Sunday, August 21, 200511
Vioxx and Merck: Sunday update
Susan's Scribblings
"All the drugs advertised in print and on television bring out the side effects and possible risks, and no doctor should prescribe a drug without discussing the ups and downs of its use with the patient. Perhaps the unfortunate victim's heart attack was actually unrelated to Vioxx--heck, some of the healthiest people can drop dead for no apparent reason--but based on what I've read and seen, this recent lawsuit "victory" may well be the start of a reversal in our ability to study, develop and heal through the good efforts of the drug companies.
My sympathies go to the widow of the man who died, but I also grieve for Merck and hope they can continue to work to produce drugs that help and heal, for people who appreciate what medicine can and cannot achieve."
Greg's Opinion:
"As for the notion that this hurts more people than it helps by prohibiting companies from producing new drugs, color me doubtful. I just don't buy it when apologists for big companies claim we're all going to hell in a handbasket if we don't cave to said company's demands for maximum immunity. Nor do I accept it as a given that we should live with a statistical probability of X deaths per Y prescriptions. Apparently, the apologist crowd would stipulate this coldhearted reality as a necessity. It isn't. If a company can't find a means to survive in a business environment that says 'when you take shortcuts that cost people's lives, you pay for it' then they don't deserve to be in business. Last I checked, after all, there were ample cars on the streets today despite Ford being held liable for their disasterous Pinto design. Those of us who do cling to social responsibility as a responsible ideal aren't out to kill off all business ... rather to rid the ones who have no good cause to put people's lives and well-being at risk. Merck, ultimately, may or may not fall into that category ... they obviously have no problem producing numerous drugs that do the world a lot of good. And more power to them. But they may well need the wakeup call of this verdict (and it's successors) to ensure a better way to produce a safer product."
NY Times: For Merck, Vioxx Paper Trail Won't Go Away:
"As Merck examines its defeat in Texas, it may be tempted to blame its problems on the ineptitude of its lawyers, who committed basic mistakes like failing to prepare witnesses and badgering Mrs. Ernst, a sympathetic widow, for 90 minutes on cross-examination.
Merck may tell itself that the part of Texas where the case was heard is favorable to plaintiffs and that the trial might have turned out differently elsewhere. It might even say that W. Mark Lanier, the Houston lawyer who represented Mrs. Ernst, is so skilled that he won a case that most other plaintiffs' lawyers would not even imagine bringing."
Ideoblog:
"The verdict was hardly surprising. As reported here, the plaintiff’s case featured resentment-mongering against executive pay and corporate profits, and exploitation of the average lay jury's innumeracy. For example, responding to witness Gilmartin’s argument that the results of a study showing Vioxx users had six episodes of heart attacks or strokes to one for placebo users were not statistically significant, the lawyer asked:
"Forget the fact that the punitive damages award is per se excessive under Texas law.
Forget the fact that the 'victim' in the Texas case (the plaintiff was his widow) died from a cardiac condition that has never been linked to Vioxx.
Forget the fact that the plaintiff had only been married to the victim for one year.
A jury has made its decision (by a vote of 10-2; had this been a federal court that would have meant a judgment for the defendant — federal civil verdicts must be unanimous).
I sat on the fence regarding professional jurors before this case. Now there can be no doubt. In civil cases where a minimum quantum of intelligence and education are required to evaluate the facts and apply the law, and where enough damages are at stake to preclude future plaintiffs from having their day in court because moron 'send a message' juries issue awards that would bankrupt a defendant long before other plaintiffs have time to even draft a complaint, we must either have professional jurors or raise the standards for jury service high enough to keep morons off the jury pool altogether."
Conglomerate:
"By the way, if you would like to see one reason why the plaintiff won and Merck lost, take a look at the video of the plaintiff's lawyer v. the video of Merck's lawyer. (Both on the W$J site.) If you were a juror, who looks like he is on the side of truth and justice?"
"All the drugs advertised in print and on television bring out the side effects and possible risks, and no doctor should prescribe a drug without discussing the ups and downs of its use with the patient. Perhaps the unfortunate victim's heart attack was actually unrelated to Vioxx--heck, some of the healthiest people can drop dead for no apparent reason--but based on what I've read and seen, this recent lawsuit "victory" may well be the start of a reversal in our ability to study, develop and heal through the good efforts of the drug companies.
My sympathies go to the widow of the man who died, but I also grieve for Merck and hope they can continue to work to produce drugs that help and heal, for people who appreciate what medicine can and cannot achieve."
Greg's Opinion:
"As for the notion that this hurts more people than it helps by prohibiting companies from producing new drugs, color me doubtful. I just don't buy it when apologists for big companies claim we're all going to hell in a handbasket if we don't cave to said company's demands for maximum immunity. Nor do I accept it as a given that we should live with a statistical probability of X deaths per Y prescriptions. Apparently, the apologist crowd would stipulate this coldhearted reality as a necessity. It isn't. If a company can't find a means to survive in a business environment that says 'when you take shortcuts that cost people's lives, you pay for it' then they don't deserve to be in business. Last I checked, after all, there were ample cars on the streets today despite Ford being held liable for their disasterous Pinto design. Those of us who do cling to social responsibility as a responsible ideal aren't out to kill off all business ... rather to rid the ones who have no good cause to put people's lives and well-being at risk. Merck, ultimately, may or may not fall into that category ... they obviously have no problem producing numerous drugs that do the world a lot of good. And more power to them. But they may well need the wakeup call of this verdict (and it's successors) to ensure a better way to produce a safer product."
NY Times: For Merck, Vioxx Paper Trail Won't Go Away:
"As Merck examines its defeat in Texas, it may be tempted to blame its problems on the ineptitude of its lawyers, who committed basic mistakes like failing to prepare witnesses and badgering Mrs. Ernst, a sympathetic widow, for 90 minutes on cross-examination.
Merck may tell itself that the part of Texas where the case was heard is favorable to plaintiffs and that the trial might have turned out differently elsewhere. It might even say that W. Mark Lanier, the Houston lawyer who represented Mrs. Ernst, is so skilled that he won a case that most other plaintiffs' lawyers would not even imagine bringing."
Ideoblog:
"The verdict was hardly surprising. As reported here, the plaintiff’s case featured resentment-mongering against executive pay and corporate profits, and exploitation of the average lay jury's innumeracy. For example, responding to witness Gilmartin’s argument that the results of a study showing Vioxx users had six episodes of heart attacks or strokes to one for placebo users were not statistically significant, the lawyer asked:
have you got $6 on you? I'm going to give you a dollar and you give me the six. It is not statistically significant in the difference. What do you think, are you in or out?"A Stitch in Haste:
"Forget the fact that the punitive damages award is per se excessive under Texas law.
Forget the fact that the 'victim' in the Texas case (the plaintiff was his widow) died from a cardiac condition that has never been linked to Vioxx.
Forget the fact that the plaintiff had only been married to the victim for one year.
A jury has made its decision (by a vote of 10-2; had this been a federal court that would have meant a judgment for the defendant — federal civil verdicts must be unanimous).
I sat on the fence regarding professional jurors before this case. Now there can be no doubt. In civil cases where a minimum quantum of intelligence and education are required to evaluate the facts and apply the law, and where enough damages are at stake to preclude future plaintiffs from having their day in court because moron 'send a message' juries issue awards that would bankrupt a defendant long before other plaintiffs have time to even draft a complaint, we must either have professional jurors or raise the standards for jury service high enough to keep morons off the jury pool altogether."
Conglomerate:
"By the way, if you would like to see one reason why the plaintiff won and Merck lost, take a look at the video of the plaintiff's lawyer v. the video of Merck's lawyer. (Both on the W$J site.) If you were a juror, who looks like he is on the side of truth and justice?"






Comments
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Curious JD
Question for the physicians who post here:
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Rich, MD
I don't thnk I ever get "complete" info from the reps.
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TomMD
CJD asks about the Merck reps honesty in regards to Vioxx.The reps are basically salespeople with limited scientific knowledge except what the companies have told them.They usually have a canned presentation and don't stray too far from what the company (with FDA approval) has told them to say. Merck is no better or worse than the other pharm companies. The reps all tend to downplay or gloss over the side effects and costs of the drugs. This endothelial dysfunction problem of Vioxx is most likely a class action of COX-2 drugs (and perhaps all NSAIA), but Merck was unlucky to be the first one to discover (by accident) and report this uncommon and serious side effect.Merck does have liability issues with Vioxx, but I don't see Vioxx as different from many of the other drugs that any physician deals with every day.
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Anonymous
They just interviewed a plaintiff's attorney on CNBC who, after defending his own legal difficulties for ethics violations in obtaining clients, stated he may sue physicians who prescribed Vioxx in addition to suing Merck. Now we're getting targeted.
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Curious JD
So Tom, if you guys can't trust the reps, how do you decide when and how to prescribe something? What do you turn to?
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DrDiSaia
I blogged on this one as well. The award is simply ludicrous.
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TomMD
CJD...well, that's why we read medical journals, go to medical education conferences,take board review courses,etc. Meetings of the American College of Physicians, as an example, are free of drug company bias and the speakers have to announce in advance if they receive any support from drug companies.There are many independent journals for physicians (Medical Letter being the best) that review new drugs on the market. In the case of Vioxx, many physicians (including me) knowing about the pharmacology of COX-2 drugs, were aware that there was probably a very slight risk of cardiovascular disease.Until this CV risk was proven in a well controlled study I felt safe prescribing this drug. The benefit of Vioxx in reducing upper GI bleeding-a potentially lethal problem for all nonsteroidal type drugs- far outweighs the very small increase in cardiovascular events. Even now the medical evidence supports this view, and like many physicians I feel Vioxx should not have been pulled from the market.
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Anonymous
I'm tired of people saying "I feel for the widow, but...." Do any of you even know this woman? I feel for innocent people unlucky enough to be working for Merck who may lose their job over this decision so they can't pay to support their families.
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Curious JD
"The trust is in the FDA for approving the drug."
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Curious JD
Dr. DiSaia,
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Anonymous
I was proscribed vioxx, I didn’t take it long. It did make me sick at my stomach, so my doctor replaced it with another. A person should know there own body and should keep a log on pain and medical history. My Mom used vioxx and swears by it, she said it was the one drug that helped her authorities. What works for one person may not work for another. As for some people that think, they need to sue a big company ever time something goes wrong. You are the reasons that some of us cannot get good medical help or the drug that will help us and our body chemistry the best. It’s not merk’s fault that you and your doctor did not research the medication you are proscribed. I have been through 10 doctors so far, three that I would return too. I must say the best one was My VA doctor. The second was a back doctor, Dr James Cole, and the third was Dr Ban wart a sports doctor. I would like to let you know the worst, but I will not mention them, because if you do not have something good to say about someone the keep quiet about them. The only one’s benefiting from these law suites is the lawyers, not the patients. Drug’s are like doctors, what works for you may not work for me. Each person should know there own body, what you eat, drink and how you live. I would love it if we moved to a medical system like the one the military has. You go on sick call, see a medic/nurse then if needed move on to a doctor if your problem is more serious. Just Like in the 80’s and 90’s when I got my hay fever, I took the medication and went home for the day I was to drowsy to work. Then some time in the mid 90’s a new medication came on line and I could work with my hay fever, while now because of some drug addicts and the abuse when I ask for sedifed or an allergy medication that work best for me wal-marts looks at me like I am a drug addict. Well thanks to our FDA and government. I’ll bet you all where not complaining when the doctor handed you a trail drug from his office and said see if this works. Well that was a drug company seeing if the drug they spent millions of dollars, to try and help and this is the thanks you sue happy people give them. When I said the drug was a little high and I was having a hard time paying for it, my doctor gave me more samples. Jesus was a healer; did he need to worry about being sued? I wish I were a judge on a trial that was suing a drug company; I would laugh at you and send you and your big lawyer home with nothing.
Post a Comment »What were you told about Vioxx by the drug reps? Did you feel like they gave you accurate and complete info?
12:28 PM
2:38 PM
9:29 PM
11:47 AM
1:03 PM
The reps are not physicians. They cannot be expected to know all of that which they represent. They are simply sales people.
Writing a prescription for a newer drug is a trial. The trust is in the FDA for approving the drug. Continued scripts for that drug follow if I like that which I see in the outcomes.
1:31 PM
All things concidered I get very little of my drug information from the reps and actually get tired of seeing them. I have enough indigent patients who need help with their medicines, that I use the drug reps to get samples for these patients.
2:08 PM
12:18 PM
As I understand it, the FDA just turns to Merck for the reports they use in deciding to approve it. Is that incorrect?
1:06 PM
Do you feel like Merck, based on the studies you've reviewed, adequately disclosed to the FDA, and you, the dangers (whatever they were) of Vioxx as compared to similar drugs and as compared to the potential upside?
1:09 PM
Mike
You have a problem or complaint about my statement: write “_mmanley@excite.com”
9:05 AM