The editor of The Lancet, Richard Horton, has condemned pharmaceutical giant Merck and the US Food and Drug Administration for acting out of “ruthless, short-sighted, and irresponsible self- interest” in dealing with Merck’s painkiller Vioxx. A researcher for the FDA has suggested that more than 27,000 deaths could be attributed to Vioxx.

Merck withdrew Vioxx from the market in September, citing new evidence that it increased the risk of heart attacks, strokes and other serious ailments. However, an article in the current issue of The Lancet argues that Merck could have and should have withdrawn the drug long ago for surveys had uncovered serious problems several years earlier. According to a report in the New York Times, Merck’s liability could dwarf recent billion-dollar settlements by other drug companies.

Dr Horton blames the FDA for not taking action earlier in the light of mounting evidence that the drug was harmful. “The most important legacy of this episode is the continued erosion of trust that public health institutions will suffer,” says Dr Horton. “Failure to act decisively on signals of risk might minimise short-term political criticism for regulators or shareholder unrest for company chief executives. But the long-term consequence of prevarication is a tide of public scepticism about just whose interests drug makers and regulators truly represent.”