selective COX-2 inhibitors have been shown to possess a significantly lower risk of serious gastrointestinal complications relative to traditional nonselective NSAIDs, the rapid uptake of these drugs have posed a small but significant risk to those individuals who may have otherwise not received any pharmacological treatment. At least one region has reported a temporally plausible increase in the rate of hospital admission for upper gastrointestinal bleeding as a result of the rapid uptake of the selective COX-2 inhibitors. Issues in understanding the clinical evidence and drug market dynamics as they relate to individuals and populations are explored in this paper along with whether or not the introduction of drugs that are safer than older alternatives can actually lead to increased population adverse event rates due to their rapid uptake.