To: Richnorth who wrote (66143 ) 9/1/2005 1:40:05 PM From: paret Respond to of 81568 Drug-Safety Reviewer Says F.D.A. Delayed Vioxx Study By GARDINER HARRIS NY TIMES November 4, 2004 n a series of testy e-mail exchanges with his bosses, a federal drug-safety reviewer contends that an effort to publish his study demonstrating the dangers of Vioxx was delayed and demeaned by top officials at the Food and Drug Administration. The e-mail and meeting notes also show that Dr. David Graham, an official in the F.D.A.'s Office of Drug Safety, is seeking to launch a study of the safety of Bextra and Mobic, two arthritis pills that are similar to Vioxx. Merck withdrew Vioxx in September after finding that it caused an increase in the risk of heart attacks. The proposed study of Bextra and Mobic would use data from the California Medicaid program, according to a note written Oct. 29 by Dr. Graham about a meeting held between Dr. Graham and his boss, Dr. Paul Seligman, director of the Office of Drug Safety. The exchanges are part of a stream of e-mail suggesting a tense environment in the F.D.A. office. In one note, Dr. Graham reports that the atmosphere has gotten so bad that Dr. Seligman has said he was going to resign. In the note from the meeting of Oct. 29, Dr. Graham wrote that Dr. Seligman said to him: "This only confirms what I suspected, that the staff don't trust me. You can't lead if the staff don't trust you. That's why I have a letter of resignation I am handing in next Tuesday.'' Dr. Seligman could not be reached for comment. In e-mail dated Oct. 25, 2004, Dr. Graham said one of his bosses, Dr. Anne Trontell, referred to his Vioxx study's conclusions "as nothing more than a scientific rumor." Dr. Graham defended his study and chided Drs. Trontell and Seligman for taking weeks to decide whether they would approve the study's publication in the Lancet, a leading medical journal. Dr. Trontell is the office's deputy director. Dr. Graham's study concluded that Vioxx, also known as rofecoxib, had a dangerous effect on the heart. The study has been submitted to the Lancet for peer review and possible publication. Meanwhile, the F.D.A. posted a version of the study on its Web site on Tuesday, after certain parts of the study were first published in The Wall Street Journal. "For all the center claims in its operating principles that respect for others is a core value, my experience with rofecoxib was just the opposite from management, once the results from this study and their potential implications came to light in August," Dr. Graham wrote in e-mail dated Oct. 26. The e-mail and notes, which were made available to The New York Times, come in the midst of a Congressional inquiry into whether the agency has been slow to respond to findings that antidepressants may cause children to become suicidal and that Vioxx may be harmful to the heart in some cases. Senator Charles E. Grassley, Republican of Iowa, who is chairman of the Senate Finance Committee, has criticized the agency for failing to respond more quickly to these findings and for suppressing the findings of its own drug safety reviewers that concluded that the drugs were risky. In the case of antidepressants, Dr. Andrew Mosholder, another reviewer at the Office of Drug Safety, concluded last fall that depressed children should not be prescribed most antidepressants because they have failed to show any benefit against depression and may cause some to become suicidal. Top agency officials refused to allow Dr. Mosholder to testify about his findings at a public meeting in February because they disagreed with his conclusions. A second study conducted by researchers at Columbia University confirmed Dr. Mosholder's conclusions in August, and the agency has since decided to place a "black-box" warning on the labels of antidepressants warning of the suicide risk. In his notes on an Oct. 29 meeting with Dr. Seligman, Dr. Graham writes that he, Dr. Mosholder and others in the Office of Drug Safety feel that "the review and clearance process had been turned into a battleground, full of contention and intimidation because our managers, the people who fill out our performance evaluations, had created a system where it was taking a great risk to stand firm in our scientific beliefs."