An ethical question has to be raised as to Merk's direct role in both the research study and the resulting NEJM article. When the drug manufacturer is involved in a study regarding their leading products future, there is a blatant conflict of interest.
The actual marketing of Vioxx does not seem to pose any ethical questions. It was marketed as a drug that would assist with arthritis and other pain treatment. This is true and therefore was highly recommended by physicians. Further, when the initial concerns regarding the cardiovascular issues started to rise, Merck followed FDA regulations and used a warning label.
The evidence pertaining to the unknown emails and memos, however, are indicative of the fact that Merck's executives knew, yet failed to adequately disclose to doctors and patients, information on Vioxx's safety. This case for lack of full-disclosure is even more of an issue when coupled with the Merck authors failure to use all the available data of the study in authoring the NEMJ article.
Merck's marketing of its product directly...
According to the law, this form of advertisement is legal. However, whether it is ethical is a different questions altogether. Prescription drugs are not like other consumer products. Not everyone can take them. They are specifically made to treat specific conditions and are to be prescribed by doctors. However, by advertising the drug it is implied that they are available to the consumer, "just ask your doctor."
The FDA failed in that they authorized Vioxx without any conclusive research on possible side-effects. Instead, the drug was approved, then the research was conducted. The FDA's subsequent, independent research was a step in the right direction.
Clearly Merck should have recalled the drug sooner, especially since the evidence suggests that they knew of the drug's deadly effects prior to its withdrawing of the product. However, Merck's decision to cease all Vioxx marketing was the correct thing to do, it was just done 100,000 heart attacks too late.
