Letters

There are slim pickings in Britain for those looking for informed comment on the African-American experience. Any with hopes that Prospect might fill the gap would surely have found Myron Magnet's piece (November) disappointing. The white, neo-conservative Magnet would struggle to convince us that he could understand the plight of African Americans, so he lets black authors like Bill Cosby do the heavy lifting for him. He quotes selectively to build a case that sounds more early-1980s than late-noughties, and manages to blame poor blacks for nearly all the ills of the black community.

These are not new arguments, and they have never told the whole story. Magnet cites statistics about black crime, bad schools and fatherless families, and makes the case for more responsibility. Fair enough. However, he fails to note the deep complexities of the lives of the poor or the biases—both cultural and institutional —still prevalent in American life and law: the higher conviction rates for blacks than whites; the drug laws that find crack cocaine sentences some three to eight times longer than those for powder cocaine; the cycle of poverty; or the shameful response to Katrina.

Even more than the lack of balance, though, Magnet wilfully ignores the strides towards responsibility made by a new generation of black leaders. He namechecks Obama and others like Corey Booker, but his article reads as if their ideas aren't central to the current debate. Instead, Magnet's Reagan-era commentary insists on a vision of black America and an era of leaders (like crack-smoking Marion Barry) that no longer holds sway.

Maryanna Abdo
Hackney/Los Angeles

Welsh grammar school
15th October 2008

The "In fact" commentary (September) notes that Welsh has "no indefinite article." From a linguistic point of view, this is neither unusual or of much interest. Indeed, a good number of languages (from separate linguistic branches) have no indefinite article. Semitic and Arabic languages do not; nor do some Indo-European languages, such as Russian.

What is unusual about Welsh is that there are two distinct patterns of adjective placement. The noun does not always precede the adjective, as in "hen ddyn" (old man).

Lizzie Taylor
Nottingham

Flirting with creationism?
21st October 2008

I've always expected Prospect's "News and curiosities" to be written with a sharp pen, but not to read as if they've been lifted from the Daily Mail, something achieved in "Civil War at the Royal Society" (October). It says: "Michael Reiss's crime was to suggest that if a child in a science lesson asked a question about creationism, teachers had a duty to explain that creationism is a belief with no basis in scientific evidence."

In fact, this is what science teachers already do, and what Reiss thinks they should stop doing. Reiss advocated something quite different: "I feel that creationism is best seen by science teachers not as a misconception but as a world view"—in other words, a complete system of thought deserving respect, even if we disagree with it. His vocation as a minister must surely have been a factor in leading him to this unevidenced view, and presumably this is at least part of the reason he resigned. (He wasn't sacked, as the article implies).

The only real scandal is that creationism is now being openly taught in Britain's taxpayer-funded faith schools—something unheard of 15 years ago.

Jonathan Dore
Burwell, Cambridgeshire

How many jobs in finance?
25th October 2008

Your November edition on the financial crisis was thought-provoking but Jonathan Ford ("A greedy giant out of control") appears to have an exaggerated view of the size of the financial sector. A "staggering" one in five people do not earn their living in finance in Britain, as he claimed. The figure is around 1.2m, nearer one in 25. People often make the mistake of confusing business services, which cover everything from advertising to IT, with financial services.

David Smith
Sunday Times

Going native in Moscow
27th October 2008

I sympathised with much of Rodric Braithwaite's article about British foreign policy (November). I agree that David Miliband's hectoring the Russians over the Georgian and Ukrainian imbroglios was clumsy. And, as a St Petersburg taxi driver said to me in January, "you Brits have turned London into a brothel full of tarts like Berezovsky and Abramovich, so who do you think you are lecturing to?" Crude, but I felt he had a point, and recent dealings with Deripaska make it seem still sharper.

Yet I would make one qualification. Diplomats, even good ones, have a tendency to see native, if not to go native, and Braithwaite was presumably British ambassador in Moscow when Anna Politkovskaya was being so bravely but suicidally vocal. Also, whatever the murky inwardnesses of the Litvinenko affair, he was arrogantly done to death on our streets. I don't think it reflects only "fashionable notions like liberal interventionism" to react strongly to such barbarities.

Brian Roberts
London SW18

Vioxx: A second opinion
31st October 2008

Anyone reading Jim Giles's article, "How Merck made a killing" (November) would be justified in asking: how did the overwhelming majority of juries and judges around the world who decided on Vioxx cases find in Merck's favour? The answer is that in each of those cases, Merck was allowed to present evidence in its defence. Evidence that Giles, despite the millions of pages Merck produced, ignored.

Part of the reason Merck was successful in much of the litigation is that claimants cannot reliably show that their alleged conditions were linked to Vioxx. Heart disease is unfortunately all too common; according to the department of health, in England in 2007 around 275,000 people died from heart attacks, 110,000 people suffered strokes. Not one of them was taking Vioxx.

But that was only part of Merck's scientific evidence. In the court trials in the US, Merck let juries hear directly from the doctors and scientists who were most involved in developing Vioxx. They explained why Merck made the scientific decisions we did, from the submission of Vioxx for approval to the US Food and Drug Administration, to the additional studies carried out, right up to the voluntary withdrawal decision in 2004. And time and time again, after hearing this evidence, juries sided with Merck.

For a start, you can't reach a judgment about an entire company and over a decade of work on a medicine based on a single email. The March 2000 email from Dr Scolnick that was quoted twice by Giles was also quoted extensively by plaintiffs. The email showed that Scolnick was concerned about the cardiovascular events in the VIGOR study (a study comparing Vioxx to naproxen in rheumatoid arthritis patients) when he first saw the data; the reaction we all hope the head physician of a pharmaceutical company would have upon the initial review of potentially concerning safety data. But, like the plaintiffs, Giles did not quote subsequent emails from Scolnick after he had carefully reviewed all the data. For example, in February 2001, Scolnick wrote to other Merck scientists involved with the study of Vioxx: "We all worried to death about the CV events last spring… I was sick at the thought we might be doing harm to patients. I know each of you well enough to know you felt the same. With all the data now available, I am no longer worried."

Merck also took the time to debunk some of the plaintiffs' favourite soundbites. For example, plaintiffs often pointed to the estimate of 140,000 heart attacks caused by Vioxx, referenced by Giles at the start of his article. But this was calculated by taking the relative risk observed in one study comparing Vioxx to placebo—the APPROVe study—and assuming it applied to everyone who ever took standard chronic doses of Vioxx in the US. Leaving aside the limitations of any extrapolation of this magnitude, the calculation suffered from a critical flaw: it assumed that Vioxx doubled the risk among people taking it compared to any other traditional anti-inflammatory medicines they might be taking. But this is not supported by evidence from a recent study which does not suggest a significant difference in cardiovascular safety between Cox-2 inhibitors and most other anti-inflammatory medicines. So, while the number makes for a good introduction to an article (as well as courtroom theatrics) it is really no more than unreliable speculation.

And Merck's disclosures about the cardiovascular safety of Vioxx did give physicians the information they needed to make informed prescribing decisions. Giles says that it was important to Merck that the "heart risk not be mentioned" in Vioxx's label. But Merck always believed the data from the VIGOR study should be in the label. It was Merck that first proposed including it in the "precautions" section of the US label, and labelling language about the VIGOR study was approved by British authorities. These labels actually included the data about blood clots from VIGOR that Giles suggests Merck was trying to suppress.

In the end, Merck relied on the common sense of jurors and courts. Would a company that believed it had a risky medicine really continue to study it extensively, knowing that it would disclose the results to regulatory authorities around the world? Would a company intent on putting profits over safety respond to the APPROVe study—the first in which a risk of cardiovascular events was observed among patients taking Vioxx compared to those taking placebo—by voluntarily withdrawing the medicine worldwide within a week of first learning the data? Would senior Merck staff continue taking Vioxx and allow their relatives to continue taking it right up until it was withdrawn if they believed it was dangerous? The answer is clearly no.

Merck's decisions about Vioxx probably have been scrutinised more than any company's decisions about any medicine in history. Where people believe they have claims for compensation, the appropriate place for that scrutiny to occur is in the courts. And when courts have had the chance to examine the evidence surrounding Vioxx, Merck believes our record speaks for itself and is worthy of a second opinion.

Kenneth C Frazier
Executive vice president andpresident, global human health, Merck & Co, Inc.
Kenneth C Frazier is a member of Merck's executive committee, which evaluates and makes strategic decisions for the company.