Silencing public health advocates: Outspoken Vioxx critic loses job after testimony against Merck in federal trial

Wednesday, March 29, 2006 by: Alexis Black
Tags: Cleveland clinic, dr. topol, Vioxx

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There's something fishy going on at the Cleveland Clinic. In a surprising move in December 2005, the prestigious clinic removed Dr. Eric Topol, a well-known cardiologist and vocal critic of Merck's prescription Vioxx arthritis medication, from his position as chief academic officer at the hospital's medical school. Topol was apparently told that the position of academic officer, which also gave him a seat on the clinic's board of governors and conflict of interest committee, had been eliminated just two days after he testified at a federal Vioxx trial that Merck was guilty of scientific misconduct, according to an editorial appearing in The Houston Chronicle

News of the elimination of Topol's position came less than a week before an announcement by pharmaceutical giant Pfizer that the Cleveland Clinic will conduct a $100-million study into the safety of Celebrex, the last of the COX-2 inhibitors (the class of drugs that Vioxx belonged to) on the market in the United States.

Coincidence? No one knows for certain, but the series of events leading up to the elimination of Dr. Topol's position at the clinic has certainly raised some eyebrows.

Let's start at the beginning. Dr. Topol started speaking out about the cardiovascular risks posed by COX-2 inhibitors, especially Vioxx, in 2001, long before the painkiller was pulled off the market in 2004 because of its link to increased risk of heart attack and stroke. Joining him in his campaign against the dangerous drugs at the time was his associate at the clinic, Dr. Steven Nissen. The two doctors, along with Debabrata Mukherjee, wrote a review of Vioxx clinical trials for the Journal of the American Medical Association in August 2001, which stated that Vioxx was linked to a 200 percent increased risk for blood clots, heart attack and stroke.

Following the decision to pull Vioxx from the market three years later, Topol continued to publicly criticize Vioxx-maker Merck for its slow response and for its decision to put the dangerous drug on the market in the first place. Dr. Nissen, however, was less vocal.

Subpoenaed in the first federal Vioxx trial in November 2005, Dr. Topol gave a three-hour videotaped deposition attacking Vioxx and accusing Merck of scientific misconduct. Less than a week after that deposition, Topol lost his position at the Cleveland Clinic.

There is one other important point to note here: At the same time Dr. Topol was being demoted, his past partner in protest, Dr. Nissen, was being asked to lead the $100 million study into the safety of Celebrex.

Was Dr. Topol muscled out?

The Cleveland Clinic has claimed that the timing of the elimination of Dr. Topol's position is purely coincidental and simply part of broader administrative reorganization at the clinic, stating that his "position was no longer needed."

However, many are not buying this claim. A Dec. 19 editorial on challenges the clinic's explanation, saying: "It seems quite odd to many observers that the doctor with superior qualifications would have his leadership position done away with as part of an administrative reorganization making that position 'no longer necessary' at a time when he would be the ideal person to lead the independent study of Celebrex."

Odd indeed. Could it be that Topol's demotion is really an attempt by the joined-at-the-hip medical and pharmaceutical industries to silence one of their most vocal critics?

It would certainly not be the first time conflicts of interest in the medical community have come into play. In fact, conflicts of interest have become a standard of sorts in the medical community, and perhaps one of the biggest reasons behind Dr. Topol's troubles is his desire to speak out against those problems in the industry.

In addition to his vocal criticism of Vioxx, Dr. Topol also reportedly questioned financial ties between the Cleveland Clinic and ArtiCure, a company that sells a medical device used in a surgical procedure the clinic promotes, according to a report in The Wall Street Journal.

Perhaps it is Dr. Topol's consumer concern that has left a bad taste in the mouths of the powers-that-be in the profit-driven medical industry, but for the average consumer, there simply aren't enough professionals like Dr. Topol in the world who are willing to fight for the health and safety of the public.

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