The painkilling drug rofecoxib (Vioxx) was originally licensed in the USA in 1999. It proved quite a success for its manufacturer, the drug company Merck, until it emerged that the drug was associated with a significantly increased risk of cardiovascular events (heart attacks and strokes). Merck withdrew the drug in 2004, but not before there were accusations that certain data had been withheld (seemingly in an effort to downplay the real risks of the drug). And last month, it was revealed that some of the data which supported the use of rofecoxib as a painkiller had been made up by Professor Scott S. Reuben, formerly of the Baystate Medical Center in Springfield, Massachusetts, USA.
Even more recently revelations have emerged which concern supposed tactics used by Merck to deal with dissenting doctors who were not supportive or actually critical of rofecoxib during its early days on the market. These were reported in a news story that was published in the British Medical Journal earlier this week .
Merck’s tactics were revealed in court during the proceedings of a class action lawsuit against Merck which is currently taking place in Australia.Extracts of internal emails from Merck employees were read out in court which discussed a “list of ‘problem’ physicians that we must, at a minimum, neutralise.” Merck apparently compiled a list of 30 doctors who were described in one email as “important from a business perspective in terms of influence and/or prescribing” and “not as supportive of Merck and/or Vioxx as we would like.”
The BMJ story cites one case which discusses a university based rheumatologist who “requires very large honorarium to talk.” In another case Merck staff recommended spending more than $50 000 on a fellowship programme for a highly influential professor and engaging him in research activities described as “show me the money”clinical trials.” Some might conclude that such tactics are indeed attempts to buy off influential doctors, and effectively ‘neutralise’ them.
It is alleged that if neutralisation was not possible, Merck appeared to make more sinister moves: it singled out one doctor, who seemed to be beyond neutralisation, with a “strong recommendation to discredit him.”
What we appear to have here is an example of a drug company attempting to wield undue influence over doctors ” with money. This is not the first time such a state of affairs has been aired in public. See here for more revelations regarding the sort of financial inducements drug companies offer doctors to help market their products.
The Merck list of 30 dissenting doctors was compiled in 1999, when concerns about rofecoxib’s safety first surfaced. Remember too, that there have been accusations that Merck withheld critical data that downplayed the hazards of the drug. This may have extended the life drug, but might also have been to the detriment of many who took. And now on top of this we have accusations that suggest that Merck undertook an organised and systematic approach to winning over key doctors with cash, while at the same time discrediting others who were not for turning. It looks to me that the marketing of Merck’s rofecoxib will go down as a tawdry episode in the history of pharmaceutical medicine. My hope is that those who have suffered as a result will get justice and due compensation.
1. Moynihan R. Court hears how drug giant Merck tried to “neutralise” and “discredit” doctors critical of Vioxx. BMJ 2009;338:b1432