Part Two: The Vioxx Scandal: How Big Pharma Killed More Americans Than Vietnam

Summary

Podcast Summary: Behind the Bastards – Part Two: The Vioxx Scandal: How Big Pharma Killed More Americans Than Vietnam

Introduction to the Vioxx Scandal

In this compelling episode of Behind the Bastards, hosts Robert Evans and Dr. Kaveh Hoda delve deep into one of the most infamous pharmaceutical scandals in history: the Vioxx debacle. Released on December 12, 2024, this episode meticulously unpacks how Merck's aggressive marketing and deceptive practices led to widespread harm, ultimately claiming more American lives than the Vietnam War.

Merck’s Deceptive Practices and the Rise of Vioxx

The episode opens with a critique of pharmaceutical advertising, notably criticizing the use of celebrity endorsements like Dorothy Hamill’s promotion of Vioxx without proper vetting or understanding of the drug's risks. Evans emphasizes the irresponsibility of leveraging trusted figures to market potentially dangerous medications:

"We just shouldn't have pharmaceutical ads like the way that we have them, because you can't. Dorothy Hamill was a great figure skater. Nothing in her life prepared her to adequately vet whether or not Vioxx was a safe medication to advertise." [04:23]

Merck's Vioxx, a COX2 inhibitor designed as a "super aspirin," was heavily promoted as a breakthrough with minimal side effects. However, internal studies revealed significant cardiovascular risks, which Merck chose to obscure rather than address.

Key Figures and Manipulation of Scientific Research

Evans introduces Dr. Jerome Grupman, a Harvard Medical School professor who authored a misleading article in The New Yorker promoting Celebrex, a drug similar to Vioxx. Grupman's failure to disclose conflicts of interest and reliance on anecdotal evidence raised significant ethical concerns:

"He described Celebrex as incredible and told Dr. Grupman that unique among all other medications ever created, it had no side effects whatsoever." [11:42]

Another pivotal figure discussed is Dr. Scott Rubin, an anesthesiologist whose fraudulent research bolstered the false safety claims of Vioxx and Celebrex. Rubin's manipulation of data and publication of 21 falsified studies under Pfizer’s funding highlight the systemic issues within Big Pharma:

"He completely falsified at least 21 of his published papers, all of which claim to show how well super aspirins could benefit postoperative healing." [58:04]

The Legal Battle and Public Backlash

The narrative shifts to the personal story of Carol Ernst, whose husband Bob died of a heart attack linked to Vioxx use. Her pursuit of justice led to a landmark lawsuit against Merck, resulting in a substantial financial verdict:

"In August of 2005, a Texas state jury awarded almost $25 million to Carol Ernst in compensatory damages and more than $200 million in punitive damages." [24:19]

Despite the victory, Merck's defense painted the lawsuit as another example of frivolous litigation, akin to the infamous McDonald’s coffee spill case. This portrayal contributed to public skepticism and backlash against the victims seeking justice.

Impact on the FDA and Public Trust

Evans and Hoda critically examine the FDA’s role, highlighting failures in oversight and the agency's inability to swiftly act on emerging evidence of Vioxx's dangers. Internal Merck communications revealed a blatant disregard for safety in favor of profits, sowing distrust in regulatory bodies:

"Internal Merck analyses in 2000, 2001, and 2002 showed that Merck was worried about lost profits if warnings or precautions were put on its label." [30:25]

Hoda expresses deep concern over the future of the FDA, fearing increased deregulation could lead to more pharmaceutical malfeasance:

"It's terrifying to me to see what's going to happen to our FDA. It's going to be the golden age of diarrhea." [31:26]

Concluding Reflections and Broader Implications

In their concluding remarks, Evans and Hoda reflect on the broader implications of the Vioxx scandal for the pharmaceutical industry and public health. They lament the loss of trust in medical institutions and the enduring impact of corporate greed on patient safety:

"They are trading lives for dollars. The longer they know, the more they get to sell this stuff without a warning is worth it to us, right?" [40:22]

Hoda acknowledges the duality of Big Pharma's role, recognizing their critical contributions to medical advancements while condemning their unethical practices:

"I have a lot of mixed emotions about pharmaceutical companies in general. We need to continue to pick at them, analyze them, be super critical of them, but also be fair about what they can do." [60:24]

Notable Quotes with Timestamps

• Robert Evans [04:23]: "We just shouldn't have pharmaceutical ads like the way that we have them, because you can't. Dorothy Hamill was a great figure skater. Nothing in her life prepared her to adequately vet whether or not Vioxx was a safe medication to advertise."

• Dr. Kaveh Hoda [31:26]: "It's terrifying to me to see what's going to happen to our FDA. It's going to be the golden age of diarrhea."

• Robert Evans [40:22]: "They are trading lives for dollars. The longer they know, the more they get to sell this stuff without a warning is worth it to us, right?"

• Dr. Kaveh Hoda [60:24]: "I have a lot of mixed emotions about pharmaceutical companies in general. We need to continue to pick at them, analyze them, be super critical of them, but also be fair about what they can do."

Conclusion

Part Two: The Vioxx Scandal serves as a sobering exposé of the lengths to which pharmaceutical companies like Merck will go to maximize profits at the expense of public health. Through thorough analysis and poignant discussions, Evans and Hoda shed light on the critical need for transparency, accountability, and stringent regulatory oversight in the pharmaceutical industry to prevent such tragedies in the future.

Transcript

[Robert Evans]

Curious about queer sexuality. Cruising at Expanding your horizons Hit play on the sex positive and deeply entertaining podcast Sniffy's Cruising Confessions. Join hosts Gabe Gonzalez and Chris Patterson Rosso as they explore queer sex, cruising relationships and culture in the new I Heart podcast, Sniffy's Cruising Confessions. Through candid conversations with guests, intimate revelations from their lives and sexpert advice, Sniffy's Cruising Confessions will broaden minds and help you pursue your true goals. You can listen to Sniffy's Cruising Confessions, sponsored by Gilead now on the iHeartRadio app or wherever you get your podcasts. New episodes every Thursday.

[Dr. Joy Hardin Bradford]

This is Dr. Joy Hardin Bradford from Therapy for Black Girls. You know that Amazon has millions of books, so you can find one that gives you just the reading feeling you're looking for. You know, like if you're looking for a relaxed feeling like with a beach read, Amazon has got it covered. Or if you're looking for more of a terrified ah with evil twins or things lurking in the woods or something, Amazon's got you. I mean, even if you want an AW teen romance, Amazon has it covered too. Amazon Books that reading feeling awaits Attention.

[Guardian Bikes Advertiser]

Parents and grandparents Are you searching for the perfect gift for your kids this holiday season? Give the gift of adventure that will last all year long. A Guardian Bike the easiest, safest and quickest bikes for kids to learn on. Kids are learning to ride in just one day. No training wheels needed. What makes Guardian Bikes special? They're the easiest to ride thanks to the thoughtful engineering, lightweight frames and kid friendly components. Kids love how fun and easy they are to ride and parents appreciate the safety features like the patented braking system that prevents head over handlebar accidents. Guardian Bikes are the only kids bikes designed and assembled in the USA factory, ensuring top notch quality and durability. They're built to last and make perfect hand me downs. Make holiday gifting stress free with Guardian bikes with guaranteed one to two day shipping for just $29. You can trust your gift will arrive in time to create magical memories this holiday season. Plus sign up for their newsletter to receive a free bike lock and pop with your first purchase. The perfect stocking stuffer for any kid on your list. Visit guardianbikes.com to secure the ultimate holiday gift today. Happy riding experience Sensational Sound with Vizio's Soundbar Collection Starting at just $99, there's a soundbar for every budget with Dolby Atmos in every model, Cinema quality sound is closer than ever. This collection features Vizio's simp simplest setup yet so you'll be Streaming your favorite iHeartradio playlists in no time. Whether you're looking for a simple setup or the cutting edge elevate SE with 360 degree sound immersion and auto rotating speakers, Vizio has you covered. Head to Best Buy or Amazon to find the perfect Vizio soundbar for you.

[Bartesian Advertiser]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Bartesian Bartesian. It's a home cocktail maker that makes over six 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off. So how about a Cosmopolitan or a Mistletoe margarita?

[Robert Evans]

I'm thirsty.

[Bartesian Advertiser]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Robert Evans]

Feel more seasonal in here already.

[Bartesian Advertiser]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jollier.

[Kaveh Hoda]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartesian. Get $50 off any cocktail maker at bartesian.com cocktail that's B A R T E S I A N dot com.

[Robert Evans]

Cocktail call Z oh, we are back. This is behind the Bastards, a podcast with Dr. Kavehota and Robert Evans, where Sophie is out of the house right now. So, you know, we're just the boys. Just the boys. No girls allowed. Except for the listeners. That's like half our listeners. Please keep listening, ladies.

[Kaveh Hoda]

Sorry.

[Robert Evans]

I'm so sorry.

[Kaveh Hoda]

We're trying to be better. I apologize. We didn't mean that.

[Robert Evans]

We didn't mean that. Just like Merc didn't mean to kill all those people that they're about to kill. Thanks part to utilizing Dorothy Hamill's star appeal. Poor Dorothy. She really did not. Again, it's one of those things where it's like, we just shouldn't have pharmaceutical ads like the way that we have them, because you can't. Dorothy Hamill's was a great figure skater. Nothing in her life prepared her to adequately vet whether or not Vioxx was a safe medication to advertise. What are you. Like, we can't put that on Dorothy Hamill.

[Kaveh Hoda]

No. Part of her training, of her many hours, prepared her to look critically at the data that was available to her. What was available to her. Something that wasn't Even available to her.

[Robert Evans]

She wasn't getting up at four in the morning every day as adolescent girl to have the COX2 enzyme explained to her.

[Kaveh Hoda]

No, that was like me, not her. We had different paths, different chances.

[Robert Evans]

And you're a terrible figure skater.

[Kaveh Hoda]

Not that bad.

[Robert Evans]

Okay. I have never seen you figure skate. I've never seen you figure skate. Can you do a Style Cow maybe?

[Kaveh Hoda]

Sure. Is that like a skateboarding move?

[Robert Evans]

Yeah, probably.

[Kaveh Hoda]

Yeah, I can do it then.

[Robert Evans]

This has been Skate Talk with Robert and Kava, two people who probably don't skate. So when we laughed our heroes at Vioxx, they just latched upon the brilliant idea of having Dorothy Hamill sell Vioxx. If you've been wondering how tens of millions of your fellow countrymen could be convinced to vote for a guy like Trump, just remember that an awful lot of them saw a video of a figure skater promising she knew a solution to their chronic pain issues. And desperate for relief, millions of people followed her to their demise. Like, that really does explain a lot. Now, in fairness, very few people are doctors. It is unreasonable to expect people who are hurting, and in some cases, literally being driven mad by pain to personally overcome the weight of a multimillion dollar ad campaign and all of the science washing that a big pharmaceutical company can do. In fact, during the early years of IAX's success, it would have seemed as if COX2 inhibitors were medical marvels backed by the best science. And it would have seemed that if you were someone who did what should be like, the responsible amount of reading on this subject, not the amount of reading we could expect from a research scientist, because research scientists who were responsible knew the dangers. But if you were, say, a normal, educated person who's like, oh, well, I'm going to read a paper of record and they're reporting on these new drugs written by a medical doctor, interviewing other medical doctors, that's really all you, as a layman should be expected to do to try to deter, like, figure out how safe a medication is. And if you were doing that with Vioxx, you would have walked away misinformed. And this brings us to one of the chief medical merchants of Vioxx, Disinfo, a Harvard Medical school professor named Dr. Jerome Grupman. He had embarked on a career as what you might call a professional semi celebrity doctor, authoring articles from the New Yorker about health and the pharmaceutical industry, which he does today. Dr. Grootman is not someone who you would call LeCrank. He served in the advisory board of the National Heart Lung and Blood Associ. He was the Dina and Rafael Reckonati Chair of Medicine at Harvard Medical School. He'd worked at a high level for the FDA and was a listed author on some 150 papers. One of his books had been adapted into a TV show, Gideon's Crossing, which I didn't expect to run into a Gideon's Crossing reference.

[Kaveh Hoda]

Not familiar with that one.

[Robert Evans]

This episode, it wasn't great. As Tom Nessie writes in the book Poison Pills, even among top level physicians who are generally known as opinion or thought leaders, Groupman stands out. It was no small matter, therefore, when he wrote a lengthy article for the New Yorker in June of 1998 entitled Super New Arthritis Drug Celebra. Celebra was the name for the drug leader known as Celebrex and very close in composition to Vioxx. The article had been carefully authenticated by the famous fact checking department of the New Yorker, which has an almost perfect record of verifying every piece of information the magazine publishes. Like Hamill, Grootman began his discussion of super aspirin with a personal story. He himself had suffered debilitating pain brought on by arthritis developed while training for the Boston Marathon. Despite years of search searching for relief, he had found no satisfactory remedy. Now a remarkable new class of drugs was offering hope to people like him and millions of others. And Groupman provided the anecdotal story of a firefighter from Nebraska whose arthritis had been alleviated miraculously thanks to super aspirin. A responsible scientist would note that the anecdotal evidence was more fit for a pharmaceutical commercial than an article in the New Yorker by a doctor. But Dr. Grupman did speak with other medical experts, like Harvard's Dr. Lee Simon, who had a seat on the FDA's Arthritis Advisory Committee and had been part of an FDA panel to evaluate how to approve super aspirins. This probably shouldn't have been allowed to happen because while he was sitting on that FDA panel deciding how to approve these medications, Dr. Simon was also a paid employee of Searle conducting clinical trials for Celebrex. He did not disclose this conflict of interest. And Dr. Grootman's article did not make any note of this fact that might have compromised a source's objectivity.

[Kaveh Hoda]

That's actually pretty shocking, I have to say, because, I mean, I know it's not a medical journal that he's writing in, but that is like, it's the New Yorker, though. Like, I mean, yeah, you would think he would. He would know. He should know better. Like, that is like if you write anything. I wrote a piece in the BMJ recently and I had to disclose everything, including who I was voting for, you know, in the election. So it's like. And who I donated money to in the election. So that's pretty shocking to me that like, they did not require that.

[Robert Evans]

They didn't require that. It's unclear to me if Grootman knew that Dr. Simon was a paid employee of Searle. But I don't think Grootman is doing as much of his due diligence as he ought to. What Simon is doing is obviously the more shady of the thing, but it's one of those. This is what I say when I'm like you. Really? I just made that comment about like people being led by a figure skater. But like, again, if you're, if you're doing your research, you could still get misled about this stuff, right? Absolutely.

[Kaveh Hoda]

I mean, by a Harvard doctor, I mean, if Covid has done nothing else, it has also raised some doubts about the reputation of places here in the Bay Area like UCSF and Stanford, where a lot of anti vaccine cranks seem to be coming out of. So it's not totally shocking to me that it's Harvard, but I could absolutely see the danger in someone with a name that big. The H bomb you're dropping there. Leading people to believe this in New York must be the intellectual elites to lead them all to believe the safety of it.

[Robert Evans]

Yeah. And Simon's quotes in the New Yorker are. It's one of those things. He's really relying a lot on the fact that he's this fancy Harvard doctor because the shit he is actually saying in this article is shit no doctor should ever say. He described Celebrex as incredible and told Dr. Grootman that unique among all other medications ever created, it had no side effects whatsoever.

[Kaveh Hoda]

Oh, come on.

[Robert Evans]

He specifically stated there are no side effects, which. Those don't exist. You might not experience side effects, but someone will. There's no drug that has zero side effects of any kind. It's not a drug if it's that way.

[Kaveh Hoda]

If I am doing the safest procedure in the world, I am never, ever going to say this is no risk. Because that's like jinxing it.

[Robert Evans]

Why would you do that?

[Kaveh Hoda]

You never do that. It's just stupid and it's untrue.

[Robert Evans]

That is zero.

[Kaveh Hoda]

That is shocking. I mean, this is.

[Robert Evans]

Maybe that's a big old red flag. Wow.

[Kaveh Hoda]

Yeah.

[Robert Evans]

Big red flag. This is, I think, where it gets into like the value of actually Having a higher level of like, kind of medical, like medical. Even training may not be totally the right word, but like in school, because that's the sort of thing it is easy to train people, to have people in general laymen be aware of, like, oh, if I see that, if I see somebody claiming there are zero side effects for anyone of this medication, that's something you shouldn't. That's sketchy, you know.

[Kaveh Hoda]

Absolutely, yeah.

[Robert Evans]

Right. So as Nessie notes, this should have been a massive and immediate red flag, just as we noted. But yeah, Dr. Grootman's article cited other medical experts making similar, similarly dubious claims. He quoted another Harvard professor, Dr. Clifford Saper, as saying, super aspirin might hold the key to treating Alzheimer's. Now this is a case where there was not evidence that it had efficacy treating Alzheimer's. Dr. Saper had a theory that inflammation in the brain caused by injured neurons led to swelling that damaged brains, and that as a result Vioxx might help. Right. And that's a perfectly valid thing to want to test. Right. But you shouldn't go out in an article, be like, this might cure Alzheimer's based on that, because that's just a theory, right.

[Kaveh Hoda]

When it's read by people, understandably, who are gonna then relate it to somebody else, as this is what it does. This is like, we think it does this. And like there's so many steps, there's so many steps, there's years of steps between point A and point B in that.

[Robert Evans]

Yep. And yeah, so quote, Dr. Saper said that Celebrex promised to break open the vicious cycle of inflammation in Alzheimer's. Quite an astonishing statement in and of itself, and even more so since he did not cite results of a single human study yet. The claim is part of an age old school of medical thinking that holds that logic and what makes sense or rational therapy should dictate the practice of medicine. But rational therapy needs to be buttressed by randomized controlled human trials to determine what is and what is not effective treatment. That's from the book Poison Pills. Now, theorizing like Saper did is of course part of the medical process, but maybe not one that should be presented to the public in a widely read article where, like, people who've got loved ones suffering from Alzheimer's are going to be like, oh my God, a miracle drug might be coming through. No, even if it works, it's fucking 15 years out or whatever. Like from, you know. Groupman's article also wildly exaggerated the harms of existing NSAIDs like Motrin and Advil, failing to discuss newer versions that had been approved and came with fewer of the side effects that so called super aspirin was meant to avoid. In his article, Groupman cited the work of Dr. James Fries, a professor at Stanford. At length, Fries himself claims Groupman distorted his research in order to make claims that Fries was not making about COX2 inhibitors. Now, Dr. Grootman was not being bribed by Merck, nor did he violate the law or medical ethics in any way that I'm aware of, other than writing a bad article. He fucked up. And part of why he fucked up was, in my opinion, he was looking to merge developing medical science with magazine pop science in a way that's not wildly different from what Malcolm Gladwell is going to be doing a few years later.

[Kaveh Hoda]

Right.

[Robert Evans]

I think that's irresponsible but not malicious or outright criminal. Right. And we are talking about some people who did outright criminal acts in this. I want to make it clear I am not accusing Dr. Grootman of doing anything criminal. The same can not.

[Kaveh Hoda]

But it's a slippery slope.

[Robert Evans]

It is, it is. You can see why it leads to people doing it.

[Kaveh Hoda]

You know, and I've said this to you before too. It's like, I think in the past, you know, when I was earlier in my medical training in my career, I didn't care that much about things like that. I would probably read it and be like, dude, what is he saying? What does he mean? Ah, forget it and let it go. Not worry about that much. But, but this is how it starts. This is how it starts. It raises enough doubt, it raises enough, it makes it vague enough and makes it cloudy enough that it's hard for people to know what is real and what isn't real. And this is where medical information, like the roots of it begin. It begins in good places sometimes. Like a Harvard doctor.

[Robert Evans]

Yeah, it's the same thing where we have this problem in journalism, right? There's a great movie called Shattered Glass starring Hayden Christensen about a journalist for the New Republic who was like their star reporter, super young. And it turned out all of his stories, he was just making them up like complete bullshit. Literally just inventing people and things in order to write entertaining stories. The New York Times a little bit later had another reporter get blown up, a star reporter for the same thing. Just completely lying about shit, tricking fact checkers. And it's one of those things doesn't have to happen all that often for people to be like, well, these outlets are no better than whatever weird Fucking conspiracy rag INFOW or whatever that I like. And you know what? That's kind of on the journalists for fucking up in that way, right? That's on the newsroom, that's on the editors. That's onto people wanting these big stories that are exciting and that get eyeballs on, right? And here you kind of have the merger of the two, right? The New Yorker wants an article that gets a lot of people to read it because, fuck, this is a miracle medicine that might help me and my loved ones with things that are really causing us problems. And as the doctor you want to be the first, you want to be the doctor who kind of establishes himself as like, I'm kind of on the ground floor of this breaking treatment.

[Kaveh Hoda]

I'm here for people. I'm here for the treatment of people. And there's going to be people who are going to be upset if Celbrex goes away or if these medications go away, because there are people out there who are like, this is the one that works for me.

[Robert Evans]

Yeah, it's fucked. So again, I just made the point that Grootman was not breaking the law. The same cannot be said for the next doctor. We're going to discuss an anesthesiologist named Scott Rubin. Starting in the year 2000, Rubin published what would become 21 papers claiming to show evidence that COX2 inhibitors performed better than non steroid anti inflammatory drugs for patients who'd received orthopedic surgery. Now, the last episode, we mostly focused on Merck, and we will later in this one as the bulk of the blame lies with them. But our old friends at Pfizer don't have totally clean, clean hands. Here. Rubin was largely pushing a line that Pfizer's product Celebrex was a game changer and that it was paired when it was paired with Neurontin and Lyrica, both Pfizer products. Together they safely reduced postoperative pain and could help eliminate the need for dangerous addictive drugs like morphine after surgery. Pfizer funded a great deal of Rubin's research from 2002 to 2007, effectively picking him up after he'd established himself as an expert in the burgeoning field of COX2 inhibitor research. The good news is that in the field Rubin attempted to influence orthopedic surgery, his work had less of an influence than he'd hoped. Most surgeons hesitated to switch to COX2 inhibitors because some very good animal studies showed they slowed the rate at which bones heal. Which is kind of a big deal if you're in the orthopedic surgery business. Wow.

[Kaveh Hoda]

I'm just impressed that the orthopedic surgeons were reading and anything.

[Robert Evans]

Hey O Sorry, sorry. That's my little dig at the surgeons.

[Kaveh Hoda]

It's really the orthopedic surgeons.

[Robert Evans]

Sorry. Speaking of orthopedic surgeons, they don't listen to podcasts, so fuck them. Here's some ads.

[Dr. Joy Hardin Bradford]

This is Dr. Joy Hardin Bradford from Therapy for Black Girls. There are millions of books on Amazon so there's a reading feeling for everyone. So if you're after that excited haha feeling like when you discover you have a lot in common with Vikings or something, Amazon has books for you. Or maybe you enjoy the sort of nervous haha that comes when the hero barely escapes the zombies. Or maybe you like the smug that comes when the villain gets what he deserves. You know Amazon has it all. Amazon Book Books that reading feeling awaits.

[Robert Evans]

Robert Evans here and I know everybody loves a great deal, but I also know most of us aren't willing to crawl through a bed of hot coals just to save a couple of bucks. Saving money has to be easy to be worth it. No hoops, no bullcrap, no sending anything in through the mail. So when Mint Mobile said it was easy to get wireless for 15 bucks a month with the purchase of a three month plan, I had trouble believing it. But it turns out it really is that easy to get wireless for 15 bucks a month. The longest part of the process is the time spent on hold waiting to break up with your old provider. To get started, go to mintmobile.com behind there. You'll see that right now all three month plans are only 15 bucks a month, including the unlimited plan. All plans come with high speed data and unlimited talk and text delivered on the nation's largest 5G network. You can use your own phone with any Mint Mobile plan and bring your phone number along with all your existing contacts. Find out how easy it is to switch to Mint mobile and get three months of premium wireless service for 15 bucks a month. To get this new customer offer and your new three month premium wireless plan for just 15 bucks a month, go to mintmobile.com behind that's mintmobile.com behind $45 upfront payment required equivalent to $15 a month. New customers on first three month plan only speed slower above 40 gigabytes on unlimited plan. Additional taxes, fees and restrictions apply. See Mint Mobile for details.

[Guardian Bikes Advertiser]

Attention parents and grandparents. Are you searching for the perfect gift for your kids this holiday season? Give the gift of Advent adventure that will last all year long. A Guardian Bike the easiest, safest and quickest bikes for kids to learn on Kids are learning to ride in just one day. No training wheels needed. What makes Guardian Bikes special? They're the easiest to ride thanks to the thoughtful engineering, lightweight frames and kid friendly components. Kids love how fun and easy they are to ride and parents appreciate the safety features like the patented braking system that prevents head over handlebar accidents. Guardian Bikes are the only kids bikes designed and assembled in a USA factory, ensuring top notch quality and durability. They're built to last and make perfect hand me downs. Make holiday gifting stress free with Guardian bikes. With guaranteed one to two day shipping for just $29, you can trust your gift will arrive in time to create magical memories this holiday season. Plus sign up for their newsletter to receive a free bike log and pop with your first purchase. The perfect stocking stuffer for any kid on your list. Visit guardianbikes.com to secure the ultimate holiday gift today. Happy riding experience Sensational sound with Vizio's Soundbar Collection starting at just $99. There's a soundbar for every budget with Dolby Atmos in every model. Cinema quality sound is closer than ever. This collection features Vizio's simplest setup yet, so you'll be Streaming your favorite iHeartradio playlists in no time. Whether you're looking for a simple setup or the cutting edge elevate SE with 360 degree sound immersion and auto rotating speed, Vizio has you covered. Head to Best Buy or Amazon to find the perfect Vizio soundbar for you.

[Bartesian Advertiser]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan Partisan. It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off, so how about a Cosmopolitan or a Mistletoe Margarita?

[Robert Evans]

I'm thirsty.

[Bartesian Advertiser]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Robert Evans]

Feel more seasonal in here already.

[Bartesian Advertiser]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jollier.

[Kaveh Hoda]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker. Get $50 off any cocktail maker at bartisian.com cocktail that's B A R T E S I A N dot com cocktail.

[Robert Evans]

And we're back. If you're an orthopedic surgeon, hit me up. I got too many bones. I could use a couple less. Probably so. Rubin's work formed an influential mass of positive seeming scientific PR arguing in favor of drugs like Vioxx and Celebrex as safer super aspirins. An article in Scientific American Notes A 2007 editorial in Anesthesia and Analgesia stated that Rubin had been at the forefront of redesigning pain management protocols through his carefully planned and meticulously documented studies.

[Kaveh Hoda]

Did he say that himself? He called his own studies machine?

[Robert Evans]

No, no, that's what an editorial to how the editors of the paper described him.

[Kaveh Hoda]

I see.

[Robert Evans]

And there's only one problem with these carefully the 20 or so carefully planned and meticulously documented studies that he had authored over a 12 year period. They were all complete bullshit, fraudulent in every way. Now we will talk more about Rubin later because a lot of his story occurs after the collapse of Vioxx. But it's important to note that just as Pfizer underwrote Rubin's shoddy research, Merck had deeply questionable science that they funded in an equally dubious way. Back during the FDA approval process, Merck had launched a strategy called Advantage in all caps because it was a very tortured acronym assessment differences between Vioxx and Naproxen to ascertain gastronomical tolerability and effectiveness. An by the Union of Concerned Scientists describes the goal of Advantage as using flawed methodologies, bias towards predetermined results to exaggerate the drug's positive effects. As part of their strategy, scientists manipulated the trial data by comparing the drug to Naproxen, a pain reliever sold under brand name such as Aleve rather than a placebo. And yeah, we covered that a little earlier, but what's important is that we now know that Vermeerk had a great deal of evidence when they were pushing this study suggesting that Vioxx massively increased the risk of cardiovascular events. Which makes the case that this was not just something where they did a bad study and put this thing next to Naproxen and it looked less risky than it does because it was next to Naproxen. They conducted that study with Naproxen because they had data showing that Vioxx massively increased the risk of heart attacks and they were deliberately trying to hide that. Right. This is all stuff that came out later as a result of the Senate investigation and numerous court cases. So yeah, we know that Merck had a lot of evidence showing this was dangerous and they deliberately hit it. And we know that this was incredibly profitable for Merck. From 1999 to 2004, Vioxx made them two and a half billion dollars a year on average. It swiftly became the best selling drug in Merck history and one of the best selling drugs of all time. And just as swiftly, it started to kill people. One of the first to die was Bob Ernst. He was a fit 59 year old triathlete who started taking Vioxx because of recurrent arthritic pain in his hand. His wife Carol had urged him to try Vioxx after seeing an ad and Bob had gone on the medication. On May 6, 2001, the two had an anniversary date at an Olive Garden in ke, Texas. Bob passed away in his sleep later that night, dead from heart failure. Now, Bob had been in very good shape, but the death of a 59 year old man from heart failure is simply not the kind of thing that most pathologists are going to consider super suspicious. It was Carol herself who got suspicious and started digging into Bob's one medication. This is the only thing he was prescribed, Vioxx. Even as early as 2001, there were studies showing that Vioxx was bad for heart health. Merck had successfully buried many of them, but there was still stuff that you could find with enough digging online. And that's exactly what his wife did. She found a lawyer, Mark Lanier, who made to take her case. And the book Poison Pills does a wonderful job of chronicling the work that they did. I'm going to have to give you a summary here, which is that In August of 2005, a Texas state jury awarded almost $25 million to Carol Ernst in compensatory damages and more than 200 million in punitive damage. Now that latter verdict was lowered quite a bit due to a Texas law, but it would be fair to call this a massive victory against Merck. And much of the case against Merck hinged on the fact that In June of 2000, Merck had provided a tranche of early user data to the FDA that revealed Vioxx users had four times as many heart attacks as people on naproxen. They didn't state this though. This was in the data. You could find it if you analyze the data, but it was not in any of the conclusions that like Merckx sent along to the fda. And the FDA really just didn't do the work to like figure this out very quickly. And so it wasn't until 14 months later, in April of 2002, that the FDA actually forced through changes and how Vioxx was labeled to reflect the evidence of risk, Merck took no action on their own to warn users about the fact that they knew that Vioxx was causing heart attacks. Now, in the later trial that would develop from all this, CEO Raymond Gilmartin would claim that Vioxx wanted to add a warning label the instant they were aware of the danger. This was a lie. As Cope and Berry write in their article Merck and the Vioxx Debacle. Lanier, that's the lawyer, introduced in the Ernst trial internal Merck documents which reveal that Merck resisted the FDA's efforts to add warnings to Vioxx's label and eventually complied in ways that the Ernst jury found obscure. You had to dig three levels to see it, one juror stated. In March 2000, when Merck became aware of the VIGOR study's findings of a significant increase in cardiovascular events for those taking Vioxx over Naproxen, Merck scientists expressed concern. In an email message written In March of 2000, Dr. Edward Skolnick, who was then Merck's head of research, stated the Vigor clinical trial had shown that Vioxx increased heart risks. The CV events were clearly there, he wrote. Despite clear warnings, Merck decided against conducting studies on the heart attack risks because marketing executives worried it might hurt Vioxx sales. Internal Merck analyses in 2000, 2000, 2001 and 2002 showed that Merck was worried about lost profits if warnings or precautions were put on its label. During that period, Merck was in private negotia with the FDA over changes to its Vioxx label. David Anstis, who at that time was the president of Merck's human health division, projected that a strict warning would reduce sales by at least 50% after the VIGOR study findings in March of 2000. A second internal Merck analysis performed in October 2000 showed a significant increase in cardiovascular events for those taking Vioxx. The Merck analysis, plaintiff's attorney Mark Lanier has argued, was never presented to the FDA nor the media, and certainly was not given to the physicians prescribing Vioxx. So this is entirely the marketing team and the CEO coming in and saying, like this will cut profits, so bury it as long as you can. Every additional year we get to sell this stuff without a warning is worth it to us, right? Whatever number of deaths there are, the money this is bringing in is so huge, like it's fine, right? That's literally a decision being made.

[Kaveh Hoda]

You know, it's like the, what's interesting to me is looking at these things is what could the FDA have done better in some of these circumstances? It's hard because some of the information is just not being given to them in what seems like a very fraudulent manner. But they need to have the power, they need to do certain things. When a drug is first approved, there's still a lot of unanswered early safety questions because for most of the studies that are getting them approved, there's like maybe 2 to 4,000 at most patients in a study. Sometimes oftentimes that's not enough to see the safety evidence and what risks are associated with it. So the FDA has to be there pushing to see more data, making sure that it stays safe. Once those numbers come out, they need to be there to do the post marketing studies. It's interesting to me to see, it's terrifying to me to see going back to what's coming in the future, what's going to happen to our fda.

[Robert Evans]

Oh God, yeah.

[Kaveh Hoda]

And how deregulated it's going to become and to see what they're going to be able to accomplish. It's going to be, I mean, I hate to say it, but I think we're going to see more drug induced injuries than ever before because more medicines are going to be coming out and fewer of them are going to have the post marketing studies to prove it.

[Robert Evans]

And that's what's fucking scary, right? Is that like we're talking, this is a massive failure by the FDA too. That happened when it was funded, right? We can argue should have been funded more, but that happened in a period totally different from the one we're entering into now. What kind of shit is going to come by now that there's no guardrails on any of this stuff? These fucking MBAs who are managing all of these pharmaceutical companies and these marketers have absolutely no restrictions. Anything that they can shovel into people's faces to make a profit. Profit.

[Kaveh Hoda]

It's funny, I'm like, you know, I get a lot of shit online for being like a pharma shill because like, you know, I promote vaccines like, because they work and they're great. And you know, I can go into that in great detail if you like. But like the funny thing is the people, those people who are so against drug companies, so few of them are against drug companies for the right reason, for reasons like this, you know, when there's real reason to Be mad about pharmaceutical companies. More people are upset about like the vaccines that have come out with good data behind them and with good studies in the limited amount of time that they're able to do. You know, it is hard. It's hard for me to wrap my brain around that how I have to be the one defending the pharmaceutical companies. And I'm as skeptical of them as anybody because of shit like this in stuff we've seen like this.

[Robert Evans]

And it's. Yeah, it's just fucking. I mean, what's coming is gonna be sick, folks, in a very literal term. But what happened in the past was pretty sick too. So it took about four years for the Carol Ernst legal case to wind on against Vioxx. Right. From her realizing there was probably something wrong with her husband's medication to actually getting a victory, which is actually pretty quick for one of these lawsuits.

[Kaveh Hoda]

Yeah.

[Robert Evans]

The company continued to push the mountain of disinformation during this time about their new star medications. Dange. One February 2001 sales memorandum forbade sales reps from discussions on a study that raised heart concerns when they talked to physicians. Right. Can't talk about this study about heart attacks from our medication when you sell it to doctors. Salespersons were also ordered to avoid discussing heart health risks and instead hand over a cardiovascular card to physicians which said Vioxx is protecting the heart rather than potentially harming it. That ought to take care of all of their questions.

[Kaveh Hoda]

Oh, good, you gave me a card.

[Robert Evans]

Well, you guys got card money? There must be nothing wrong with this stuff. No one shady can afford this kind of embossing. My God, look at that.

[Kaveh Hoda]

It's okay, guys. They gave me a card.

[Robert Evans]

The Ernst lawsuit was not the first or last against Merck. Most were brought by survivors of heart attacks or more often, the family members of people who had perished. Perished. Merc upped their game, as this passage from Colpenberry's article makes clear. Merc prepared an in house training game for Vioxx sales representatives dubbed Dodgeball. Sales trainees could only move on to the next round of the card game if they gave Merc approved answers to doctors questions raising Vioxx safety concerns or dodged such questions altogether.

[Kaveh Hoda]

Wow.

[Robert Evans]

Dodgeball. They're literally playing dodgeball with their death meta. They have questions about their death medicine.

[Kaveh Hoda]

It is death medicine. It is interesting the way they train their reps. They train them to deal with different types of doctors. They are very smart. They recognize that there's four or five different types of doctors and they range from the owl, which is the name they'd give one in their training sessions, which is the guy you want to avoid, the person you want to avoid, because they're going to ask the more detailed questions, they're going to keep drilling to get the answers. And then the one they love are the ones they call the peacocks, which you just have to kind of stroke their feathers. Tell them they're pretty and smart, and those are the ones that are going to sell your medication. I mean, they know the psychology of doctors very well, probably better than doctors do. So the pharm reps, it's changed maybe a little bit, but this was like the most evil time of the farm reps, when they had the most power and doctors were the least prepared to deal with.

[Robert Evans]

Right, right. It's also this kind of like there's less of an inbuilt, like immunity within the medical community because you guys weren't used to being sold to this way. Yeah, it's like when they first started getting Americans hooked on cigarettes and people had never seen an advertisement before and they're like a cowboy. Well, I'm buying a cigarette now. So a later congressional inquiry found that Merck leadership divided the studies on Vioxx into approved and background studies. And any study that showed a danger to heart health was consider background study. And so their salespeople were forbidden to discuss them with doctors. This was a violation of company policy. Now, all through 2001 and 2002, the FDA sent letters to Merck poking at it for failing to properly disclose the dangers of Vioxx. But it still took again, 14 months for any sort of labeling change to be mandated. Part of why is that officials within the FDA were in the tank for Merck. Not all of them, but enough. At later Senate committee investigations, an FDA scientist testified that he had brought forward concerns about Vioxx, his superiors, and been pressured to shut up. Another researcher who had gone to the FDA with complaints was Gurkan Paul Singh, a Stanford professor who claimed that a Merck senior executive complained to his superiors at the university when he reported Vioxx to the fda. Singh claimed, I was warned that if I persisted in this fashion, there would be serious consequences for me because, of course, Merck has the ability to donate a lot of money to a university like St. Stanford. Now still, some brave academics continue to blow the whistle, as this paragraph from a New York Times article by Alex Berenson, Gardner Harris and Barry meyer summarizes. In 2001, the first major study critical of the drugs appeared in the Journal of the American Medical Association. The report, written by Eric J. Topol and cardiologist at the Cleveland Clinic, reanalyzed data from several clinical trials of Vioxx and Celebrex. It reported that both drugs appeared to increase the risk of heart attack and stroke, but that the danger from vioxx appeared higher. Dr. Tapol, the chairman of the clinic's department of Cardiovascular Medicine, immediately called for trials to determine whether or not the drugs increased cardiovascular risk. Merck and Pfizer both rebuffed that request and said that the Cleveland Clinic report was flawed because it failed to do, among other things, to include data from other studies. Dr. Tapol became a harsh critic of both drugs, but his ire focused on Vioxx, Merck even before his 2001 report appeared. He said in a recent interview that company scientists came to Cleveland to try to convince him not to publish it. Merck officials denied doing so. A year later, a study by Dr. Wayne Ray, an epidemiologist at Vanderbilt University, found that Medicaid patients in Tennessee who were taking high doses of Vioxx greater than the recommended long term dosage of 25mg daily had significantly more heart attacks and strokes than similar patients who were not taking high doses.

[Kaveh Hoda]

So back when Alex Berenson used to write useful things.

[Robert Evans]

Yeah, it's okay. His career has moved forward now he doesn't have to do that anymore. I don't know. It's all pretty bad, right? It's terrible. There's a degree to which at least you can see these heroes who tried to do something. Even though your university is telling you stop. Merck is sending scary guys to your door to be like, are you sure you want to publish that study?

[Kaveh Hoda]

Yeah, yeah, it is. It is funny. Like, I didn't realize until this how slow moving a car wreck this was.

[Robert Evans]

Yes.

[Kaveh Hoda]

Like, this has been. There's a whole thing. It's been happening for a while. It's. I didn't realize that it is so much. It's more nefarious than I expected.

[Robert Evans]

Yeah, well, because Merc, like, there's no argument. They don't know exactly what they're doing. They are trading lives for dollars. The longer they know. Avengers. Eventually we'll have to stop selling this stuff because we know how dangerous it is. But every day we get to keep selling it. We're recouping that investment. We're making a profit. And whatever we have to pay out in the end is going to be less than what we're making.

[Kaveh Hoda]

I wonder how they justified it to.

[Robert Evans]

Themselves if they did Money, money, money.

[Kaveh Hoda]

I know. And your listeners are like, what the fuck is wrong with this guy? What kind of. Does he not listen to the show? Does he not understand? Understand? But I mean, like, I feel like everybody thinks, baby, but like, these farm. Like the people of the head of this farm company, they're doing this now how, like, is. Are they lying to themselves in some way? And what lie is that that they're telling themselves? That's the part I don't understand.

[Robert Evans]

They know who to lie to and not. They're lying, I think, to a lot of the doctors and to some of the salespeople. You know, salespeople don't maybe know how to analyze whether or not this is a good study or whatever. So they're just like, oh, those other studies that showed a danger. They're not good for this reason or that reason. And you're just some fucking sales rep that got hired out of college. Maybe you don't really give that much of a shit. But there are people, plenty of people, who know exactly what they're doing. And those people who know exactly what they're doing just don't care. They don't feel bad about the fact that they're getting people killed. Right.

[Kaveh Hoda]

There's just like in every episode I do, there's like this one moment where I turn to you and I'm just like, robert, why do bad people do bad things? I just don't understand it. I'm so dumb in that way. My brain doesn't.

[Robert Evans]

Yeah, I mean, it's not dumb. You just aren't. You just have a soul. And I'm working to get rid of it. Yeah, well, that's. That's the only thing that's going to let us win. We all have to get rid of our souls today. Which, by the way, I've got a great new medication for getting rid of your souls. First step, you're going to go to your local. Not a local gas station, actually. You want to go to a truck stop about 30 or 40 minutes outside of town. If you can actually see people, if there's more than a half dozen rigs parked outside, that's probably a good truck stop. And you're going to go in there, and behind the counter, there should be a wall of pills. And you're just going to ask for all of them. And you pour that into a cup. And this is critical, you mix it in with Mountain Dew Code Red, not Baja Blast. That'll fuck it up. Do not mix Baja Blast in Mountain Dew Code Red. And then Shoot that shit as fast as possible. And that's going to get rid of your soul. And then you're ready to join us on the front lines fighting the demons.

[Kaveh Hoda]

Don't do that, people.

[Robert Evans]

You'll also be able to see demons. That's a promise.

[Kaveh Hoda]

Yeah, you're going to see some shit.

[Robert Evans]

You're going to see some demons. Yeah, all of that fucking ibogaine or whatever the fuck they put those in, those pills, those random trucker pills that they just. They all. They almost call them Adderall, but not quite.

[Kaveh Hoda]

I want to go check it out now. I mean, I live in San Francisco, so we don't have like, you know, 40 minutes outside of town is like another town. So I gotta like, go pretty far.

[Robert Evans]

You gotta go down the five to that place that sells split pea soup and then. Yeah, yeah, yeah. You can find interesting pills there. Yeah, yeah.

[Kaveh Hoda]

All right, I'm going to do it, actually. I think this is a good day trip.

[Robert Evans]

Yeah, this will be good. Let's go do it together. We'll buy all the trucker pills and we'll see how they work.

[Kaveh Hoda]

Can we livestream that? I think that would be a good thing.

[Robert Evans]

Oh, yeah. Oh, yeah. So in late September 2004, as the death toll mounted and Merck's legal team was buried in cases, they made the decision to pull Vioxx off the market altogether. This is right after the case has been decided against them. There is no longer keeping this cat in the bag. And now it's about damage control. Their official justification was that they just had a long term clinical trial which showed that some patients developed cardiovascular problems after taking the drug for 18 months. The data showed 15 heart attacks, strokes or blood clots per thousand people over three years, compared with seven and a half cardiac events in the general population. And even if you believe this Merck study, which I think is kind of trying to pad how bad it is, that's still much worse. That's still a real no problem. The stock market reacted first, costing Merck somewhere in the neighborhood of $26 billion in a day. But that's not real money. They get it back. You know how the stock market works. The next reaction came from the families of people who died due to Vioxx, leading to a rush of new lawsuits. But the initial public reaction was beyond muted. It was, in fact, downright hostile to the victims. And this likely has something to do with a particularly toxic aspect of US culture I call scalding McDonald's coffee syndrome. Now, you've probably heard the story about the woman who had a hot coffee spill in her lap at a McDonald's drive through and she sued them and got a bunch of money. This is a thing that especially when I was younger, I think more people know the real story now, but you would see viral memes all the time. You'd see it in like newspapers. You know, it was really a thing like my parents generation loved to hate on. It was particularly a big thing for like conservatives who were angry at how mean all these frivolous lawsuits hurting innocent corporations. Like this woman spills coffee in her own. And like the reality was McDonald's had the coffee way higher than they were legally allowed to have it. They should not have been selling or handing people coffee that hot. And it gave her third degree burns to like her entire genital area. Like it was a hideous, hideous life altering injury that she suffered because they were not doing what they legally should have been doing. Anyway, we don't need to rant on this, but at the time this happens, a lot less people realize the true story there. And so there is this big backlash against frivolous lawsuits against companies. And the Merck Vioxx lawsuits initially get lost in that right When Carol von Ernst won her case against Merck, a lot of pundits of the day kind of loop this in with the McDonald's coffee case as another example of our sue happy culture run amok. From the book Poison Pills, Carol Ernst lawyer Mark Lanier was blasted by everyone from physicians to newspaper columnists for winning the trial by twisting the facts and relying on nothing but an ignorant jury of hicks, despite the fact that his witnesses included some of the best known physicians and scientists in the world. Even as the Texas jury was deliberating, Merck's lead attorney, Jerry Lowry, said if he had any evidence Vioxx causes arrhythmia, this case would have been over. Three weeks ago. A few months after the trial verdict, CNBC broadcast a debate between Lanier and Richard Epstein, the James Parker Hall Distinguished Service professor of Law at the University of Chicago and a senior fellow at the whole Hoover Institute. The professor had written an op ed piece for the Wall Street Journal and said that physicians lamented the fact that they could no longer use the drug. Many leading newspapers, including the Washington Post, also mocked the Ernst trial. In an editorial entitled the Vioxx Hex, the Post wrote that the Texas jury in that case awarded $253.4 million to the widow of a man who died of a heart attack triggered by arrhythmia, which is not a condition Vioxx has been proven to cause. The Post said the jury was confused about the medicine evidence. And this is number one, that fucking dude debating Lanier on stage as a Hoover Institute guides right wing think tank. But number two, you've got all these like big publications going like, oh, these, it's a Texas jury. So clearly they're hicks. They don't understand our big city science. They just got bamboozled by this smooth talking lawyer who just hated Merck. It's so fucked up.

[Kaveh Hoda]

You're totally right. It was like this era where it was like people like, there has to be personal accountability for this. Like they should have known that there was a small risk with medications and they, I mean they're missing the point which was that the risk was obfuscated in the beginning, I think. I mean it sounds like, to be honest with you, it still, at some point they look back at these medications and they said, you know what, there might be a role for them. And they're actually, you know, very well could be a good use for some of these meds.

[Robert Evans]

Celebrex still has some uses and stuff, right?

[Kaveh Hoda]

I mean even, even Vioxx could have had specific uses for very well chosen patients. And they'll never get to that. Those patients will never get to that. They'll never get to have that benefit of a medicine that could actually work. Because again, instead of all the money going into research development, figuring out exactly who benefits and who gets harmed from it and who should have it and who shouldn't, they spent all their money and energy in finding ways to sell it and for as long as possible. And they painted themselves into a corner at the end and they couldn't at that point then say, okay, well actually only these small set of people should use the medication because the risk is then worth it in the small subset. But they couldn't do that. They had to withdraw completely. So it's just so stupid on so many levels. It's so, and it's such a waste and it's a waste of all the time and effort that went into making the medication again, again too, because again, the concept behind the medication, looking at COX2 inhibitors, looking at ways to selectively attack those pain, the pain pathways shut down the pain pathways before they cascade into inflammation and pain. It's all smart, it's good. And now to my knowledge, I don't know if people are even thinking about this anymore and we still have problems with NSAIDs. NSAIDs still cause problems. Lots of health problems still come from Advil, Alivrophone. They still cause me headaches because I have to go and take care of people bleeding because of them. They cause heart issues, kidney problems, liver problems, like people should be. We should be researching new pain medications and worrying about how to do that. Right, as opposed to how to make as much money off of it as possible. But that's not where we are. It's not who we are. So I don't know why I'm saying this. I'm just.

[Robert Evans]

No, I mean it's all very frustrating, right? The way that this worked is just comprehensively bad for everybody but a handful of people at the top of Merck. It's bad for the research scientists at Merck who were not shady motherfuckers who will always exist under a cloud of suspicion because they worked during the Vioxx era. It's bad for the people who might have benefited from a Vioxx that was rolled out in a more reasonable way to a smaller subset of people. It's bad for all of the tens of thousands of people who lost loved ones and the people who had life altering injuries as a result of it. That it's just terrible for everybody. But you know, Dr. Hoda, what's not terrible for anybody?

[Kaveh Hoda]

What's that?

[Robert Evans]

Products and services that support this podcast, all of which have been FDA approved. And if we've learned anything this episode, that always means good.

[Kaveh Hoda]

Good.

[Dr. Joy Hardin Bradford]

This is Dr. Joy Hardin Bradford from Therapy for Black Girls. There are millions of books on Amazon, so there's a reading feeling for everyone. So if you're after that excited haha feeling like when you discover you have a lot in common with Vikings or something, Amazon has books for you. Or maybe you enjoy the sort of nervous haha that comes when the hero barely escapes the zombies. Or maybe you like the smug that comes when the villain gets what he deserves. You know Amazon has it all.

[Guardian Bikes Advertiser]

Amazon Books that reading feeling awaits attention parents and grandparents. Are you searching for the perfect gift for your kids this holiday season? Gift Live. The gift of adventure that will last all year long. A Guardian Bike. The easiest, safest and quickest bikes for kids to learn on. Kids are learning to ride in just one day. No training wheels needed. What makes Guardian Bikes special? They're the easiest to ride thanks to the thoughtful engineering, lightweight frames and kid friendly components. Kids love how fun and easy they are to ride and parents appreciate the safety features like the patented braking system that prevents head over handlebar access. Accidents. Guardian bikes are the only kids bikes designed and assembled in the usa. Factory ensuring top notch quality and durability. They're built to last and make perfect hand me downs. Make holiday gifting stress free with Guardian bikes with guaranteed one to two day shipping for just $29, you can trust your gift will arrive in time to create magical memories this holiday season. Plus sign up for their newsletter to receive a free bike lock and pop with your first purchase. The perfect stocking stuffer for any kid on your list. Visit guardianbikes.com to secure the ultimate holiday gift Gift today. Happy riding experience Sensational sound with Vizio's Soundbar Collection Starting at just $99, there's a soundbar for every budget with Dolby Atmos in every model. Cinema quality sound is closer than ever. This collection features Vizio's simplest setup yet, so you'll be Streaming your favorite iHeartradio playlists in no time. Whether you're looking for a simple setup or the cutting edge elevate SE with 360 degree sound immersion and Autorot rotating speakers, Vizio has you covered. Head to Best Buy or Amazon to find the perfect Vizio soundbar for you.

[Bartesian Advertiser]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan Partisan. It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off, so how about a Cosmopolitan or a Mistletoe margarita?

[Robert Evans]

I'm thirsty.

[Bartesian Advertiser]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Robert Evans]

Feel more seasonal in here already.

[Bartesian Advertiser]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jollier.

[Kaveh Hoda]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartisian. Get 50 off any cocktail [e-mail] cocktail that's B A R T E S I A N dot com cocktail the 2004 NASCAR Cup Series championship was won in dramatic fashion. Well, they changed right side tires. Only the entire wheel came off. But what happened throughout the year is what makes it one of NASCAR's biggest seasons. Hear all the stories on NASCAR Live presents 2004 Chasing History. But he climbed up on the pit.

[Robert Evans]

Box and someone came over and got a hold of him. And then it was on NASCAR Live.

[Kaveh Hoda]

Presents 2004 Chasing History. Listen today in the iHeartRadio app or.

[Robert Evans]

On your favorite podcast platform. And we're back. So we're drawing to a close in this episode, and I have a question.

[Kaveh Hoda]

Did they actually lose money overall from this? How much do we know? How much?

[Robert Evans]

No, no, no, no, no. They pay, in total, a little less than a billion dollars in penalties and additional civil settlements for their victim. They are making two and a half billion dollars a year during the period of time where they're selling this.

[Kaveh Hoda]

And it's out for five years.

[Robert Evans]

Something like five years. Yeah.

[Kaveh Hoda]

Yeah. Okay.

[Robert Evans]

Yeah, so that's cool. Now, one of my favorite side parts in this story is that the Washington Post takes, like, a huge, strong stance to defend an unethical megacorporation and got something wrong, which is not a thing that ever happens again. Anyway, about a year after the Post's article talking about how unfair it is to sue Merck, Harvard School of Public Health issues a Public Health Bulletin warning that Vioxx use was associated with severe heart rhythm disorders and an increased risk of kidney failure. More research comes out in the following years that further vindicates everyone who tried to warn Merck and the world about Vioxx, the medication that had been prescribed to some 20 million people in 80 countries by the time it was polled. We will never have a comprehensive list of the number of people killed and injured as a result of Vioxx, but what we do know is harrowing. Dr. David Graham, the Associate Director for Science and medicine in the FDA's Office of Drug Safety, testified before the Senate Finance Committee that Vioxx had been associated with at least 100,000 heart attacks and more than 55,000 premature deaths, that is in the United States. He compared the cost to two to four jumbo jetliners crashing every week for five years.

[Kaveh Hoda]

Holy shit.

[Robert Evans]

Yeah.

[Kaveh Hoda]

Striking imagery.

[Robert Evans]

Yes. That's. That's a lot of dead people.

[Kaveh Hoda]

God.

[Robert Evans]

Mm. Now, the lawsuits that resulted from this are far too numerous to chronicle, save to note that Merck initially promised to fight each of the 30,000 lawsuits against them independently. We'll fight everyone. Then they agreed in 2008 to provide what could have been almost 5 billion as part of the settlement. But I don't know how much of that they actually paid out. And then they pled guilty to a misdemeanor for illegal promotional activity. That was about another 950 million in penalties and civil payments. So they wound up paying a good amount of money. That's like. They lost a good two years or so of the Profits that they made.

[Kaveh Hoda]

Did Dorothy Hamill do any time?

[Robert Evans]

No. No. Dorothy Hamill does not go to prison for her many skating free many crimes. They do plead guilty to a misdemeanor for introducing a misbranded drug to interstate commerce. So that's nice. But no one at Merck is locked up for what they did. Nor do any of the scientists who'd agree to help cover up studies or push disinfo suffer lasting career harms, with the notable exception of our friend Scott Rubin. Paul White, the editor at the Journal of Anesthesia and Analgesia, claims that Rubin's study showing the benefits of COX2 inhibitors helped sell billions of dollars worth of both Celebrex and Vioxx. In 2009, he was revealed to have completely falsified at least 21 of his published papers, all of which claim to show how well super aspirins could benefit postoperative healing. Pfizer had funded Rubin's work from 2002 to 2007, the years when they were also making bank on a little medication called Celebrex. His employer, Bay State Medical center, claimed to Scientific American that Rubin had been paid directly by Pfizer for his work and that he had then decided how much of that money would fund research and how much would go into his pocket. Which sounds fine. That's not sketchy. There's nothing. How could that lead to anything?

[Kaveh Hoda]

Bad, man. You know, it's giving anesthesiologists a bad name.

[Robert Evans]

It is, it is.

[Kaveh Hoda]

And these are guys who deal with a lot of fentanyl, so that is wild. That is. Well, I am actually. I would love to read his article. Articles that are totally fabricated.

[Robert Evans]

Oh, yeah, there's some good breakdowns on them from scientists who are more qualified than me to talk about it. It's a fascinating story. One of my favorite quotes from this is that his employer base date when people would note that that's not how pharmaceutical. You're not just supposed to give a single guy cash. That's not how pharmaceutical research is supposed to be done. A spokesman for Bay State Medical center told Scientific American, I don't know how many dollars went to Rubin or his group. Wow. No idea.

[Kaveh Hoda]

Holy hell.

[Robert Evans]

A Pfizer spokesperson insisted the grants were properly disbursed to Bay State in accordance with Pfizer policy, but that they weren't familiar with the records retention policies of Bay State. So who knows? Who knows how much money? Between 10 and $100,000, at least. But he was actually asked to pay $360,000 in Restit. He got sentenced in 2010 after pleading guilty of massive fraud. Prosecutors argued that he'd been paid huge money in grants and never performed the studies he'd been paid to conduct. He just pocketed the cash and published lies about Celebrex. Thankfully, justice was done. He was given six months in prison and asked to pay 360,000 in restitution to the pharmaceutical companies who'd sponsored his work. The real victims in all this.

[Kaveh Hoda]

Holy shit. Actually, I mean, he did some time. That's something. I mean, I do know doctors that's gone to actual prison for, like, Medicare fraud and that sort of thing, like, done actual time. It's not common, but, you know, it can certainly happen. I mean, the things I'm seeing are there. It's always fraud related, you know, and actually, six months isn't as long as I've seen other people go for what I kind of consider to be lesser crimes, but they weren't crimes committed directly against the American government and Medicare fraud. So that's probably why he only got six months.

[Robert Evans]

Yep. Yeah. And that's the story of IOX. Dr. Hoda, how you feeling? How you Good.

[Kaveh Hoda]

I mean, you know, I. Again, it comes down to, like, I'm always a little torn when I do episodes or talk about how terrible pharmaceutical companies are, because they are terrible, and I have so many problems with them. But there's always a part of me that's like, they are super important at the same time, and. And we do need them more than ever to be really focused on important world health issues and infectious diseases. And the problem is the things I really care about, the things I think are really important, are not necessarily things that they're gonna make money off of, and they just don't really care. So I'm very torn. I have a lot of mixed emotions about pharmaceutical companies in general. And it bothers me when people. People assume that I am, like, pro pharmaceutical company because I hate them more than anybody, really. I mean, I really do. But at the same time, we do need their help. Unless we get more scientists like Dr. Peter Hotez, who's, you know, a friend of the show has come on who has made his own pharmacy or like, vaccines at cost. These great, like, vaccines. And people still accuse him of being a pharma shill, even though he works completely outside of the pharma world. So I'm very torn about pharmaceutical companies in general. And I think it is very, very, very important that we continue to, like, pick at them, analyze them, be super critical. Of them, but also be fair about what they can do, what they should do and what we should expect from them. I think we have to be able to look at them critically and look at them in a sort of. We have to look at them critically, but we also have to be able to be fair and reasonable about what we expect from a massive corporation. These are examples like this case here of things that should never have been allowed to have happened and are going to continue to happen because we aren't going to have the over sight of these companies. And it's going to become easier and easier for things like this to happen, which is my fear. Unless doctors and scientists around the world have the time and energy to really pick apart at every detail and every study that comes from them. But I think even academic medicine is going to be under the gun in the coming years too. I don't feel great for my friends who have like, who have academic jobs in medicine. I think they're all going to be at risk. Who's going to get paid, who's going to be able to get to stay, who's going to be able to get their research done. It's all going to be at the whim of people who know very little about science and care very little about science. So I'm very depressed is the answer to your question.

[Robert Evans]

Yeah, I mean that's. Yeah, there's not much more to say on the matter than that. Right. Like this is, I guess part of what's so frustrating to me is that the sweep of like the anti intellectual crusade that is going to cost so many people their lives is of such catastrophic danger to every positive gain that we have made as a society in the last 150 years is fueled in part by the irresponsibility, greed and wastefulness of people who knew better, who are not ideologues, who are not misinformed, who are just willing to. Well, the system can handle me fucking around in this way or why shouldn't I get paid, right? Someone will catch it. It won't be that bad. And those little acts of malfeasance provide a lot of the fuel, the distrust, the hatred for elites and whatnot. When I say elites, I mean in the medical sense. You've got doctors and people at the FDA who are in the tank for these sketchy drugs that get people killed. And means that when we have a fucking pandemic, less people trust them. Right? Like Vioxx is not 0% of why so many people were hesitant to trust medical science during COVID Right. And neither is the opiate epidemic. Right. And that, that doesn't mean that the people. That RFK has a point. It means that, like, if you let people get away with shit like this, and we always do, it'll just keep getting worse. Somebody who is, who is absolutely has no limits what whatsoever will start taking advantage of the situation.

[Kaveh Hoda]

Yeah, that's exactly right.

[Robert Evans]

That's exactly right.

[Kaveh Hoda]

So, yeah, it's going to be a wild four years. There's going to be so much diarrhea.

[Robert Evans]

Yeah, there's going to be a lot of diarrhea. Look, folks, every year I go to Vegas, I find whichever buffet has the rancidus muscles and I eat 14 to 15 plates. And that provides me with the internal strength and resilience I need to handle any kind of change to our health and safety food standards. I' to be fine in this sick new world, kava. I'm going to be eating rancid mussels like a king.

[Kaveh Hoda]

So many, so many foodborne illnesses. So much. It's going to be the golden age of diarrhea.

[Robert Evans]

It's going to be the golden age of diarrhea. The brown age. Really? Yeah. That's what we're going to call this, the Gildan age and the, the brown age. Well, actually we could call it the guilton age, which is an old timey term for like, like shit encrusted on your ass.

[Kaveh Hoda]

Perfect. We'll have to explain it, but it works.

[Robert Evans]

Yeah, you have to explain it. You have to explain it. But you know, why? Does that make it bad? Anyway, no.

[Kaveh Hoda]

Yeah.

[Robert Evans]

All right.

[Kaveh Hoda]

Thanks for having me.

[Robert Evans]

The plug.

[Kaveh Hoda]

That was a blast. Yeah, it's always good. Nice seeing you. Nice seeing your face. For your listeners who may have an interest in learning more about medical topics, you can listen to my podcast, the House of Podcast, anywhere you get your podcast and follow me at Blue sky at kmd. And thank you.

[Robert Evans]

Yeah, thanks for coming on the show.

[Bartesian Advertiser]

Behind the Bastards is a production of Cool Zone Media.

[Robert Evans]

For more from Cool Zone Media, Visit.

[Bartesian Advertiser]

Our website, coolzone media.com or check us.

[Kaveh Hoda]

Out on the I Radio app, Apple Podcasts, or wherever you get your podcasts.

[Bartesian Advertiser]

Behind the Bastards is Now available on YouTube.

[Kaveh Hoda]

New episodes every Wednesday and Friday.

[Bartesian Advertiser]

Subscribe to our channel YouTube.com hindthebastards.

[Robert Evans]

This.

[Dr. Joy Hardin Bradford]

Is Dr. Joy Harnon Bradford from Therapy for Black Girls. Reading books gives you feelings. I mean, that's what they do. And with millions of books on Amazon, there's a reading feeling for everyone. Like there's an awestruck. Whoa. Feeling you get when you read about a dragon flying across the sky. But that's different from the surprised whoa you get when you read that the best friend did it. And that's totally different than the hubba hubba whoa. When the stable boy becomes a stable man and Amazon's got all the woes. Amazon Books that reading feeling awaits Attention.

[Guardian Bikes Advertiser]

Parents and grandparents Are you searching for the perfect gift for your kids this holiday season? Give the gift of adventure that will last all year long. A Guardian Bike the easiest, safest and quickest bikes for kids to learn on Kids are learning to ride in just one day. No training wheels needed. What sets Guardian Bikes apart? Designed especially for stability, they're low to the ground with a wide wheelbase and ultra lightweight frames. Offering superior control and balance, this design gives young riders the ability to learn in just one day without tears or frustration. Guardian Bikes are the only kids bikes designed and assembled in a USA factory, ensuring top notch quality and durability. They were also featured on Shark Tank and are the New York Times Wirecutter Top Kids bike pick for 2024. Make holiday gifting stress free with Guardian bikes with guaranteed one to two day shipping for just $29, you can trust your gift will arrive in time to create magical memories this holiday season. Plus sign up for their newsletter to receive a free bike lock and pop with your first purchase. The perfect stocking stuffer for any K on your list. Visit guardianbikes.com to secure the ultimate holiday gift today. Happy riding experience. Sensational Sound with Vizio's Soundbar Collection starting at just $99. There's a soundbar for every budget with Dolby Atmos in every model. Cinema quality sound is closer than ever. This collection features Vizio's simplest setup yet, so you'll be Streaming your favorite iHeartradio playlists in no time, whether you're looking for a simple setup or the cutting edge edge elevate SE with 360 degree sound immersion and auto rotating speakers, Vizio has you covered. Head to Best Buy or Amazon to find the perfect Vizio soundbar for you.

[Bartesian Advertiser]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and pared all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan Partisan. It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off, so how about a Cosmopolitan or a Mistletoe Margarita?

[Robert Evans]

I'm thirsty.

[Bartesian Advertiser]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Robert Evans]

Feel more seasonal in here already.

[Bartesian Advertiser]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jollier.

[Kaveh Hoda]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartisian. Get 50 off any cocktail maker at bartisian.com cocktail that's B A R T E S I A N dot com.

[Robert Evans]

Cocktail we are the voice of NASCAR.

[Kaveh Hoda]

The green flag is in the air.

[Robert Evans]

And we are underway.

[Kaveh Hoda]

The Great American Race.

[Dr. Joy Hardin Bradford]

The Motor Racing Network NASCAR Cup, Xfinity.

[Kaveh Hoda]

And Craftsman Truck Series racing live on.

[Robert Evans]

Your hometown radio station and MRN or.

[Kaveh Hoda]

NASCAR.com Martinsville, Talladega, the Chicago street course.

[Robert Evans]

We have the side by side action and last lap passes for the win. Photo finishes Ryan Blaney will win. The voice of nascar, the Motor Racing Network.