Merck & Co.’s marketing team targeted doctors viewed as unfriendly toward Vioxx to bring them into the fold, neutralize or discredit them, the plaintiff’s lawyer in the nation’s first Vioxx-related lawsuit to go to trial alleged Tuesday.
Houston litigator Mark Lanier questioned Nancy Santanello, head of Merck’s epidemiology department, about an internal list of 36 doctors identified as "physicians to neutralize” in an e-mail circulated two months after the popular painkiller went on the market in 1999.
"Attached is the complete list of 36 physicians to neutralize with background information and recommended tactics. You will notice that some have already been ‘neutralized,’ " the e-mail said. It also said a previous e-mail had a subset of the 36 physicians "we would like to get involved in Merck clinical research” and that the e-mail’s recipient should "be aware of our most challenging (and also most vocal) national and regional physicians.”
Santanello said the term "neutralize” was a marketing strategy to educate doctors about Vioxx.
"I’m not a marketing person. What the marketing people do is ask the scientists to meet with the physician and explain the data to them,” she told jurors.
The case is the first of more than 4,200 Vioxx-related state and federal lawsuits filed across the country to go before a jury, according to Merck.
Federal lawsuits have been consolidated in New Orleans, where a federal judge said Tuesday that the first would go to trial in November, Merck spokesman Kent Jarrell said. Lawyers in the federal actions have yet to choose which suit will go to trial first. Other state cases are slated for trial in South Texas and New Jersey in September.
In the Angleton case, Santanello is Merck’s corporate face, representing the company among its team of lawyers.
Lanier pressed her Tuesday about written recommendations to gain each doctor’s support for Vioxx. In one case, the document said "Show me the money” next to the name of a doctor and then noted Merck had provided that doctor with $25,000 to support a program to examine treatment of arthritis. In another instance, the document said ‘’discredit” next to the name of a doctor allegedly deemed unwilling to be swayed.
Santanello said such grants from pharmaceutical companies are common. She also said "discredit” meant providing an alternate viewpoint, and doctors who expect their views on drugs and treatment to be heard can be critical if they think a company ignores them.
"They definitely consider themselves thought leaders, and they want to be included,” she said.
The case on trial 40 miles south of Houston centers on the May 2001 death of Robert Ernst, a 59-year-old produce manager at a Wal-Mart who also ran marathons and worked as a personal trainer. He took the drug for about eight months before he died in his sleep of an arrhythmia—or irregular heartbeat—next to his widow, Carol, who is the main plaintiff.
She alleges that Vioxx caused his death and that Merck knew the drug was dangerous years before voluntarily pulling it from the market in September.
Lanier on Tuesday presented documents that showed several Merck sales representatives repeatedly called Ernst’s doctor, Brent Wallace, in Cleburne near Fort Worth, in 1999 and 2000 to discuss Vioxx safety and encourage him to prescribe the drug more often.
Merck says the company acted responsibly, disclosed Vioxx research and voluntarily removed the drug from the market last year when a study showed it doubled the risk of heart attack if taken for a year and a half or more.
New Jersey-based Merck also argues that no studies link Vioxx to arrhythmia, so the drug couldn’t have caused Ernst’s death. Lanier’s legal team argues that arrhythmia is most often caused by heart attack, but Ernst died too fast for his heart to show damage.