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Prescription for Change
Drug giant Merck was back in hot water this month when it was accused by the prestigious New England Journal of Medicine of manipulating data on its pain medication drug Vioxx. According to the medical journal, Merck suppressed information it had on additional heart attacks among Vioxx users when it published its clinical trial data five years ago. Had that data been included, it would have shown that the drug was far more risky than other pain relievers already on the market. This latest revelation added to the mounting woes of Merck, which is fighting for its corporate life in courtrooms across the nation. It seems clear that when the company put its blockbuster arthritis drug Vioxx on the market in 1999, it already had the results from clinical studies that indicated the drug might put patients at increased risk for heart disease. Yet the company not only withheld that scientific information in order to win support for Vioxx, it also had a strategy for influencing physicians – the people who would actually prescribe the drug for patients. Merck went so far as to publish a training manual for its sales representatives called "VIOXX Dodge Ball," instructing the marketers on how to dodge doctors' questions on safety concerns. In its power point presentation, Merck would instruct its sales reps on how to “dodge” physicians’ concerns like “I am concerned about the cardiovascular effects of Vioxx.” Sadly, these concerns proved to be all too real. Not only were Merck’s sales reps trained to dodge questions, internal records showed that the company targeted important doctors in the community and set out to woo them with gifts and in some cases outright financial assistance. The gifts – typical of other pharmaceutical companies – ranged from pens, notepads and pizza to watches, golf trips and five star dining. A New York Times article reported that five and even six figure checks have arrived unsolicited in doctors’ offices as a means of inducing prescriptions by the industry. At a minimum, Merck’s salespeople were to “neutralize” the doctors who seemed hostile to Merck and Vioxx. Clearly, the company’s strategy of suppressing adverse studies and influencing physicians worked. For a time Vioxx was considered a hugely profitable drug for the company. But then the reports of patients’ injuries and deaths started to mount.
Placing strict monetary limits or outright bans on gifts from pharmaceutical companies to doctors is one way for states to eliminate the unethical practice of gift-giving by pharmaceutical companies. For example, Minnesota was the first state to cap gift value at $50 per gift, with some exceptions, in 1993. Also, states can require doctors and drug companies to report the value, nature, and purpose of any gift or economic incentive over a certain value given to a health care provider. Recently Maine and Vermont have enacted laws doing just that. Holding up to public scrutiny the pharmaceutical industry’s gifts and doctors who take them will help to curtail this scandalous practice, help save health care dollars, and most importantly save patients’ lives. That’s all for now. I’ll be keeping an eye on the Capitol and will talk to you again next week. |
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