By Brezis, Mayer Belmaker, R H
Recent events and reports increasingly suggest misalignment between the interests of the pharmaceutical industry and those of public health. Johnson & Johnson illegally and effectively promoted Propulsid off-label for children despite internal company documents raising safety concerns. Death in drug trial has been described as a "trade secret." On Vioxx, Topol wrote: "Sadly, it is clear that Merck's commercial interest exceeded its concern about the drug's toxicity" (2). More and more concerns are raised by scholars and major journal editors about the type and the quality of published evidence, often biased towards efficacy of new products.
This year, similar concerns have been expressed by the editors of The New England Journal of Medicine, commenting that an original article on Vioxx did not accurately represent the safety data available to the authors. Since 2001 Merck has been denying the risk of myocardial infarction, spending around $160 million/year in advertising Vioxx. Merck sent a note to its sales representatives, ordering: "Do not initiate discussions on [this topic]" and instructing them to show doctors asking about Vioxx and myocardial infarction a pamphlet prepared by its marketing department, indicating that Vioxx was associated with reduced cardiovascular mortality (10). Topol concluded: "Sadly, it is clear to me that Mercks commercial interest (...) exceeded its concern about the drug's (...) toxicity" (2). When fighting a pharmaceutical giant, it may not be wise to be so outspoken: While Merck's CEO received over $30 million in bonus and stock options in 2004, Topol was recently fired from his position at the Cleveland Clinic.