Denialism by Michael Specter Read Free Book Online Page A

better than the cheaper and more readily available drugs they were taking in the first place. And just as often, the drugs for sale were so new to the market that their safety was hard to gauge. “Americans must face an inconvenient truth about drug safety,” Henry Waxman, the veteran California congressman, said when asked his position on the impact of these advertisements. Waxman is perhaps the most astute congressional observer of American medicine, and since the election of Barack Obama, in his new role as chairman of the House Energy and Commerce Committee, he may also be the most powerful. “The truth is that we inevitably allow drugs on the market whose risks are not fully known,” he said. In 2006, the Institute of Medicine suggested a moratorium on such advertising, a brief pause before permitting companies like Merck to hawk powerful chemicals as if they were Cheerios or vacuum cleaners. That would certainly have saved many of the lives lost to Vioxx.
    People tend to see what they are looking for, however, and to millions, pain relief was all that mattered. When it comes to getting a message across, the Super Bowl, where ads for drugs like Vioxx and Viagra have been ubiquitous, will always matter more than the New England Journal of Medicine . In this atmosphere, Eric Topol was largely on his own, and he became the target of Merck’s fullest fury. “Merck went after me with all they had,” he told me. Topol had collaborated with Merck often—at the time of his clash with the company over Vioxx he was actually running one of its trials, for the anti-platelet drug Aggrastat. Like most people in his profession, Topol considered Merck a remarkable place. During one stretch beginning in 1987, it was named by Fortune magazine for seven straight years as the most admired corporation in America, a record that remains unmatched. Merck seemed to prove that profits and decency were not incompatible. “I was in no way predisposed to have negative feelings toward Merck,” Topol said. “In fact it was quite the contrary.” None of that mattered, though, because they came after him with a cleaver. “They said my first paper was ‘data dredging,’” by which they meant a pedantic report full of numbers that proved nothing. “They told anyone who would listen that I had been a fine researcher until the day that paper was published, but at that moment I had suddenly lost it. And at the time all I had said was, ‘Wait a minute, there needs to be some more study here.’ ”
    By the end of 2001, however, Topol had moved on. He had begun to focus primarily on genomics and his research switched from treating heart attacks to preventing them. Others were studying whether Vioxx increased the risk of heart attacks, and he felt he had done all he could to address the issue. At the time, Topol had no idea how divisive Vioxx had become at Merck itself. It turned out that scientists there had worried as early as 1996 about the effect the drug would have on the cardiovascular system. The reason for that concern was clear. Vioxx altered the ratio of two crucial substances, the hormone prostacyclin and a molecule called thromboxane, which together help balance blood flow and its ability to clot properly. Suppressing prostacyclin reduces inflammation and pain, and that made Vioxx work. Suppress it too powerfully, however, and thromboxane can cause increased blood pressure and too much clotting, either of which can lead to heart attacks. By 2002, Merck decided to embark on a major study of the cardiovascular risks caused by Vioxx—just as Topol and his colleagues had suggested. The trial would have produced useful data fairly rapidly, but just before it began, the company abruptly scuttled the project. In the end, Merck never made any significant effort to assess the cardiovascular risk posed by its most successful product.
    Instead, the company issued a “Cardiovascular Card” to sales representatives. More than three thousand