From the Washington Post, via ThinkProgress, comes an article about Merck, the maker of Vioxx, which “was withdrawn from the market last September after another clinical trial found that people who had taken the drug for 18 months were five times more likely to have heart attacks and strokes than those on a placebo.”
“Merck & Co.’s longtime leader Raymond V. Gilmartin abruptly resigned yesterday on the same day congressional investigators released a slew of documents detailing how the company continued to aggressively promote its arthritis drug Vioxx after it knew of potentially serious safety concerns.
The documents made public by the House Committee on Government Reform showed that Merck directed its 3,000-person Vioxx sales force to avoid discussions with doctors about the cardiovascular risks identified in a major clinical trial of the drug in 2000. Sales representatives were told instead to rely on a “Cardiovascular Card” that said Vioxx was protecting the heart rather than potentially harming it. (…)
Merck and other drug companies say their “detailers” act as neutral educators to guide physicians in prescribing drugs, but the more than 20,000 pages of documents released yesterday showed that Merck’s representatives were coached to be aggressive salesmen.”
OK: so far we have another story about companies harming people in order to protect profits. (Preemptive note to von: I do not assume, and do not mean to imply, that all companies do this. Many don’t, and it’s a constant source of amazement to me that more companies don’t realize that publicly doing the right thing can actually get one good press, and that bad stuff like this often becomes public, with very bad results. But there have been such stories before, and this is, well, another one.) You have to wonder what the executives who decided to have their sales force aggressively market a drug they knew would result in avoidable deaths told themselves, and how they slept at night. Still, it’s not an unfamiliar phenomenon.
Here, however, is where things get truly surreal:
“They were trained how to smile, speak and position themselves most effectively when talking with doctors, and were exhorted to sell Vioxx and other Merck drugs using the Rev. Martin Luther King Jr.’s “I Have a Dream” speech.
Rep. Elijah E. Cummings (D-Md.) read from a Merck training manual that directed instructors to play a recording of the speech and then say to the sales force: “King was someone with goal-focus — he kept getting shut down but kept going. . . . Just as with a physician, you must keep repeating the compelling message and at some point, the physician will be ‘free at last’ when he or she prescribes the Merck drug, if that is most appropriate for the patient.” ” (emphases added)
I can’t think of any response to this that would really do justice to the idea of selling not just any old medication, but one you know can have lethal side effects that you are not disclosing, using the ‘I Have A Dream’ speech. Really, I can’t. But I do wonder who this sales pitch is supposed to work on. If someone came into my office and tried to pitch a pain medication in this way, I’d burst out laughing and show him or her the door. And if I were a Merck sales executive and one of my subordinates came up with the idea of this pitch, one more marketing person would join the ranks of the unemployed.
I mean, what’s next? Telling doctors that once they prescribe Rogaine, they can say to themselves, “Now lettest thou thy servant go in peace, O Lord”? Pitching Viagra using the ‘Ave Maria’?
After my mother’s liver transplant, we went thru a fairly tedious application process, which was repeated bi-annually, but then received all her anti-rejection drugs from Novartis totally free for four years. Roughly $150k. Of course, a fair assumption is that we were the far from unique or unusual. Not was this the only drug we received free.
So I have a generally more positive view of a lot of drug companies, and questions as to what all is included in their “marketing” budgets. Maybe my mother’s free drugs?
OTOH, she also had a need for an orphaned very benign steroid, “oxandrin”, and in the course of the long research I did on the drug….well, to be brief, it involves an exclusive license to manufacture or sale in the US, and some obscene price-gouging of HIV sufferers.
$5 per dose in America, 5 cents in Mexico.
Makes me wonder what the pitches of the old snake-oil medication looked like. I’ll bet there was some mighty King James language in there.
I interpret the articles discription of use of the “I have a dream” speech as part of the motivation in training the salesmen, not as part of the sales pitch itself. It’s not clear to me what the “compelling message” was that would free the physician from the pesky salesman.
If it were part of the sales pitch, it wouldn’t be the first time the speech was used to sell. King’s ‘Dream’ Becomes Commercial is a reminder of a what I remember as a mercifully short ad campaign.
Ah, hilzoy, this is why you and I will never rise to the top of the marketing department of the Sirius Cybernetics Corporation.
The scientific corruption here is staggering. The paper demonstrating Vioxx’s supposed value was authored by Dr. Lisse of the University of Arizona. Dr. Lisse’s name was used by Merck to give an entirely-false scientific imprimatur to the results.
Lisse didn’t know a ding-dang thing about the experiments: Merck did all the work. Merck hid the heart attack data from Dr. Lisse so that Vioxx’s level of danger never reached statistical significance, and Lisse never bothered to inform himself of the facts until his victims began accumulating in the nation’s morgues (below quoted from the May 1st NY Times):
Dr. Lisse said that while he was listed as the paper’s first author, Merck actually wrote the report, an unusual practice.
“Merck designed the trial, ran the trial,” Dr. Lisse said. “Merck came to me after the study was completed and said, ‘We want your help to work on the paper.’ The initial paper was written at Merck, and then it was sent to me for editing.”
Dr. Lisse said he had never heard of the case of the woman who died, until told of it by a reporter. “Basically, I went with the cardiovascular data that was presented to me,” he said.
The 73-year-old woman who became the subject of the debate inside Merck died on Oct. 21, 1999, a few minutes after calling her son to tell him she felt short of breath. By the time her son reached her house, she was dead. Records show she had been taking 25 milligrams of Vioxx a day as part of the clinical trial.
My name is Tina Harris and i would like to show you my personal experience with Vioxx.
I am 40 years old. Have been on Vioxx for 6 months now. I had quit taking Vioxx long before the recall because it was the only new med introduced into my regimen at the time the symptoms started. I was told that if I continued to take it, I would be let go from my job because of inability to perform simple tasks.
I have experienced some of these side effects –
vertigo, diarrhea, abdominal pain, respiratory problems and memory loss. I still have memory loss and have gaps in my thinking process where I can’t even think of common words I am trying to say, even to this day.
I hope this information will be useful to others,
Tina Harris