I think you have to think about your goals too. Everyone says you don't want risk in your first round pick. I say that's bull as a general rule. If you want to win your league then taking a chance on Pujols after several people have passed CAN make sense. If you're looking for a non-risky better than average finish then sure, avoid that first round risk. But you win competitive leagues by taking calculated risks. Assuming Pujols' health stays the same as its been since 2003 when he first injured the elbow then he's going to be a huge contributor to your fantasy team. The only downside risk here is of the catastrophic type.
But again, it all comes back to your goals and your risk tolerance.
As for who I'd personally pick ahead of Pujols in a league I wanted to win, here's my list:
Definite: ARod, Holliday
Maybe: Santana, Wright, MCab
I waffle there a bit on the latter three because it really depends on your league context and risk tolerance both. Wright and MCab are certainly safer and both have Pujols-like upside while Johan is in for one heck of a season and could dominate the pitching categories.
Hope springs eternal
grows like ivy on the vine
then dies in the fall
--Haiku for a Cubs Fan, The Loveable Losers