Just one year has passed since Merck’s Vioxx fiasco and major U.S. drug manufacturers are already facing a downward shift in sales as they attempt to work around an increasingly untrusting public.

Today's NY Times examines the big business of big drugs revealing an industry that while far from suffering, is unquestionably feeling the effects of shifting public opinion. Americans are becoming less responsive to drug manufacturer's marketing and promotion, the FDA is slow to approve many new medicines, and doctors are prescribing fewer controversial drugs like antidepressants and hormone replacement therapies.