The Washington Post, "Painful Withdrawal for Makers of Vioxx; Pulling of Arthritis Drug Raises Questions on Marketing, Safety Risks"

          Backed by a $195 million ad campaign, featuring testimonials from former skater Dorothy Hamill and music by the Rascals to appeal to aging baby boomers, Merck had sold Vioxx to more than 20 million Americans since its approval in 1999 and millions more worldwide.
          An examination of how and why Merck reacted offers an unusual look at how safety issues are handled in clinical trials once a drug is on the market and the complex business of weighing risks against benefits.With Vioxx, researchers had been warning about the drug's possible cardiovascular risks since 2000, only a year after it was approved by the FDA. Data from a company study found then that users had four times as many heart attacks and strokes as those who used another painkiller.
          When the recall occurred, it came about because of a major clinical study sponsored by Merck that tracked 2,600 patients for almost three years to find out if Vioxx helped prevent colon polyps. Merck launched the effort hoping to create new markets for Vioxx, while also laying to rest questions about the drug's connection to heart attacks and strokes.
          Far from it, the trial confirmed the predictions of Merck's harshest critics, who had long complained that the New Jersey manufacturer was closing its eyes to Vioxx's problems and improperly pushing a dangerous drug onto consumers with aggressive ads. Vioxx and other Cox-2 inhibitors like Celebrex had been promoted as wonder drugs, since they provided pain relief to arthritis sufferers without causing stomach problems, but now Vioxx is off the market and the others are under a cloud.
          Cleveland Clinic cardiologist Eric J. Topol, an early critic of the drug, estimates Vioxx may have caused 30,000 to 100,000 heart attacks and strokes, many of them "preventable" because patients could have taken other drugs.