Vioxx Settlement Puts Painkillers Back in the Spotlight

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In a statement quoted by the Associated Press, Merck said the additional heart attacks "did not materially change any of the conclusions of the article." Merck also said the additional heart attack data was not included in the study, because the heart attacks were reported after Merck's cut-off date for including study data.

Cox-2 inhibitors do work to ease pain, Topol said. "They work at least as well as NSAIDs and, in some patients, better," he said. "Unfortunately, this whole class of drugs has been hit by an outlier."

With the FDA slapping a strong "black box" warning on Celebrex's label, Topol believes the public and doctors are now well-informed about that drug, so they can make appropriate decisions about which patients should or should not receive the medicine.

"Celebrex is safe for most patients, so is Vioxx," Topol asserted. Celebrex, at higher doses, can increase the risk for blood clots, "but the risk never appeared to be as at the same level as Vioxx," he said.

Topol believes people who have heart disease might be at increased risk of heart attack from Celebrex, but there is no real proof of that, he said.

Going without cox-2s may have its downside for patients, too, experts added.

Since Vioxx and Bextra were taken off the market, rates of gastrointestinal events serious enough to require hospitalization have risen significantly, according to a presentation Thursday at the American College of Rheumatology annual meeting, in Boston.

In fact, these complications have risen 21 percent, said a group led by Dr. Gurkirpal Singh, a rheumatologist and a clinical professor of medicine at Stanford University School of Medicine.

Again, when it comes to stomach risks, the decision as to whether to prescribe Celebrex should be made on a case-by-case basis, one expert said.

"There is a lot of confusion over the cox-2 inhibitor Celebrex and the traditional NSAIDs as well," said Dr. Mark Fendrick, a professor of internal medicine at the University of Michigan School of Medicine and professor of health management and policy at the University of Michigan School of Public Health.