A woman stands at the edge of a river. She wants to get to the other side.

With her are three experts. Each weighs the benefits against the risks of wading across.

The toxicologist assures her that the river is only cold, not toxic.

The cardiologist assures her that, given her good health, the cold will not affect her.

The hydrologist assures her that the river is neither so swift nor so deep that she cannot cross.

The woman refuses. Perplexed and annoyed, the experts go through their reasoning in great detail. The chance that something bad will happen is one in a million.

Still she refuses. Now angry, the experts demand to know why she has ignored their expert advise.

The woman points upstream to a bridge which she uses to cross the river easily.

This story, which opens Mary O’Brien’s very fine book Making Better Environmental Decisions, came to mind when I read about the FDA’s expert panel approving the continued use of COX-2 inhibitors such as Vioxx, Celebrex, and Bextra.

These nonsteroidal anti-inflammatory drugs used for pain relief, particularly among people with arthritis, are of concern because they increase the risk of heart attacks. The experts weighed these risks against the benefits and found that the benefits won.

Sufferers should wade across the pharmaceutical river. If not with COX-2 inhibitors (for which dire warnings are recommended), then with older drugs like ibuprofen, naproxen, and aspirin.

But what’s upstream?

Here’s a clue: anti-inflammatory.

Inflammation is a biochemical cascade that’s part of your immune system. It’s job is to get rid of tissue damaged by infection or injury and then promote the growth of new tissue. We are all familiar with acute inflammation: a cut that gets infected or a sprained ankle.

Chronic inflammation, such as arthritis, is a low grade version of the same process: remove damaged tissue and promote new growth.

Much of inflammation can be treated or resolved altogether without drugs. Jack Challem’s book The Inflammation Syndrome describes those alternatives.

What else is upstream?

For pain, there are a wide variety of alternatives. Some require a prescription. Some do not.

But FDA experts and the doctors who listen to them are not likely to cross that bridge. Unless you point upstream to the alternatives.