AFTL Women’s Caucus Journal Article November/December 2004 “VIOXX: ONCE AGAIN WE LEARN THAT NEITHER MANUFACTURERS NOR THE FDA LOOK OUT FOR THE AMERICAN PUBLIC” by Virginia M. Buchanan, Levin, Papantonio, et al
Vioxx, a Cox-2 inhibitor non-steroidal anti-
risks of Vioxx. Specifically, the FDA said the company
inflammatory medication, was rushed to approval by the
was engaging in promotional practices to minimize the
FDA in 1999. It became available for use on an unlimited
potential cardiovascular effects of the drug. Merck had
basis in May of 1999. Since that time, Merck, the drug’s
undertaken a campaign to downplay the results of the
manufacturer, has spent over half a billion dollars
VIGOR study and misstated the effects of Naproxen on
promoting and marketing the drug, including direct
advertising to consumers. Vioxx was initially offered as apain relieving medication for chronic pain. It was also
Rather than looking at the long term effects on patients
marketed as a pain reliever for juvenile rheumatoid
using Vioxx, Merck directed its efforts to expanding the
arthritis sufferers, including children over the age of 2.1
use of the drug. Merck wanted to get approval for the use
Vioxx was prescribed to millions of patients, and sales of
of Vioxx to prevent recurrent colon polyps.4 During the
Vioxx in 2003 were just under $2.5 billion. Vioxx was one
course of the research, known as the APPROVe study,
researchers were alarmed to see the number of heart
of the fastest growing and largest performers of Merck’s
attacks and strokes which occurred among the patients.
pharmaceutical products. Some estimate that Vioxx was
The results were so stunning, the study was halted. The
one of the top 10 selling drugs in the world in 2003.
results of the APPROVe study, together with an analysis
done by an FDA researcher, Dr. David Graham, confirmed
Although Vioxx was never offered as a medication with
the suspicion that Vioxx poses significant cardiovascular
life-saving propensities, the FDA approved a fast track
application process for Vioxx with the justification thatVioxx would offer relief to millions of sufferers of chronic
These two events caused Merck to voluntarily withdraw
pain. At that time, there were representations by Merck
the drug from the market on September 30, 2004.
that Vioxx would not cause gastrointestinal complica-tions, including ulcers and bleeding, that were seen in
The public statements about it being a voluntary with-
other over-the-counter non-steroidal medications.2 Vioxx
drawal are questionable. Based upon reports and infor-
was the first NSAID, selective, Cox-2 inhibitor, so Merck
mation from FDA researcher Dr. Graham, it appears that
was able to quickly gain a large market. Merck was
the safety and efficacy of Vioxx were challenged almost
unable to demonstrate at that time, or at any time, the
from the beginning, from within the FDA. The concerns
superiority of VIOXX as a pain relieving agent.
were ridiculed and rejected. However, with the results ofthe most recent study and the analysis done by the FDA,
In a post-marketing study, known as the VIGOR study, a
the FDA could no longer turn a blind eye to the impact of
number of patients were given Naproxen, while others
Vioxx on patients. The FDA had effectively shirked its
were given Vioxx.3 The studies showed that there were
responsibility up to the point of the most recent disclo-
more than double the number of cardiovascular events in
sures. Given its hands-off approach with Merck, it is
patients taking Vioxx than Naproxen. At that time,
unclear what the FDA would have done had the medica-
members of the international medical community,
tion not been voluntarily withdrawn by the manufacturer.
including Dr. E. J. Topal from the Cleveland ClinicFoundation and Dr. James Wright from the University of
One can surmise that the evidence must be overwhelm-
British Columbia, called for further testing of Vioxx, to
ing for Merck to withdraw a drug that generated a sub-
specifically assess cardiovascular effects. Neither the
stantial portion of its profits and for which they had
FDA nor Merck took any action to follow-up on the
committed such an extensive and elaborate marketing
concerns that Vioxx could in some way be related to the
campaign. The Wall Street Journal has reported that
increase in heart attacks and stroke as seen in the
there was substantial evidence known to Merck and
VIGOR study. Neither the FDA nor Merck heeded the
acknowledged by its leading VIOXX researcher that the
admonition of the medical experts that the safety of
evidence was clear that there were some cardiovascular
Merck blindly ignored the information published in the
Sadly, the limited ability and commitment on the part of
the FDA to regulate pharmaceutical companies are clear
various studies of Cox-2, NSAIDS, each time criticizing
in this instance. Chronic pain can admittedly be a
some aspect of the conclusions. Merck instead went to
significant problem for those who suffer from such a
great lengths to both increase its marketing budget and
condition. However, VIOXX was broadly marketed to
continue its representations that Vioxx was safe and
virtually all people with chronic pain, without regard to
efficacious for the control of pain.
severity of the problem, and certainly without full disclo-
sure of risks. Merck was all too willing to take advantage
In September, 2001, the FDA made some effort to reign inMerck’s overzealous marketing efforts. The FDA admon-
ished Merck about misinforming physicians about the
of the complacent, deferential attitude of the FDA. Thedrug has been marketed very aggressively since 1999, and
its withdrawal at the end of the third quarter of 2004leaves many Vioxx users and surviving family members
questioning whether their strokes or heart attacks werethe result of VIOXX use.
Strokes and heart attacks are disabling and sometimes
deadly conditions. The cost of care, loss of earnings andservices to the community caused by stroke and heartattack on an annual basis are enormous.
More than 300 cases have been filed so far for what isbelieved to be adverse affects of Vioxx. As more discov-ery is completed, more will become known about just howmuch Merck knew about its drug. In addition, its specificmarketing goals and conduct will be identified through itsinternal documents. Merck will undoubtedly assert aproprietary interest in its documents, and the public willmost likely never know the actual corporate philosophiesabout Vioxx. Based upon what has been publicallydisplayed, though, it appears clear that Merck wanted tomake sales at all costs. That cost may have been theloss of health and life for many.
Dr. Topol has called for a congressional inquiry into whatMerck and the FDA have done.6 It would benefit many ifthe challenge is accepted by Congress. This is a problemwhich must be fixed. ____________
1See Vioxx packaging indications for use. 2“The double-edged sword of Cox-2 selective
NSAIDS.” J. M. Wright, CMAJ, Nov. 12, 2002; 167 (10).
3The results of the VIGOR study for Vioxx
gastrointestinal outcomes research were released inMarch, 2000.
4Interestingly, the APPROVe study seems to fit
into what was outlined in a Wall Street Journal articlepublished on November 1, 2004; the article discussesinternal emails and documents of Merck and whatappears to be a concerted effort by Merck to designstudies which would de-emphasize the cardiovascularrisks of VIOXX.
5The FDA researchers worked in conjunction with
Kaiser Permente in evaluating medical records of 1,300patients.
6Failing the Public Health–Rofecoxib, Merck and
the FDA” E. J. Topol; N. England J. Med., 21 Oct. 2004;351(17): 1707-9.
Laboratório Apresentação de Primogyna Cart. c/ 1 blíster c/ 28 drágeas de 1mg. Primogyna - Indicações Terapia de reposição hormonal (TRH) para o tratamento dos sintomas da menopausa em mulheres com útero intacto ou histerectomizadas. Contra-indicações de Primogyna A TRH não deve ser iniciada na presença de qualquer uma das condições listadas abaixo. Se alguma dess
NIH Public Access Author Manuscript Oral Dis . Author manuscript; available in PMC 2008 February 28. Oral Dis . 2007 November ; 13(6): 508–512. Oral biofilms, periodontitis, and pulmonary infections S Paju 1,2 and FA Scannapieco 3 1Institute of Dentistry, University of Helsinki, Helsinki, Finland 2Department of Oral and MaxillofacialDiseases, Helsinki University Central Hospital,