Healthcare Reform

Merck’s actions throughout the entire Vioxx affair have been utterly despicable. When the company pulled the drug off the market in September, CEO Raymond Gilmartin claimed that the scientific findings that led to the withdrawal were “unexpected.” Which is like releasing a ravenous wolf into a pen full of sheep then acting surprised that lamb chops are on the menu. Because recently uncovered internal Merck documents show that as far back as 1998 — a year before the drug was even approved by the FDA — the drug giant had evidence indicating that Vioxx was a potential killer.

But instead of going back to the drawing board, the company made the heart-stopping decision to push ahead — using every weapon in its well-funded arsenal to put off regulators, rope in consumers, and keep the bad news from surfacing. They did a masterful job, turning Vioxx into a commercial elixir: Last year alone, sales of the drug totaled $2.5 billion. It was a huge success. Unless you were one of the people who had to be sacrificed for it.

Merck’s CEO also claimed that the company’s handling of Vioxx showed it was “really putting patient safety first.” Which it definitely did — if by “first” he meant right after profits and Merck’s stock price.

Indeed, those internal documents reveal that nothing in the Merck corporate hierarchy was more important than covering the company’s backside. One offers an “obstacle handling guide” for “all field personnel with responsibility for Vioxx.” Another is titled “Dodge Ball Vioxx” and suggests ways Merck salespeople can deal with troubling questions raised by doctors concerned with the safety of Vioxx. The final four pages of the manual each contain a single instruction: “DODGE!” (I wonder if Ben Stiller has heard about this? I smell sequel!)

Merck also exhibited a rare gift for putting negative findings into a positive light. When one scientific study found that Vioxx, while indeed multiplying the risk of cardiovascular complications, caused fewer digestive side effects than other pain relief drugs, the company strong-armed the FDA into displaying the good news about fewer upset stomachs more prominently on the drug’s label than that pesky stuff about more heart attacks. I’m surprised they didn’t try to turn this tidbit into a TV ad: “Sure Vioxx can increase your chances of cardiac arrest, but at least you won’t have an upset tummy when it kills you!”

Speaking of ads, the most loathsome aspect of the whole Vioxx affair is the way Merck used a $500 million marketing campaign to persuade over 20 million Americans to pop its noxious little pill. And company executives continued to run these ads long after they knew that there was big trouble brewing. I’m sure that our evangelical friends in the red states will agree that there ought to be a special place in hell for corporations that show such a wanton disregard for human life.

And if any of this sounds familiar, it should. It’s certainly giving me a profound sense of drug company déjà vu, with the tragic stories of Baycol, Rezulin and Duract still fresh in my mind. How many times do we have to travel down this deadly path — the side of the road littered with bodies and the empty containers of drugs that were approved despite serious questions, and left on the market despite growing evidence of innocent lives being lost?

And after each case come the inevitable calls for accountability and promises to reform the system — promises that are then forgotten until the next killer drug hits the headlines.

During last week’s hearings on the Vioxx scandal, Dr. Graham, while citing an additional five drugs that he feels pose a danger to the public, said that the nation’s compromised drug oversight system had left Americans “virtually defenseless” against killer drugs and warned that we are facing “the single greatest drug safety catastrophe in the history of this country or the history of the world.”

And you thought our biggest problem with pharmaceuticals was President Bush refusing to allow us to get cheap drugs from Canada. Which he laughably justifies because of concerns about the safety of Canadian drugs.

So why don’t things ever change, even as the death toll mounts? As always, the answer can be found by following the money. The big pharmaceutical companies continue to be the 800-pound gorillas of American politics — their power stemming from a muscular combination of lobbying ($150 million a year), campaign contributions (close to $50 million doled out to federal candidates over the past four years) and powerful friends in very high places (Donald Rumsfeld was formerly CEO of drug industry powerhouse G.D. Searle, and Mitch Daniels, the former White House budget director and new governor-elect of Indiana, was a senior vice president at Eli Lilly).

In a 2000 e-mail, Merck’s chief of research called Vioxx’s propensity to cause heart attacks and strokes “a shame.” Something his company clearly lacks. Of course, the real shame is that we continue to have a regulatory system in which corporate greed, political timidity and a culture of cronyism have rendered the public good a quaint afterthought.

Sen. Charles Grassley, the conservative Republican who chairs the Senate Finance Committee that held the Vioxx hearings, lambasted the FDA for being “under the thumb” of the very pharmaceutical companies it is supposed to regulate, saying the agency “has a relationship with the drug companies that is too cozy.” Are Democrats going to sit by while conservatives like Grassley take the moral lead on this issue?

If the Democratic Party is serious about reclaiming the moral values high ground, it needs to stop trying to figure our how to triangulate on gay marriage and take a long hard look in the medicine chest mirror. Then open it up, let fly with the proper moral outrage, and start cleaning out the mess that lies inside. It’s time for Democrats to become the real pro-life party.