For those who defend Merck's Practices ... Did Merck target doctors critical of Vioxx?

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Did Merck target doctors critical of Vioxx?

Plaintiff's lawyer alleges company circulated list of 'physicians to
neutralize'


The Associated Press
Updated: 2:06 p.m. ET July 19, 2005


ANGLETON, Texas - Merck & Co.'s marketing team targeted doctors
viewed as unfriendly toward Vioxx to bring them into the fold,
neutralize or discredit them, the plaintiff's lawyer in the
nation's first Vioxx-related lawsuit to go to trial alleged Tuesday.


Houston litigator Mark Lanier questioned Nancy Santanello, head of
Merck's epidemiology department, about an internal list of 36 doctors
identified as "physicians to neutralize" in an e-mail circulated
two months after the popular painkiller went on the market in 1999.


"Attached is the complete list of 36 physicians to neutralize with
background information and recommended tactics. You will notice that
some have already been 'neutralized,'" the e-mail said. It also said a
previous e-mail had a subset of the 36 physicians "we would like to
get involved in Merck clinical research" and that the e-mail's
recipient should "be aware of our most challenging (and also most
vocal) national and regional physicians."


Santanello said the term, "neutralize" was a marketing strategy to
educate doctors about Vioxx.


"I'm not a marketing person. What the marketing people do is ask
the scientists to meet with the physician and explain the data to
them," she told jurors.


'Show me the money'
Santanello is Merck's corporate face among the company's team of
lawyers and continued absorbing verbal punches from Lanier regarding
the ethics of Merck's marketing and commitment to safe drugs.


Lanier pressed her about written recommendations to gain each
doctor's support for Vioxx. In one case, the document said, "Show
me the money" and then noted Merck had provided him with $25,000 to
support a program to examine treatment of arthritis. In another case,
the document said "discredit" next to the name of a doctor
allegedly deemed unwilling to be swayed.


Santanello said such grants from pharmaceutical companies are common.
She also said "discredit" meant providing an alternate viewpoint,
and doctors who expect their views on drugs and treatment to be heard
can be critical if they perceive that a company ignores them.


"They definitely consider themselves thought leaders, and they want
to be included," she said.


'Dodge Ball' training game
On Monday Santanello testified that an in-house training game for
Vioxx
sales representatives dubbed "Dodge Ball" wasn't about learning
to dodge questions from doctors about the drug's safety.


In the case, the widow of a man who took the drug for about eight
months before he died in his sleep alleges that Vioxx caused his
death,
and that Merck knew the drug was dangerous years before voluntarily
pulling it from the market in September.


Merck says the company acted responsibly, disclosed Vioxx research and
voluntarily removed the drug from the market last year when a study
showed it doubled the risk of heart attack if taken for a year and a
half or more.


Lanier presented an internal memo Monday laying out the "Dodge
Ball" training and asked Santanello why trainees could only move on
to the next round of the card game if they gave Merck-approved answers
to possible doctors' questions about Vioxx safety or dodged such
questions altogether.


"The point is, you never had to answer the question if you dodged
it?" Lanier asked.


"Basically you're trained to answer questions from physicians -
not to dodge questions," Santanello said, noting participants
couldn't win if they dodged all the questions.


Warning letters from FDA
Lanier also highlighted warning letters Merck received from the Food
and Drug Administration about misrepresenting or downplaying Vioxx
safety concerns in aggressive marketing that included glitzy
television
ads.


Merck added warnings about cardiovascular risks to Vioxx's label in
2002. About 20 million people took Vioxx before it was pulled from the
market.


The trial centers on the May 2001 death of Robert Ernst, a 59-year-old
produce manager at a Wal-Mart in Cleburne, near Fort Worth. Ernst also
ran marathons and worked as a personal trainer. He died in his sleep
next to his wife, Carol.


His autopsy report says he died of an arrhythmia, or irregular
heartbeat, secondary to plaque buildup in two major arteries.


Whitehorse Station, N.J.-based Merck argues that no studies link Vioxx
to arrhythmia, so the drug couldn't have caused Ernst's death.
Lanier's legal team argues that arrhythmia is most often caused by
heart attack, but Ernst died too fast for his heart to show damage.


URL: http://www.msnbc.msn.com/id/8628576/