Welcome to Dergulation: Cures That Kill Patients

Are there mourners out there wondering who may have killed more people recently, Osama bin Laden or the big drug corporation, Merck and Co.? When Osama kills, he does so with criminal intent; but when Merck’s anti-arthritis drug, Vioxx, kills its users, the drug company may well not have criminal intent as defined by the law. Thus, regardless of how much we might like to see him locked up in a federal penitentiary for the rest of his life, Raymond V. Gilmartin, Merck’s chairman, president and C.E.O., will escape the gallows and lesser forms of punishment.

Nevertheless, Mr. Gilmartin’s corporation may be responsible for the deaths of more people than died in the World Trade Center. The W.T.C. victims were murdered, and the President of the United States, however fitfully, is trying to get the master terrorist who ordered up the deed. If the past is any guide, however, Mr. Gilmartin will turn up at the White House in a dinner jacket some night and have a Medal of Freedom pinned on him by the President.

Over the years, Mr. Gilmartin sold billions of dollars’ worth of Vioxx to millions of people, although there was every reason to think that this drug kills by way of causing heart attack and stroke. When Mr. Gilmartin took Vioxx-a drug which does nothing that other, cheaper drugs don’t do more safely-off the market, he said he did so on the basis of “new data.” But no new information was needed, as is amply attested to by Eric J. Topol, chairman of the Department of Cardiovascular Medicine at the renowned Cleveland Clinic.

“In 2001, I was part of a team from the Cleveland Clinic that published a paper demonstrating the significant heart attack risk of Vioxx,” he said. “Our research … found that compared to naproxen, a commonly used over-the-counter anti-inflammatory drug with similar benefits, Vioxx has a five times greater heart attack risk. In response, Merck claimed that early conclusions about the risk were flawed and attributed the comparatively high heart attack rates to an unproven protective effect of naproxen. Our study was followed by several others demonstrating Vioxx’s dangers. Each time Merck had a similar reply: the study was ‘flawed.’ Merck finally had to acknowledge the truth, but only by accident.”

Nevertheless, Mr. Gilmartin has been hawking this junk in every home via his relentless TV ad campaigns. We will never know how many people may have paid for the privilege of dying by strong-arming their doctors into prescribing Vioxx after being gulled by a Merck ad. The lawsuits have already begun, and the newspapers are speculating that Mr. Gilmartin may ultimately have to sign checks in the billions to pay for what he and his corporation are accused of doing. Shed no tears for Mr. Gilmartin and any opprobrium that ultimately may attach to him: He is the chairman, president and C.E.O., which is the same as being the dictator of Merck. He is the big and absolute kahuna; what he says, Merck does. That’s the way it is with the people who run the big corporations: They get the money, they get the sex, they get the flattery, they get the power, they get the politicians, they get the kowtow, they get the “yes, super sahib” treatment, they get to go to the head of every line-and they get the blame.

With the peasants brandishing their pitchforks as they converge on the mounting piles of evidence proving what Mr. Gilmartin and his company have done, Merck’s chairman, president and C.E.O. (it is thus he styles himself) took the junk off the market and published a full-page ad in The New York Times proclaiming “Merck Voluntarily Withdraws VIOXX.” There follows a block of text which, given what Dr. Topol has written, can be characterized as misleading, if not mendacious

-but cleverly worded. Among the things that Mr. Gilmartin (or, more likely, a well-paid ghostwriter) said was: “We are taking this action because we believe it best serves the interests of the patients …. Be assured that Merck will continue to do everything we can to maintain the safety of our medicines.”

You can take that for whatever it’s worth, but countless people will doubtless believe it. Mr. Gilmartin thinks they will, for no sooner were the trucks picking up unsold crates of Vioxx from the drugstores than Mr. Gilmartin was on TV and in print peddling something called Vytorin. It is supposed to help you keep your cholesterol levels low-and to prove it, Mr. Gilmartin’s advertising agency (ever the source of valid medical science) has scads of codgers, geezers and crones dancing merry jigs and displaying the happy vitality of 21-year-olds. In the small print, the Vytorin ads warn about “muscle breakdown” (not good for dancing the jig) and also against taking this preparation if the old coot in question is also taking itraconozole, fibric-acid derivatives, veraparril, courmarin, and on and on, until the list of incomprehensible names dulls the eyes of even the most enthusiastic of ancient clog dancers.

Time was when the drug industry was divided into two parts: patent-medicine companies that sold merchandise not requiring a doctor’s prescription, and “ethical” pharmaceutical houses that sold prescription medicine-and that never, ever advertised to the lay public. The term “ethical” is no longer applied to people in the drug business, an industry which pushes its poisons with the same abandon as the people who sell pizzas and automobiles.

Medicines are poisons-poisons which, when carefully and skillfully used, restore us to health. “Carefully” and “skillfully” have nothing to do with peddling these dangerous substances out of every TV set in the country, but the power to regulate and police this industry has all but disappeared. Clearly, Vioxx wasn’t properly tested-or was insufficiently tested-before it was made available not merely to doctors, but mass-marketed to the millions. There is supposed to be a government agency whose duty it is to prevent such scandals, but I can’t remember its name. Oh, yes: the Food and Drug Administration, an appendage of the government which only makes it into the papers when a new disaster surfaces. We can only hope that the F.D.A. is accomplishing something out of sight, at least insofar as supervising the activities of smaller corporations with less clout and less money.

Whatever the case, a scandal like this reflects not only on Mr. Gilmartin and his Merck, but on the F.D.A-one more scandal where the agency shows up a day late and a dollar short.

The F.D.A. has to do its work in a climate antithetical to government regulation of anything. For decades now, the big money and big power have insisted that public control of any activity is inimical to individual freedom, while at the same time the power of the various federal police forces to invade home and soul have been remorselessly expanded. Regulation of corporations is bad; regulation of individuals is good. Business must have a level playing field, which turns out to mean that individuals get no field to play on. The labor unions have long since been destroyed, so now the big money has turned to depriving individuals of resort to the courts. The Republicans are relentless in their drive to take away the right of people to sue for malpractice and are dedicated to making the class-action suit a thing of the past. How the lone person can find protection, let alone redress, in a society dominated by corporate power and the theology of free marketism is beyond me.

Where are people to turn? Where can they find effective help, not warm and fuzzy schnoodling? The best you can get these days are recorded messages of empathy-a word they use because they think it means more than “sympathy,” but it doesn’t. It’s not grief counselors that people need, it’s less grief, and how are they going to get that? Through the Internet? By putting their dying words of reproach in a blog? Never has the word “freedom” been tossed around with more strident repetition, and seldom has it had less practical application in day-to-day life.

So what the hell-pass the Vioxx, Mr. Gilmartin. We’ll pop one of your pills and hope for the best.