White Coat, Black Hat: Adventures on the Dark Side of Medicine [2010] by Carl Elliott

Author:Carl Elliott
Language: eng
Format: mobi
Tags: Industries, bad pharma, Health & Fitness, Health Care Issues, Medical, !!!, Ethics, Pharmaceutical & Biotechnology, read it, Business & Economics
ISBN: 9780807061435
Publisher: Beacon Press
Published: 2010-10-13T00:00:00+00:00

In 1999 Merck launched its blockbuster pain drug the COX-2 inhibitor Vioxx. Within a year of its launch, prominent academic physicians, including Merck’s own thought leaders, were raising questions about a possible link between Vioxx and heart disease.52 Desperate to squelch this criticism, Merck executives began to circulate a list of thought leaders who needed to be “neutralized” or “discredited.” In an internal e-mail, a Merck employee wrote, “We may need to seek them out and destroy them where they live.”53

One such thought leader was Dr. Gurkirpal Singh, a rheumatologist with an adjunct appointment at Stanford University who had started to consult and speak for Merck in the late 1990s, nearly two years before Vioxx was launched. Merck had recruited Singh as a thought leader because of his research showing that naproxen, a competitor of Vioxx, was associated with gastrointestinal bleeding. Singh began giving grand-rounds lectures and dinner talks, commanding what a Merck salesperson described as “relatively large honoraria” of twenty-five hundred dollars per event. In a seven-month period, Singh gave forty talks for Merck.54

By early 2000, however, Merck had completed a large study that showed damaging results. The VIGOR study found that although Vioxx caused less gastrointestinal bleeding than naproxen, it was associated with an increased risk of heart disease. As Singh later told a Senate subcommittee, “The results of the VIGOR trial—a five hundred percent increase in the risk of heart attacks with Vioxx—stunned me. Clearly, the trade-off of five hundred percent increase in heart attacks for a fiftypercent reduction in stomach bleeds did not seem attractive.” Merck duly submitted the VIGOR study to the FDA, but in the company’s press releases, they gave the results a remarkable spin. Rather than concluding that Vioxx caused more heart attacks than naproxen, Merck claimed that naproxen protected the heart. Singh asked Merck repeatedly for the raw data from the VIGOR study. “I wanted to know how many heart attacks, how many strokes, how many deaths were occurring in each one of the groups, and what were these actual number of patients at risk, and how many ended up having an event.” Merck stonewalled him, promising that the results would eventually be made public.

Frustrated with Merck’s unresponsiveness, Singh began to speak openly about the potential risks of Vioxx. In his lectures he showed a cartoon of a man under a blanket, asking the audience to speculate about what Merck was hiding. At first, Merck responded by simply canceling Singh’s lectures. But some people in the company worried that this strategy would backfire. An internal e-mail from a San Francisco–area business director said, “The one thing I am pretty sure of is that Dr. Singh could impact us negatively if he chose to do so . . . I would recommend we handle this very carefully . . . I just don’t think canceling all the programs and walking away completely will serve us well in the long term.”

Eventually, a senior executive at Merck, Dr. Louis Sherwood, made a telephone call to the home of a department chair at Stanford, Dr.

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