[Ip-health] Vioxx and the Mortality Paradox
Riaz K Tayob
riaz.tayob at gmail.com
Wed Jun 6 06:24:41 PDT 2012
[Will WHO not make a statement about substandard medicines...]
June 05, 2012
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The Health Benefits of Cyanide
Vioxx and the Mortality Paradox
by RON UNZ
In recent weeks my description of the possible scale of the Vioxx
Disaster has begun getting a little coverage on the web and in the
British press, leading to some strong “push back” by people who say I
can’t possibly be right. They may certainly be correct in their opinion,
but I think their reasoning is mistaken, so I thought I’d briefly
summarize the analysis once more, emphasizing again that the evidence is
I realize most readers may be growing increasingly weary of Vioxx
mortality disputes—I certainly am—but given the tens or more likely
hundreds of thousands of American deaths at issue, adding a few short
paragraphs of text seem not totally unwarranted.
(*) In 1999, Vioxx was marketed to the American people by Merck as a
particularly effective anti-pain medication with minimal side-effects, a
sort of super-aspirin substitute targeted at arthritis sufferers in the
over-65 category. Backed by an eventual half-billion dollars of
advertising, it soon became one of the most widely popular—and
lucrative—drugs in this country and the world, with some twenty-five
million total American prescriptions. As a consequence, it also became
one of Merck’s most important revenue sources.
(*) In 2004, a detailed published FDA study proved that Vioxx had deadly
consequences in its patients, greatly increasing the risk of sudden
cardiovascular death, and had probably killed at least 30,000-60,000
Americans since its introduction. Learning of the pending publication of
this study, Merck immediately pulled the drug from the market. The media
later discovered that Merck had apparently been aware of these huge
cardiovascular health risks from the very beginning, but had decided to
ignore them, presumably because the drug was so lucrative. Merck
eventually paid some $8 billion dollars in total government fines, legal
expenses, and damages for Vioxx-related deaths.
(*) As it happened, the 2004 American death rate unexpectedly dropped by
50,000, the greatest such national decline in sixty years, a decline
whose cause completely mystified American health authorities, who
searched in vain for some possible logical explanation. This decline was
almost entirely due to fewer deaths in 65+ age range, mostly due to a
large drop in cardiovascular fatalities.
(*) Interestingly enough, an examination of the American mortality data
freely available on the government CDC website reveals a corresponding
rise in deaths for Americans 65+ which had previously occurred in 1999,
the year Vioxx was introduced. This 1999 mortality rise was the largest
in the past fifteen years, and—perhaps coincidentally—a sharp shift in
the rate of cardiovascular deaths had once again been the leading factor.
It is completely impossible for me to say whether or not the recall of a
an extremely popular but deadly drug proven to cause cardiovascular
deaths among its 65+ target population had any direct connection to the
huge drop in cardiovascular deaths among Americans 65+ during that same
year. Similarly, the earlier sharp rise in 65+ cardiovascular deaths the
year the drug had been introduced may or may not be purely coincidental.
But one would think these intriguing facts might arouse a bit of
curiosity within American media and government circles.
Based on these items, I have advanced a speculative hypothesis
suggesting a much higher Vioxx death-toll than is currently accepted.
One of the main arguments which various critics have made against my
hypothesis is that although the American 65+ death rate did undergo
rather surprising upward and downward shifts during 1999 and 2004, the
years that Vioxx was introduced and then removed, the behavior of the
death rate during the intervening years was far less remarkable. A few
people have argued that the widespread use of a deadly drug during
2000-2003 would surely have caused large, continuing changes in the
mortality figures, and their absence tends to completely eliminate the
Unfortunately, this reasoning is incorrect, and confuses an impact upon
total longevity with an impact upon mortality rates. This can easily be
understood if we consider an extreme thought-experiment.
Suppose, for example, that the government required everyone aged 65 and
above to immediately take cyanide tablets, and established this as a
permanent policy going forward, with mandatory cyanide doses being a
fixture of every 65th year birthday party.
Obviously, this would lead to many premature American deaths and a very
substantial change in American lifespans. Indeed, since our current
life-expectancy is around 78, the vast majority of Americans henceforth
would be killed by government cyanide, instead of dying naturally. Over
the next hundred years, the overwhelming majority of all deaths would be
from cyanide, and the total cyanide death-toll in America might approach
the half billion mark. Clearly, cyanide would become a very major
negative health factor in American society.
However, the actual impact upon the annual American death-rate would be
small or perhaps even favorable during nearly the entire period in
question, a totally astonishing result. This seeming paradox follows
from the fact that everyone eventually dies of something, and therefore
there would automatically be huge drops in cancer, heart attack,
strokes, and car accident fatalities which would almost exactly balance
out the rise in cyanide deaths.
Consider, for example, the American population one hundred years from
now and compare it with a non-cyanide scenario. In the former case,
there would be no one aged 65+, with that portion of the population
having succumbed to cyanide; but those would be the *only* differences
in total net-fatalities compared to the base-case Every other American
death would have been the same under the two scenarios, though certainly
with different timing. And if we average that small slice of additional
deaths over the one hundred years in question, the average annual impact
is fairly small.
Obviously, the first year of a mandatory-cyanide scenario would see a
huge die-off of all those 65+. But mortality rates after that would
generally be pretty ordinary, perhaps even sometimes *lower* than under
the normal situation, depending upon the shape of the evolving
age-distribution curve. Indeed, it is quite possible that people just
looking at the mortality rates for the ninety-nine following years and
comparing these with current projections might notice they were somewhat
reduced, and wrongly conclude that mandatory cyanide might have
significant beneficial properties, since it seemed to cut mortality
rates. This rather counter-intuitive result might be termed “The
Mortality Rate Paradox.”
However, if at any point, the mandatory-cyanide policy were
discontinued, that particular year would see a remarkable *drop* in the
annual death rate, followed by smaller changes in subsequent years,
until eventually a new age-mortality equilibrium was established. Thus,
the only significant signals of a mandatory cyanide policy found in the
annual mortality rates would come at the beginning and at the end of the
Obviously, Vioxx did not remotely have the lethality of cyanide, nor was
its use universal among the elderly. Moreover, any Vioxx-related
mortality shifts were substantially masked by much larger directional
mortality trends due to the aging of the population, improvements in
life-saving and other medical technology, and all sorts of other
factors. Distinguishing signal from noise is not as trivial as examining
the slope of a curve.
But it does seem a bit intriguing that the mortality-curve for Americans
65+ followed a very similar trajectory to that of the extreme
thought-experiment: a sharp rise in the year of introduction, a few
years of relative stability, and then a very sharp drop in the year of
Most of the Vioxx defenders put the total six-year death toll perhaps
around 33,000, or roughly 6,000 additional deaths per year. But the
actual shifts we find at the crucial starting and stopping points are
far higher than this. For example, elderly deaths actually rose 35,000
in the year Vioxx was introduced, a figure several times larger than the
average for the preceding few years, and dropped by 67,000 in the year
it was withdrawn, which was similarly anomalous and remarkable, many
times higher than the recent average change. Both these mortality shifts
were heavily driven by the cardiovascular category.
It seems to me that a Vioxx-induced premature American death toll which
was well into the hundreds of thousands is the most parsimonious
explanation of these surprising mortality statistics.
Ron Unz can be reached at his website.
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