Merck Attempted to Quash Vioxx Criticism

Drug maker Merck attempted to censor critics of Vioxx as early as 2000, an investigation by NPR finds. That year, a study indicated that the painkiller might cause heart problems. The story raises larger issues about the role of pharmaceutical firms' funding of medical schools and independent doctors.

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NPR is reporting that drug giant Merck attempted to censor critics of its painkiller Vioxx several years before the drug was taken off the market. The critics were concerned about reports suggesting the drug was potentially bad for the heart. Internal documents obtained by NPR show that Merck closely watched doctors who questioned Vioxx's safety and applied pressure to their medical institutions to try and stop the criticism. In a follow-up to a report broadcast yesterday, NPR's Snigdha Prakash explores what this says about the independence and future of medical research.

SNIGDHA PRAKASH reporting:

Like all drug companies, Merck pays influential doctors to promote its drugs. One of the doctors Merck recruited to help launch its painkiller Vioxx was Gurkirpal Singh of Stanford University. Merck wanted Singh because he had worked on a seminal study that had established the need for new painkillers such as Vioxx, and its rival, Celebrex, that were gentler on the stomach. In 1999, the year Vioxx was launched, Singh gave 40 lectures in seven months for Merck. The company paid him up to $2,500 apiece. Then, in 2000, Merck got evidence that Vioxx could be bad for the heart. Singh drew attention to those potential problems in his lectures to doctors. Merck canceled many of his talks. And when Singh still didn't back off, Merck senior vice president Dr. Louis Sherwood called Singh's boss at Stanford to complain. Singh's boss, James Free, says he felt threatened by the call. He says he was left with a sense that if he didn't rein in Singh, Merck's financial support for medical research at Stanford would be at risk.

Mr. DAVID ROTHMAN (Columbia University College of Physicians and Surgeons): Is it wrong for a drug company to make that phone call?

PRAKASH: David Rothman is director of the Center on Medicine as a Profession at the Columbia University College of Physicians and Surgeons.

Mr. ROTHMAN: The answer to that question is yes. If research grants become a tool for marketing, we've crossed a line.

PRAKASH: Ted Mayer, a lawyer representing Merck, says it's unfair to say that Sherwood's call implied any threat to Stanford's research funding. Sherwood was a former academic himself.

Mr. TED MAYER (Lawyer Representing Merck): I think what Dr. Sherwood was trying to do was to speak peer to peer, as somebody who had been a chief of medicine at respected hospitals, to a colleague, and to express his view of the science to his colleague in a context where he expected that he would get a fair hearing for his view.

PRAKASH: Sherwood also denies he made threats to Stanford or anybody else. Singh's boss wasn't the only senior academic whom Sherwood called. He also called heads of departments at seven other institutions to complain about researchers there who had criticized Vioxx.

Drummond Rennie is deputy editor of the Journal of the American Medical Association.

Mr. DRUMMOND RENNIE (Deputy Editor, Journal of the American Medical Association): They'd never pick up the phone did he not represent real money in the form of real grants coming in large amounts and that's the problem. Everybody is in hawk, if you like, to money they already have and the expectation of future money from the big pharmaceutical companies.

PRAKASH: Merck spread money liberally to cultivate doctors and researchers who could help Vioxx's sales. The company offered a range of inducements from speaking fees to research grants, as well as meals in fancy restaurants and trips to resorts. Vioxx racked up billions in sales. But the arrangement proved risky for public health. By one estimate, Vioxx caused at least 38,000 deaths from heart attacks. Merck disputes that number. David Rothman of Columbia says it's time to re-evaluate the relationship between drug companies and academic medical researchers.

Mr. ROTHMAN: Look, we all knew that drug reps were company salespeople and we all knew that docs were a little bit too friendly to get their big dinners and their trips, and we've begun to rein that in. And we haven't really yet begun to figure out how to control relationships between academic medical institutions and drug companies.

PRAKASH: Rothman says there's no question the drug companies and universities need each other.

Mr. ROTHMAN: We do want new drugs. We do want new discoveries. We do want universities being able to take what they've learned about molecules over to drug companies to enable them to produce them and distribute them. We don't have the luxury of saying, `Never the twain shall meet.'

PRAKASH: But he and others say the terms of the alliance between academia and big drug companies must be more transparent and better regulated. Otherwise, the risk is too great, that an arrangement that's meant to nurture research and public health may poison it. Snigdha Prakash, NPR News, Washington.

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