ARGUMENTATIVE ESSAY3
of life, and adverse impact of treatment (Bassler, Montori, Briel, Glasziou, & Guyatt,
2008). The ADAPT trial was stopped due to evidence from APC trial which
demonstrated an increased risk of cardiovascular and cerebrovascular diseases,
among patients that consumed celecoxib and other types of COX-2 inhibitors.
Therefore, early termination of the drug failed to evaluate the effect of conventional
NSAID naproxen sodium and the selective COX-2 inhibitor celecoxib for the primary
prevention of Alzheimer’s dementia (AD) which was the primary study outcome.
Furthermore, truncated trials have been mentioned to overestimate treatment
effects (Bassler et al., 2008). In the ADAPT study, participants who experienced
cardiovascular or cerebrovascular death, MI, stroke, CHF, or TIA in the celecoxib-,
naproxen-, and placebo-treated groups were 28/717 (5.54%), 40/713 (8.25%), and
37/1070 (5.68%), respectively which summed up a hazard ratio (95% confidence
interval [CI]) for celecoxib of 1.10 (0.67–1.79) and for naproxen of 1.63 (1.04–2.55).
Antihypertensive treatment was initiated in 160/440 (47.43%), 147/427
(45.00%), and 164/644 (34.08%) which produced a hazard ratio (CIs) of 1.56 for
celecoxib (1.26–1.94) and 1.40 for naproxen (1.12–1.75) (Martin, 2006). The number
of accrued outcome events was small, but the overestimated treatment effect can be
huge that violates the ethical research requirement of scientific validity. Subsequent
use of overestimated treatment results by clinicians to make clinical decisions also
violates the ethical requirements of social value and violates a favourable risk–
benefit ratio (Murad et al., 2017).
Social Value:
On the other hand, it is very important that investigators comply with the
ethical obligations while dealing with research participants. However, there might be

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Ethics in Healthcare: A Critical Analysis of the ADAPT Clinical Drug Trial

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