MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
ROBERT SIEGEL, host:
And I'm Robert Siegel.
We continue now with our story about Merck and its efforts to suppress safety concerns about the painkiller Vioxx. NPR's Snigdha Prakash picks up with a look at how Merck exerted its influence in the world of top medical institutions.
SNIGDHA PRAKASH reporting:
Dr. Louis Sherwood's campaign to fix Vioxx critic Gurkirpal Singh began with a series of phone calls to Singh's bosses at Stanford University.
Professor JAMES FRIES (Stanford University): I don't usually receive phone calls on a Saturday at home from representatives of drug companies, so it was definitely unusual.
PRAKASH: James Fries is a professor of medicine at Stanford. It was October 28th, 2000.
Prof. FRIES: I received a call from a medical director at Merck stating that someone on my staff had been making wild and irresponsible public statements about the cardiovascular side effects of Vioxx.
PRAKASH: Fries says Sherwood hinted there would be repercussions for Fries and Stanford if Singh's statements didn't stop. He was left with a sense that Merck's financial support to Stanford was at risk. Fries started making calls of his own, and what he learned was this. Researchers at seven other institutions, including the University of Minnesota, the University of Texas-Southwestern and a Harvard teaching hospital had also raised doubts about Vioxx's safety. Sherwood had placed calls to those institutions as well.
Prof. FRIES: A number of investigators who had spoken publicly had been called or their chairs of their departments had been called, the deans of their medical schools. And a variety of veiled and not-so-veiled threats had been made that they were saying bad things about the drug company and that the people to whom they reported should take steps to see that this stopped.
PRAKASH: At Merck, medical director Sherwood wrote an e-mail to bring the marketing department up to speed. NPR has obtained that e-mail. It suggests that part of Merck's strategy to suppress criticism was intimidation. Sherwood's words are read by an actor.
Unidentified Reader: November 7th, 2000, Fries and I discussed getting Singh to stop making the outrageous comments he has in the past few months. I'll keep the pressure on and get others at Stanford to help.
PRAKASH: Sherwood advises one of the marketing executives on how to pressure Singh himself. He says, `Tell Singh that we told his boss about his Merck bashing, and tell him...
Unidentified Actor #8: `...should it continue, further actions will be necessary.' Don't define it.
PRAKASH: Lisa Bero is a professor of clinical pharmacy and health policy at the University of California-San Francisco. She's done extensive research showing how funding from drug companies influences academic science. She reviewed Sherwood's e-mail at NPR's request.
Professor LISA BERO (University of California-San Francisco): I didn't realize how powerful the drug companies thought they were--for example, having enough influence over a department to say, you know, `Change what your faculty member is saying.' You know, I haven't ever seen that documented before.
PRAKASH: Another document written by Sherwood shows Merck tried to use that influence on several occasions. After Stanford Professor James Fries learned about Sherwood's calls to other medical institutions, he sent a strongly worded letter to Merck's CEO. The letter questioned the propriety of Sherwood's calls. Sherwood wrote an internal memo in response. NPR has obtained that memo. In it, Sherwood writes, `There was no orchestrated campaign or specific program to deal with' what he calls `problem individuals.' Yet he lists groups of Merck executives who managed those critics.
Unidentified Reader: January 23, 2001, I will only get involved when our representatives, regional medical directors, Merck research lab physicians or key individuals in the therapeutic business group have felt frustrated by their inability to reach out to or balance selected individuals.
PRAKASH: And Sherwood implies that when that happened, he did lean on Vioxx critics and on other institutions.
Unidentified Reader: Without trying to appear immodest, I believe I am the most respected physician in the pharmaceutical industry among academic chairs and deans; therefore, when I call them on a matter of urgent concern, they generally take it seriously. This has been a source of strength since I have been able to exert balanced leverage in some difficult situations.
Prof. BERO: Well, the first thing I thought is, `What kind of leverage are we talking about?'
PRAKASH: Lisa Bero of UCSF.
Prof. BERO: And the first thing I thought of was money in all the various ways that it can come to departments.
PRAKASH: In 2004, Stanford's Medical School got 9 percent of its research budget, or $29 million, from drug companies. NPR surveyed several medical schools and found that's not unusual. David Rothman is of the Columbia University College of Physicians and Surgeons.
Dr. ROTHMAN: Look, medical research is expensive. No one can take a call from a drug company high official critical of an investigator and not realize that behind that call is the implicit reminder, implicit threat, `If you can't control your folks, how do you expect us to continue to do business with you?'
PRAKASH: Merck and Sherwood deny the allegations in this story. Ted Mayer is a lawyer representing Merck.
Mr. TED MAYER (Lawyer): Merck was not trying to silence critics. The scientific or the safety profile of this product was very well known in data that was available to the public, and it was vigorously debated. And it's perfectly appropriate to have that vigorous debate.
PRAKASH: Mayer says Merck was concerned about Dr. Singh because many of his talks went far beyond that vigorous debate.
Mr. MAYER: The number of people who heard those talks who were physicians and understood the data well believe that those talks were--contained unbalanced, inaccurate information and that the views were not supported by the data and were kind of at the extreme end, among hundreds of scientists that were making these presentations.
PRAKASH: In an interview with NPR, Dr. Louis Sherwood says it was rare for him to complain to department heads. He says he firmly believes in academic freedom. He says he only made calls when faculty members were being unfair to Merck and acting unprofessionally.
Dr. LOUIS SHERWOOD (Merck): I never, never made any threats to withdraw funding or hamper anybody's faculty appointment. Under no circumstances did I ever do that.
PRAKASH: Then why did Stanford's James Fries feel threatened when Sherwood called?
Dr. SHERWOOD: No one likes to be criticized. Now sometimes when an academic physician is criticized for his or her actions, they may interpret that as a threat. But under no circumstances did I threaten Stanford or Dr. Fries or anyone with funding issues or anything else. That would have been inappropriate.
PRAKASH: FDA whistle-blower Dr. David Graham estimates that at least 38,000 people died from taking 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): And each one of those is somebody--is a real person with a real family, real people who grieve for them. And I think it's the job of a physician, physicians who are doing research, physicians who work in drug companies--all physicians--to care about that.
PRAKASH: Merck says its physicians strongly believed in the safety and benefits of Vioxx. The company says the risks of Vioxx weren't clear, until just last fall when, it says, Merck acted promptly and voluntarily withdrew Vioxx. Snigdha Prakash, NPR News, Washington.
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BLOCK: As we've just heard, NPR surveyed medical schools to find out how much they depend on money from the drug industry. You can read the results at our Web site, npr.org.
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