The discovery of cyclooxygenase 2 (COX-2) a decade ago heralded one of the most rapid and expensive development and marketing of a new class of drug that we have witnessed. This has resulted in publication of an interesting mixture of exceptionally high quality basic and clinical research. Based on the COX dogma, that COX-1 isgood and COX-2 isbad, we were promised equal therapeutic efficacy to conventional non-steroidal inflammatory drugs (NSAIDs) with the COX-2 selective inhibitors and absence of gastrointestinal side effects that otherwise represent a significant public health problem. Have these promises come to fruition?

The semantic problem about the term COX-2 selective agents is acknowledged,1-3 but for our purpose (accepting that nimesulide and etodolac, at least, have …