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As this plays out, I think it will behoove people to consider things carefully from a business and strategic perspective as well as a medical perspective. I have no idea what the scientists at Merck know or believe in their hearts, but I have a pretty good feel for what their executives and defense council know and feel in their bonus checks. Their position on Fosamax will not change slowly, if it changes at all. It will change in one fell swoop when the economics of standing foursquare behind it and propping up ther science are no longer feasible or financially more profitable than a more legal approach to dealing with the issue.
In other words, they could be very well aware that their drug sucks and can cause catastrophic damage to a few unlucky people, and simply not care as long as there is plausible deniability or small potential legal exposure relative to the revenue it produces. I'm a cynic, but my experience has been that morality and ethics are things executives can afford to be concerned with AFTER they hit their numbers.

As long as they can muddy the waters amongst prescribing physicians, even a few percentage points in market share is more than the entire 40 million set aside for defense. Understanding their economics will be key to making sense of any actions or science that doesn't seem to be completely logical or credible.

March 25, 2010 - 3:13pm

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