West Coast Editor

Only two of what could be an avalanche of Vioxx cases have reached court so far - but the next boulders rolling down the hill might be even more crushing with a state judge's insistence that at least 10 of the next plaintiffs on the docket must have taken the painkiller for 18 months or longer.

Friday's The Wall Street Journal reported the plan, noting the Whitehouse Station, N.J.-based Merck & Co. Inc. is opposed to it. The company's shares (NYSE:MRK) closed at $30.03, unchanged.

But the idea makes sense to Andrew McDonald, analyst with ThinkEquity Partners LLC in San Francisco, since 18 months is the point at which Merck's trial data began to show the greater risk of heart attack and stroke.

"The most recent court case involved a death of someone who was treated [for] a shorter period," he pointed out. A New Jersey jury cleared Merck of liability for the heart attack suffered by a man who took Vioxx intermittently for two months.

"How can one blame Vioxx if the evidence doesn't suggest that short duration therapy is causative? Longer than 18 months, Vioxx is a killer," McDonald told BioWorld Today. "Of course Merck doesn't want those cases to go to court."

Merck pulled the COX-2 inhibitor, approved in 1999, off the market more than a year ago based on clinical findings that some patients who used it for 18 months or longer had an increased risk of heart attack or stroke, and the product has not returned despite the FDA's decision that it could, with restrictions. Vioxx (rofecoxib) had been chalking up sales of about $2.5 billion per year. (See BioWorld Today, Feb. 22, 2005.)

In August, jurors found the drugmaker responsible in the cardiac death of a Texas man and awarded his widow $235.4 million - a verdict that Merck is appealing.

Estimates have pegged Merck's ultimate Vioxx liability as high as $50 billion. The company has set aside $675 million for legal defense.

Navdeep Jaikaria, analyst with Rodman & Renshaw, of New York, covers several biotech companies partnered with Merck, and noted they are "typically not big deals" and probably not in danger, "not at this point, at least. At some point, the Vioxx cases have to stop."

Meanwhile, public opinion about big pharma seems likely to continue to slide. PricewaterhouseCoopers, of New York, compiled a report showing that in 1997, nearly 80 percent of people questioned about pharmaceutical companies believed they were doing a good job serving their customers. By 2004, that had fallen to slightly more than 40 percent, placing it well below computer hardware companies and car manufacturers. (See BioWorld Today, Sept. 2, 2005.)

McDonald summed up what might be the public attitude.

"At Merck, the mantra should now read, Profits before people,'" he said. "I don't expect them to win those cases. The senior management of Merck should go to jail."

Merck was not immediately available for comment.