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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline: Don't miss Derek Lowe's excellent commentary on drug discovery and the pharma industry in general at In the Pipeline

In the Pipeline

« No More Merck For A Couple of Days | Main | Mutual Suspicions »

August 21, 2005

Okay, One More Merck Point

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Posted by Derek

You know, there is one more thing about the Merck case I'd like address. This is brought on partly by the general press coverage of whether Merck knew this or hid that, and partly by an intensely irritating comment to Friday afternoon's post.

You would think, to hear the way some people talk, that no one at Merck ever took Vioxx. That they just launched it onto the market with an evil cackle and a shout of "Caveat emptor", then sat back to watch the money roll in. Actually, employees of Merck very likely took Vioxx at a rate above that of their cohorts in the general population - employee discounts, you know. I've no doubt that this applies to Merck's marketing department, to their clinical development groups, and to their toxicologists. Why shouldn't they take their own company's drug if they're in need of a COX-2 inhibitor?

It's not very far to the conspiracy theories that pop up about cancer, about HIV, about every awful disease you can imagine. "You know," some fool will whisper to you, "that the drug companies really have a cure for it. They're just waiting until more people get sick. In fact, they're probably making sure that as many people get it as possible."

It's difficult for me to express coherently my contempt for that idea. Let me assure you that employees of pharmaceutical companies, and their relatives, and their friends, are potential heirs to every disease that this world offers, just like everyone else. I might add that it's particularly hard to watch someone you know suffer and die from a disease that you've been working for years to treat, but still have nothing to offer for.

So enough of this division between Merck and the rest of the world. Merck is a large company, with tens of thousands of people in it. Many of them took Vioxx. No small number of those people probably worked on it. I'd like to hear how that pulpit-pounding Texas attorney would work them into his world view.

Update: For plenty of good commentary on the legal aspects of the Merck verdict, see Ted Frank's post at Point of Law.

Comments (12) + TrackBacks (0) | Category: Current Events | Press Coverage


COMMENTS

1. daksya on August 22, 2005 12:58 AM writes...

You would think, to hear the way some people talk, that no one at Merck ever took Vioxx.


I read somewhere, that the wife of Merck's CEO took Vioxx till the day it was withdrawn.



I think that the best case that can be made for 'pharma-conspiracy' is a subtle one viz.


1)every drug has non-zero risks;

2)risk detection and quantification is a fuzzy science;

3)pharmacorps are shareholder-bound profit maximisers;

4)drug selection is based on efficacy and risk assessment, and other factors like cost;

5)the faculties of the end-(lay)-user to make such assessments is not as adept and finetuned as someone with an inkling of biology education;

6)yet the pharmacorps have to market to these end-users;

7)their promotion markets the product with descriptions which pay token heed to the risks but don't provide more context if the pharmas believe that the layperson's perception won't interpret it with the proper perspective

8)then there's a fraction of the end-users, for whom the risks manifest, and the pharmas become the villains.



The key is: education. When the public accepts that no treatment is risk-free and not all risks can be detected and tagged, and the pharmas also move away from the "full satisfaction or your money back" pseudopanglossian attitude in advertising, then there will be a saner rapport between pharmas and public.

Permalink to Comment

2. Kay on August 22, 2005 7:19 AM writes...

You would think that some at Merck thought to themselves, "This drug is designed for outliers, yet marketed to all via food, frienship, fifties, and flattery. I'll take aspirin because it works for me."

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3. Phil-Z on August 22, 2005 8:36 AM writes...

Kay,
This reminds me of the folks who hear about a plane wreck and decide to drive cross country instead. They've exchanged a small "exotic" but well publicized risk for a huge but familiar one.

Do you really think taking asprin is risk free, or even low risk?

Permalink to Comment

4. tgibbs on August 22, 2005 10:39 AM writes...

You would think, to hear the way some people talk, that no one at Merck ever took Vioxx.

As it happens, I know somebody who now works for Merck (not directly involved with Vioxx development). We had occasion to speak shortly after the Vioxx thing broke. He said, "I've taken Vioxx; I have some in my medicine cabinet, and I'm not getting rid of it." Although he believed the data on cardiovascular risk, and thought that Merck had done the right thing by pulling the drug, as far as his personal use was concerned, he felt that its advantages outweighed its risk when it came to short-term use.

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5. Dr_Toot on August 22, 2005 12:41 PM writes...

Hell, I've got a "BIG PHARMA" bumper sticker on my SUV, so as to better identify me while I run children down in the park, cackling & tossing pills out as I go. Look, you work in a high-profile health-related industry in a capitalist society or no, & you're gonna catch blowback. But who's watching the Watchers?! Here in N.C., the General Assembly is stumbling over enacting even the most basic of reforms limiting the bribery of our esteemed representatives. Moral of the story: send yer kid to law school.

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6. Kay on August 22, 2005 1:13 PM writes...

Phil: It's important to be suspicious of every new prescription when old, solid alternatives have not yet been tried. Established medications cannot support the costs of the 4 F's. Unless the new drug has a spectacular data set (doesn't happen often), then it's important to be the 10 millionth to be dosed rather than the 10 thousandth. Here's a brain teaser: how many CDER employees were taking Vioxx relative to those taking established meds?

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7. LNT on August 22, 2005 2:21 PM writes...

Derek, I wonder if you could address one interesting point that this "conspiracy theory" raises: Does our success in the curing diseases hasten our demise? It seems that our industry will eventually run out of financially and scientifically "attractive" diseases to cure --maybe not in our careers -- but certainly in the next 50-75 years I would guess. It seems to me that in spite of our lucrative short term financial heath, the long-term prospects for the pharmaceutical industry is pretty grim.

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8. Tom Bartlett on August 22, 2005 2:29 PM writes...

"It seems to me that in spite of our lucrative short term financial heath, the long-term prospects for the pharmaceutical industry is pretty grim."

If I could pipe in (17 year med chemist). There are two issues: 1)How many patentable

Derek? Your take?

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9. Tom Bartlett on August 22, 2005 2:33 PM writes...

"It seems to me that in spite of our lucrative short term financial heath, the long-term prospects for the pharmaceutical industry is pretty grim."

If I could pipe in (17 year med chemist). There are two issues: 1)How many patentable less-than 500 molecular weight entities are still out there? A lot, IMHO, but it's ever more difficult to put your finger on them, and some will be pretty tricky to make.2) How many good, but under-served biological targets are there? Well, with 500 plus kinases alone, plus all those ion channels-- I think finding reasonable targets will be readily "do-able" for the next 50 years or so.

Derek? Your take?

Excuse me-- my first two commenting attempts were truncated because I used a "less than" carat.

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10. Observer on August 23, 2005 5:44 PM writes...

It is sad that Derek Lowe bolsters Vioxx by knocking aspirin. I don't remember seeing any evidence that aspirin is more toxic than Vioxx: the pharmaceutical industry and its fear mongers did a wonderful job destroying children's aspirin because of Reyes' syndrome when aspirin is the drug of choice in Kawasaki's syndrome. Nowhere has it been proved that aspirin causes causes Reyes' syndrome.


I also find it intersting that the effectiveness of NSAIDs is always related to the amount of aspirin that it is equivalent to.

Perhaps the watchword should be: use a medication only if you need it,and only if you accept the consequences, known and unknown that may come with it.

As with the case against aspirin, in Ernst I am not impressed by the level of proof. The problem of proximate cause was not solved. Simply because something may happen does not prove it did happen.

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11. tombartlett7 on August 24, 2005 6:16 AM writes...

To Observer: NPR said it nicely yesterday, in a story about using Aspirin to prevent colon cancer: Gastric bleeds don't sound bad unless you have had one.

Permalink to Comment

12. Yevgeny Vilensky on August 30, 2005 12:57 AM writes...

Re the pharmaceutical industry:

As people live longer due to the hard-working efforts of people like you guys, humans will start developing new diseases. For example, one common fallacy is that industrialization has led to cancer (incidence of cancer in this century is substantially higher than in the last). Never mind that people are now living long enough to get it and that we're better capable of diagnosing it.

So, if anyone thinks about voting for John Edwards for President in 2008, there will be many more suits like the Vioxx one to look forward to because nothing will get done to fix this.

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