Merck’s sin – for which it will pay dearly – was not that its arthritis drug carried increase risks for some patients.

The drug company’s sin was going to great lengths to hide important information about Vioxx’s side effects while pimping it to an unsuspecting public through huge amounts of advertising.

A jury earlier this month awarded the widow of a man who died after taking the drug $253.5 million in damages. The huge amount is all about symbolism. Texas, where the trial was heard, limits punitive damages to $1.6 million, reducing the total amount of the award to no more than $26.1 million, and Merck will appeal the ruling.

But the jury-awarded amount is important. The $229 million in punitive damages came straight from the drug company itself. In a 2001 memo, Merck estimated that it could increase profits by that amount if it were able to delay a Food and Drug Administration warning label.

For some patients, Vioxx was a wonder drug. It eased arthritis pain without irritating the stomach, a common problem with other pain medications. For others, the medicine was about as effective as other drugs on the market, but, as Merck was well aware, it also increased the risk of heart attack or stroke among some.

It’s that increased risk that is the foundation of the Texas lawsuit and more than 4,000 others. It’s questionable whether Vioxx played a significant part in the death of Robert C. Ernst, for which it has been punished. The evidence was far from conclusive.

But the jury made a straightforward assessment. Merck had put the quest for profits above the welfare of its patients. It traded a slick marketing campaign for good science and withheld information vital for doctors and patients to make informed decisions.

Very few medical treatments are completely risk-free. Every surgery carries with it a risk, every pill a possible side effect. It’s up to the individual, in consultation with doctors, to decide what level of risk is acceptable. Merck placed its finger illicitly on the scale for Vioxx and altered that risk analysis.

One way or another, and whether it’s to the Ernst family or one of the thousands of others who have filed suit, the company will pay.