ANGLETON, Tex., July 25 - The painkiller Vioxx probably led to the death of Robert Ernst, a cardiologist told jurors on Monday in the first Vioxx lawsuit to reach trial.
"I think to a reasonable medical probability Vioxx was a significant contributing factor in causing this event," said Dr. Isaac Wiener, an expert witness called by the plaintiffs in the case.
His view could be supported by Dr. Maria M. Araneta, the coroner who conducted Mr. Ernst's autopsy, whom the plaintiffs said they planned to call to testify on Tuesday. Mr. Ernst, a 59-year-old marathoner, died in his bed on May 6, 2001, after taking Vioxx for eight months. His widow and children have sued Merck, contending that Vioxx caused his death.
Dr. Araneta now works in the United Arab Emirates and was not expected to testify in this case. A lawyer for Merck said Monday that the defense will try to block her testimony, arguing that the plaintiffs had not given proper notice that Dr. Araneta would be called. On Monday, evening, Judge Ben Hardin of District Court in Brazoria County, ruled that Merck's lawyers should have a chance to take Dr. Araneta's testimony under oath before the judge on Tuesday but without the jury present. Judge Hardin will then rule whether to allow her to testify. Dr. Araneta's testimony could be crucial because her autopsy found Mr. Ernst died of an arrhythmia, or irregular heartbeat. The autopsy did not mention a heart attack as a cause of death.
Clinical trials have repeatedly linked Vioxx to heart attacks, but Merck says that clinical trials have never shown a link between Vioxx and arrhythmia, undoing any link between Vioxx and Mr. Ernst's death.
But in an interview in Houston on Sunday, Dr. Araneta said she thought that Mr. Ernst could have suffered a heart attack that killed him so quickly that it did not produce visible heart damage during her autopsy. W. Mark Lanier, a lawyer for Mr. Ernst's family, has repeatedly made that argument, which cuts to the core of Merck's defense.
"If a person dies suddenly and has a heart attack, you cannot see the changes with the naked eye," Dr. Araneta said.
Dr. Wiener, a cardiologist at the University of California, Los Angeles, offered the jury similar testimony on Monday under questioning from Mr. Lanier.
Mr. Ernst probably died of a type of arrhythmia called ventricular fibrillation, in which the heart loses the ability to pump blood, Dr. Wiener testified. The fibrillation was probably provoked by ischemia, or lack of blood flow to the heart. The ischemia may in turn have been caused either by a blood clot or by the fact that Mr. Ernst's coronary arteries had narrowed, restricting the flow of blood to the heart, he said.
Generally, scientists and doctors think that Vioxx can promote blood clots, leading to heart attacks and strokes. More than 7,000 people have sued Merck, contending that they suffered heart attacks or strokes after taking the drug.
Dr. Wiener said he could not be certain that the lack of blood flow had caused Mr. Ernst to suffer the damage to the heart muscle commonly called a heart attack. But the question of whether Mr. Ernst suffered a heart attack is ultimately irrelevant, because the ventricular fibrillation killed him before any signs of a heart attack would have been apparent, he said.
"I view this kind of sudden cardiac death as on the same spectrum of disease as a myocardial infarction," or heart attack, Dr. Wiener said.
Under cross-examination from David Kiernan, a lawyer for Merck, Dr. Wiener acknowledged that he had no evidence that Mr. Ernst had suffered a heart attack.
But he added repeatedly that the autopsy also did not rule out the possibility of a heart attack because of the speed with which Mr. Ernst died.
Mr. Kiernan also pressed Dr. Wiener over a comment the doctor made in his deposition with lawyers for Merck last month. In the deposition, Dr. Wiener said Mr. Ernst could have suffered sudden cardiac death even if he had not been taking Vioxx.
Dr. Wiener acknowledged his statement but said Vioxx had increased Mr. Ernst's risks.
