Thursday, June 09, 2005

merck: where profits come first

so the other day when i was reading this blurb on prwatch, my mind immediately went racing to the gutter. apparently pharmaceutical giant merck is trying to make over its image after its medication vioxx was pulled from the market for causing pulmonary and death problems. merck has a new slogan:

merck: where patients come first

i immediately started researching to put together an ad parody around erectile enhancement and the idea of "coming first". the possibilities there are endless. but after browsing through merck's website, i realized that merck doesn't make any dick drugs! i couldn't find a single penis drug on their product page. somewhat disappointed, i abandoned my ad parody idea, and i almost even felt sorry for merck that they have so far been unable to cash in on the ever-growing erection market.

but then tonight i was listening to all things considered on my drive home from work and was fortunate enough to catch their massive exposé on merck. it's a long story: long enough that it took up most of my drive home (and wasn't finished when i arrived, causing me to have one of those "driveway moments"), and big enough that npr has already posted a transcript of the story.

npr somehow (though one of those "undisclosed sources" that right-wingers seem to hate?) acquired some extremely incriminating internal documents from merck that detail how merck tried to buy off various high-profile doctors so they would speak well of vioxx, which from what i understand is fairly common.

When they located a prospect, they entered the details about that doctor into a spreadsheet at headquarters. Spreadsheet entries included items such as:

"...treats all of the major sports teams, including the Lakers basketball team and the Dodgers baseball team, as well as the high-profile members of our society."

"... 2,4OO prescriptions per year... also known nationally... Writes for a lot of rheumatology textbooks."

Merck's vast army of sales representatives gathered intelligence on what it would take to win over individual doctors. Their notes included the following strategic observations:

"Use in many speaking engagements... At least $20,000 for speaking engagements for the remainder of the year."

"Will speak for us only at certain restaurants and high honorarium... Likes to feel important... He needs the VIP treatment."

this is all ethically questionable (if the question is "is this unethical or is it super duper unethical?") but like i said, it's relatively common practice. so it wouldn't really be a story if it stopped there. but it doesn't; it's just getting started.

the story goes on to discuss a stanford researcher named gurkirpal singh, who did some paid speaking engagements for merck for awhile, but then started having doubts about the safety of vioxx. singh began to think, you know, maybe vioxx wasn't really that great, and maybe it was killing thousands of people, or something like that.

merck expected singh to be a good little paid-off corporate shill and ix-nay on the eart-hay attacks-way. but singh grew increasingly concerned about the potential dangers of vioxx, & he dared to openly discuss his concerns in his speaking engagements. then, worst of all, started recommending rival product celebrex instead of vioxx. that was it: the guy had to go.

the npr story discusses just how deeply merck "investigated" singh:

The profile of Dr. Singh is remarkably complete," says Columbia's David Rothman, who reviewed the final document for NPR. "One can't help but almost frame it in terms of an FBI dossier, except here Dr. Singh is not cavorting with possible communists, or possible gangsters. Here the dossier is filled with Dr. Singh's take on Vioxx, who is Dr. Singh talking to. It's scrupulously watched and very, very carefully recorded."

once it was clear that singh would not come back into the fold, merck had to take him out of play. so merck tried to call singh's bosses at stanford & get him in trouble. merck also called the deans at at least 7 other institutions that also had pesky researchers who dared to suggest that maybe vioxx was causing heart problems.

but why would merck think that a couple phone calls would be enough to make these universities clamp down on their employees?

"Look, medical research is expensive," says David Rothman of the Columbia University College of Physicians and Surgeons. "No one can take a call from a drug company high official, critical of an investigator, and not realize that behind that call is the implicit reminder, implicit threat -- 'If you can't control your folks, how do you expect us to continue to do business with you?''"

of course none of that did much good for merck, as the fda eventually pulled vioxx from the market, and at least 38,000 people are now estimated to have died because of the drug.

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