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essential information at Merck’s disposal. (Nor could he find any scientific support for the company’s suggestion that the results reflected Aleve’s previously unrecognized protective powers rather than the dangers of Vioxx.)
    “Deb had gone onto the FDA Web site to look at all the data presented in the advisory committee meetings—something, by the way, that I had never done,” Topol said, shaking his head with a wan smile of admiration for the diligence of his young colleague. Vioxx was not the only cox-2 inhibitor on the market; Celebrex, made by Pfizer, was introduced that same year, and Bextra had also recently been approved by the FDA. But each drug functioned in a slightly different way and the numbers for Vioxx were more disturbing than those for either of the others. Mukherjee told Topol that there was a “real problem with Vioxx in particular,” he recalled. “I had many other things on my mind so I said, ‘Nahhh, it’s not that big a deal. We have different work to do. Let’s not waste our time on this.’ Deb wouldn’t have it. He insisted that I look at the data with him, absolutely insisted. So I did.”
    Once Topol had the statistics in front of him, he saw why Mukherjee had become so agitated. “The evidence was right there,” he said. “I still cannot believe that nobody else had seen it. That’s when I began to understand what was really going on in that USA Today story. It just clicked: the company was attributing these miraculous functions to Aleve instead of investigating the potential dangers of their new drug. They were playing games: what they said at the time didn’t seem to be an outright lie, but it also wasn’t the truth that people needed to know. I said let’s write this up. After all, these data mattered. It wasn’t even a heart study, it was supposed to assess stomach complications, but you can’t just shy away from information like that. There were too many lives at stake.”
    Topol and Mukherjee quickly put a paper together, along with Steven Nissen, another prominent cardiologist at the Cleveland Clinic, who had attended the advisory meeting where Vioxx was approved. “Deb drove the research and I gave it a framework,” Topol said. The paper was the first independent analysis to include all the data the FDA had obtained from the VIGOR study, and it cast serious doubt on the supposition that naproxen offered special cardiovascular protection. The study was published in the Journal of the American Medical Association later that year. The three stopped short of calling for a moratorium on the use of Vioxx—the data at their disposal were not conclusive enough to warrant such a suggestion. However, they did warn doctors to take special care when prescribing the drug to people with heart disease. In their review, the authors stressed that Vioxx and other cox-2 inhibitors could cause serious side effects, and that a broader examination of their impact would be essential. “Given the remarkable exposure and popularity of this new class of medications,” they wrote, “we believe that it is mandatory to conduct a trial specifically assessing cardiovascular risk and benefit of these agents. Until then, we urge caution in prescribing these agents to patients at risk for cardiovascular morbidity.”

    ERIC TOPOL IS TANNED and trim, a gangly man in his fifties with an oval face, graying hair that has begun to thin, and the type of relaxed affect that only someone who moves from a climate like Cleveland’s to balmy San Diego could cultivate. Today, Topol has an entirely new kind of job: he is professor of genomics and the director of the Scripps Translational Science Institute in La Jolla. Scripps, one of the nation’s largest biomedical research organizations, is eager to apply the emerging science of genomics—the information contained within our genes—to clinical medicine. Topol believes genetics will soon provide the knowledge we need to make substantial reductions