Now, big pharma has made some great contributions to health care. But that does not mean we should ignore what they do wrong. And what I object to is how they market their drugs.

Hearing gives look into Vioxx marketing

Instructions to the company’s sales crew were as detailed as how long to shake a physician’s hand — three seconds — and how to eat bread when dining with doctors — “one small bitesize piece at a time.”

Sales representatives were offered $2,000 bonuses for meeting sales goals, and worked in campaigns with such code-names as “Project Offense” to try to boost sales even as regulators were about to increase warnings on the drug’s label.

Don’t bring up the heart risks, warns a February 9, 2001, memo.

And when doctors asked about those risks, the Merck sales reps were to refer to a “cardiovascular card” with data suggesting that Vioxx could be safer than other anti-inflammatory drugs. Yet the card, also released Thursday, doesn’t include the very study that raised the first warning signal that Vioxx could harm.

“The Cardiovascular Card is an obstacle handling piece,” says an April 2000 memo to Vioxx sales reps, written just after the first heart-related research began trickling in. It “will allow you to set the record straight with your physicians.”

The documents were released at a hearing of the House Government Reform Committee.

Merck Vice President Dennis Erb defended the company’s handling of Vioxx, noting that it promptly released details of studies that first raised the specter of heart damage — and followed up by performing the study that ultimately doomed the drug.

“We believed wholeheartedly in the safety of Vioxx and that Vioxx was an important treatment option,” he said. “My own father was a regular user of Vioxx until we voluntarily withdrew it from the market.”

But even as scientific debate about Vioxx’s heart risks began in 2000, sales of the painkiller steadily soared, to $2.5 billion in 2003.

“Why did doctors write so many Vioxx prescriptions even as evidence of harm mounted?” asked Rep. Henry Waxman, D-California.

Sales tactics in directly promoting the drug to doctors, he concluded: “When it comes to the one thing doctors most needed to know about Vioxx — its health risks — Merck’s answer seems to be disinformation and censorship.”

Now I know that some will argue that this just represents free market salesmanship. However, I do believe that pharmaceuticals should be held to a different standard than cars, clothes, or refrigerators.

I refuse to meet with sales reps – because I do not believe a word they say. This article reinforces my paranoia.

Related posts:

1. Risks and benefits – what if Merck starts selling Vioxx again?
2. More on Vioxx
3. TV drug ads
4. Post marketing studies – are they another drug company trick?
5. An interesting perspective on the Vioxx damage award

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