Internal documents revealed Merck's marketing team developed the ADVANTAGE strategy to skew clinical trial results, comparing Vioxx to naproxen rather than a placebo. In 16 of 20 published papers, Merck employees were initially listed as lead authors before being swapped with outside academics. After 80 million patients took the drug, Merck withdrew it in 2004. The Lancet estimated 88,000-140,000 heart attacks in the US alone.