A Texas jury’s decision to award $253 million in damages in the first successful Vioxx lawsuit will go down as a bitter pill for patients and doctors. It is a prescription for big payouts for the members of the tort bar and a bad omen for litigation to come.

Vioxx, a product of Merck, was an exciting new arthritis treatment when it first hit the market in 1999. It was as effective as more traditional over-the-counter treatments on the market, such as ibuprofen and naproxen, but easier on the stomach, making it almost a godsend for patients afflicted both with arthritis and ulcers. However, large studies performed after the drug’s release showed that it carried an elevated risk of heart problems.

These risks may have been worth taking for patients who really needed the drug. The risks were not serious enough that the Food and Drug Administration would have been likely to pull the drug off the market, but Merck did so anyway. And the lawyers pounced.

The facts of the Texas suit should have made it a difficult case for the plaintiff. Robert Ernst, a marathon runner, died in his sleep in 2001 of an irregular heart beat after taking Vioxx for about eight months. Yet whatever other cardiac problems the drug might cause, irregular heartbeat is not one of them, according to a scholar at the American Enterprise Institute, John Calfee.

So this verdict may well be best understood as a sign that Merck had already lost the public-relations battle for the hearts and minds of jurors before the case even went to trial, a trend that augurs poorly for the company’s fate in other courtrooms down the road. More than 4,000 Vioxx-related lawsuits currently are pending.

There is not any persuasive evidence that Cox-2 inhibitors – the type of compound that includes Vioxx as well as the popular Celebrex – are any more dangerous than the over-the-counter treatments on which they were supposed to improve. That scientific fine point has gotten lost in the tort-bar feeding frenzy surrounding the withdrawal of the drug. Many experts expect Friday’s verdict to be reduced, or even reversed, on appeal. But it may already have opened the floodgates. It’s a tragedy for patients for whom Vioxx was an invaluable treatment, even with the higher cardiac risk.