Vioxx Controversy

60 Minutes had a great segment this past Sunday on the
Vioxx recall and Merck's irresponsible actions (inactions).
Anybody catch it?

Here's an excerpt from a great article in the New York Times 11/14/2004.

"Despite Warnings, Drug Giant Took Long Path to Vioxx Recall"


In May 2000, executives at Merck, the pharmaceutical giant under siege for its handling of the multibillion-dollar drug Vioxx, made a fateful decision.

The company's top research and marketing executives met that month to consider whether to develop a study to directly test a disturbing possibility: that Vioxx, a painkiller, might pose a heart risk. Two months earlier, results from a clinical trial conducted for other reasons had suggested such concerns.

But the executives rejected pursuing a study focused on Vioxx's cardiovascular risks. According to company documents, the scientists wondered if such a study, which might require as many as 50,000 patients, was even possible. Merck's marketers, meanwhile, apparently feared it could send the wrong signal about the company's confidence in Vioxx, which already faced fierce competition from a rival drug, Celebrex.

"At present, there is no compelling marketing need for such a study," said a slide prepared for the meeting. "Data would not be available during the critical period. The implied message is not favorable."

Merck decided not to conduct a study solely to determine whether Vioxx might cause heart attacks and strokes - the type of study that outside scientists would repeatedly call for as clinical evidence continued to show cardiovascular risks from the drug. Instead, Merck officials decided to monitor clinical trials, already under way or planned, that were to test Vioxx for other uses, to see if any additional signs of cardiovascular problems emerged.

It was a recurring theme for the company over the next few years - that Vioxx was safe unless proved otherwise. As recently as Friday, in newspaper advertisements, Merck has argued that it took "prompt and decisive action'' as soon as it knew that Vioxx was dangerous.

But a detailed reconstruction of Merck's handling of Vioxx, based on interviews and internal company documents, suggests that actions the company took - and did not take - soon after the drug's safety was questioned may have affected the health of potentially thousands of patients, as well as the company's financial health and reputation.

The review also raises broader questions about an entire class of relatively new painkillers, called COX-2 inhibitors; about how drugs are tested; and about how aggressively the federal Food and Drug Administration monitors the safety of medications once they are in the marketplace.

The decisions about how to test Vioxx were made in a hothouse environment in which researchers fiercely debated how the question should be pursued, and some even now question whether the drug needed to be withdrawn. It also took place amid a fierce battle between Vioxx and Celebrex in which federal regulators said marketing claims ran ahead of the science.

Today Merck faces not only Congressional and Justice Department investigations, but also potentially thousands of personal-injury lawsuits that could tie the company up in litigation for years and possibly cost it billions to resolve.

In late September, more than four years after that May 2000 meeting, Merck announced that it was pulling the drug off the market because a long-term clinical trial showed that some patients, after taking the drug for 18 months, developed serious cardiovascular problems. The data that ultimately persuaded the company to withdraw the drug indicated 15 cases of heart attack, stroke or blood clots per thousand people each year over three years, compared with 7.5 such events per thousand patients taking a placebo.

But the company never directly tested the theory that it used to explain the worrisome results of the clinical trial in 2000. Merck was criticized for what some charged was playing down the drug's possible heart risks; in one case, it received a warning letter from the Food and Drug Administration for minimizing "potentially serious cardiovascular findings.'' And when outside researchers found evidence indicating Vioxx might pose dangers, Merck dismissed their data.

Good for lawyers

Who cares about the lawyers (but I wish them well).

"Less tha two weeks ago the British medical journal, The Lancet, published a study which concluded that based on previous studies Vioxx should have been withdrawn several years earlier."

CBS 60 Minutes, 11/14/2004

It's too bad about the heart issues. Maybe it coudl be re-issued with warnings? It is DAMN good shit for pain/inflammation.

Many patients wish to continue taking Vioxx, as it's the only thing aside from huge doses of oxycontin that helps their pain. I have some good info on this at home, but my computer is currently dead :( I'll try to get it asap.

Vioxx had problems from the beginning, it is comparable to other nsaids without any great advantages except for gastric safety. Oxycontin if used with the right reasons can be a great drug. Voltaren and indocin are the most effective nsaids

Many Olympians use it.

"without any great advantages except for gastric safety."

Lack of addictiveness? Lack of drowsiness? Doesn't make you feel stoned? Isn't a schedule II controlled substance like Oxycontin is?

Just over the horizon, it looks like nannies are going to snatch up Celebrex. I'd like to take this opportunity to give a big "FUCK YOU!" to the damn FDA.

I was comparing it to antiinflammatories, not narcotics. There are 20-25 other antiinflammatories, as bood or better than vioxx, been on the market for more than 10-20 years.

howardo, all the things I mentioned are with regard to Oxycontin which you refer to as "a great drug."

Oxy is great for it's application... it's the only thing that can help some people who have extreme pain. Everything has side effects, just have to weight the risk against the benefit.

Oxycontin is a great drug when used for the proper type of patient. I have treated many patients with severe chronic pain with it, it is longer lasting than other narcotics and quite effective. And because of its slow release, it does not make people feel stoned