Evelyn Pringle June 16, 2006
Merck's top management team reportedly remains unphased by Vioxx litigation woes. In fact, Prudential Equity Group analyst, Timothy Anderson, says Merck's Chief Executive, Richard Clark, specifically told him that "Vioxx does not keep him up at night."
According to Mr Anderson, "the company believes that lower court cases will be overturned on appeal, and it is even considering trying to reintroduce Vioxx."
"A reintroduction might help Merck's legal case," Mr Anderson states, "as long as the FDA or its advisers do not decide that Merck's risks really do outweigh its benefits," he said in a June 21, 2006, article in Forbes.com."
Critics say that's not even a remote possibility because the FDA is still under fire for its own part in the Vioxx disaster and it wouldn't dare pull a stunt like that.
When it comes to saving Merck in the Vioxx litigation, the FDA is at odds with some of the most powerful leaders in Congress. Senator Charles Grassley (R-Iowa), chairman of the Senate Finance Committee, is on record as saying the Vioxx debacle has shown that the FDA has gotten too cozy with drug companies to conduct proper oversight.
"The Vioxx example showed that the FDA and Merck were too close for comfort," he said in a speech. "Testimony and documents at our Finance Committee hearing showed that the FDA allowed itself to be manipulated by Merck."
Documents indeed reveal that the FDA knew about the problems with Vioxx very early on. A memo written by Shari Targum, MD, Project Manager for the Division of Anti-inflammatory Drug Products, clearly shows that as of November 18, 1999, the Data and Safety Monitoring Board of the VIGOR study, a committee independent from Merck, was concerned over the deaths from cardiovascular events in the Vioxx group, compared to the group taking another painkiller.
This memo documents a clear date of recognition by the FDA of when cardiovascular events were brought to the attention of Merck.
Admittedly, if it was up to the Bush administration, the FDA would allow Vioxx back on the market today. Bush does everything in his power to protect the profits of Big Pharma, the industry most responsible for his 8-year rent free lease of the White House.
Under Bush, the FDA has in fact become Big Pharma's chief enabler when it comes to getting away with murder. A newly released report on June 26, 2006, titled, "Prescription for Harm: The Decline in FDA Enforcement Activity," says that FDA enforcement actions have declined by 50% since Bush took office.
"The number of warning letters issued by the agency for violations of federal requirements," the report said, "has fallen by over 50%, from 1,154 in 2000 to 535 in 2005, a 15-year low."
"During the same period," it noted, "the number of seizures of mislabeled, defective, and dangerous products has declined by 44%."
Bush has never hesitated to utilize the FDA in the Big Pharma protection racket. For instance, on January 18, 2006, the FDA issued new regulations for labeling prescription drugs, supposedly aimed at providing doctors and patients with clearer information about their risks. But in the preamble to the regulations, the FDA inserted a claim that lawsuits alleging a failure to warn of known or reasonably knowable risks are preempted by federal law.
Also, amicus briefs filed by FDA attorneys appointed by Bush, on behalf of the drug companies, have tried to claim that because private lawsuits threaten to disrupt the nation's system of drug regulation, federal standards preempt requirements established by state judges and lawmakers, and that if a state court finds that a drug is unsafe, it is in direct conflict with the conclusion reached by the FDA.
With Bush using the FDA to do the dirty work, Republicans lawmakers up for reelection this fall, don't have to make a spectacle of themselves fighting for such blatant industry-friendly legislation during an election year.
A partner in the LA based Baum Hedlund law firm, attorney Karen Barth Menzies, has been litigating claims against drug companies for more than a decade and says "the Vioxx public health debacle has served to highlight deep-seeded problems within the FDA."
"Drug companies are profit-driven," she explains, "and are loath to issue warnings about risks associated with their drugs, even those that become quite clear."
"Medicine is no longer about health," Ms Menzies notes, "its about market share and profits."
Since Bush took office, the FDA has sent out its legal squad to assert the preemption argument on behalf of drug companies in attempt to defeat private citizens in lawsuits numerous times. However, Ms Menzies' team of Baum Hedlund attorneys has knocked the FDA briefs out of the ball park in a several cases, including Witczak v Pfizer and Motus v Pfizer.
But "the FDA's legal arm has continued to intervene in private civil lawsuits on the side of drug companies," she says, "arguing that FDA's decisions should not be second-guessed by anyone, the federal preemption argument."
In the past 15 plus years, Ms Menzies notes, the FDA has been worse than "comatose" as the New York Times recently described the agency. "It has sided with industry and become an adversary against consumers," she points out.
"And it is precisely for this reason," she says, "that the public is in such desperate need for an agency that advocates for them, rather than the drug industry."
In light of recent disasters like Vioxx that have resulted in large part due to a lack of regulatory oversight, Ms Menzies contends that the "FDA's decisions must be second-guessed for the safety of the public."
Medical experts agree that the FDA must be second-guessed. "With an FDA that regularly displays incompetence and negligence in its deliberations about the efficacy and safety of medications," says Dr Grace Jackson, author of, Rethinking Psychiatric Drugs: A Guide to Informed Consent, "it cannot possibly be the case that this federal agency possesses the institutional expertise to which courts or litigants should now defer."
"Indeed," she notes, "if the FDA is preempting anything, it is the sound practice of medicine, and the integrity of American health care."
It will truly be a fatal day for the concept of separation of powers when a federal agency like the FDA can wield the power to enact federal law by filing legal briefs in private lawsuits, funded by tax dollars, to defeat American citizens who are already up against one of the most profitable industries on earth.
Moreover, if FDA attorneys are going waste tax dollars, the least they can to is come up with a few valid arguments. The argument that drug companies are not allowed to warn the public by adding a new warning to a label when dangers become known because it would violate FDA regulations, is ridiculous. There is not now, and there has never been, a law that prevents a drug maker from strengthening a warning or labeling consistent with the company's specific regulatory ability to do so under 21 CFR 314.70(c)(6)(iii)(A).
The guy responsible for this silly argument is the FDA's Chief Counsel, Daniel Troy, recruited straight off of Pfizer's legal team, was Big Pharma's inside man until he quit the FDA in the fall of 2004.
Instead of going after the drug companies for killing off citizens with lethal drugs in the name of profits, he devoted much of his time filing Joe Tax Payer funded briefs, on behalf of his former industry clients, and even invited drug company attorneys to submit their cases to him for amicus brief consideration.
On March 1, 2004, Jessica Rae Dart, an attorney involved in civil litigation against Pfizer, filed an affidavit in support of a plaintiff's motion and described a lecture she attended by Mr Troy that clearly shows him offering the FDA's services to trial lawyers representing drug companies.
On December 15, 2003, Ms Dart said, Daniel Troy, Chief Counsel of the FDA, headed a discussion for pharmaceutical firms and defense attorneys titled, "The Case for Preemption" at the 8th Annual Conference for the In house Counsel and Trial Attorneys, Drug and Medical Device Litigation" in New York City.
During Troy's "Case for Preemption" talk, she said, Troy stated that he was the initiator behind all the FDA Amicus Briefs and/or Statement of Interest filed on behalf of manufacturers "since the new administration" took over. Specifically, he stated, "I am not the only one who decides," but "I am the initial proposer."
According to the affidavit, Troy made it clear that he wanted to file more amicus briefs on behalf of the drug companies and actually invited members of the defense attorney's audience to approach him with requests for briefs, stating "we can't afford to get involved in every case," we have to "pick out shots," so "make it sound like a Hollywood pitch."
However, in an obvious effort to try and level the playing field for the little guy, in 2004, Representative, Maurice Hinchey (D-NY), chastised the administration for taking the FDA in a radical new direction, "seeking to protect drug companies instead of the public," and persuaded the House to cut $500,000 from the budget of the chief counsel's office as a penalty for the FDA's aggressive opposition to citizen's lawsuits.
Although the FDA's current Chief Counsel, Sheldon Bradshaw, might not have the direct and visible financial links to Big Pharma of his predecessor, critics say, he certainly does not represent a changing-of-the-guard in political leadership at the FDA.
"In fact," Attorney Menzies says, "following in his predecessor's footsteps, Bradshaw submitted a legal brief in support of Pfizer's federal preemption arguments."
Judges across the nation have flat-out rejected the FDA's argument. A Minnesota court said it declined "to treat statements from a single FDA legal brief as declarations afforded the preemptive force of law."
A California court ordered the brief stricken from the record calling it "hearsay and irrelevant," and an Illinois judge said it "contains nothing more than legal argument by [FDA] counsel."
Most recently, in a June 6, 2005, Vioxx court hearing, the FDA's position on preemption hit a major road block with New Jersey State Court Judge, Carol Higbee, who is handling the Vioxx cases, when she labeled the FDA's Final Rule's preamble "a political statement by the FDA." She scoffed at the agency's preemption claim and said:
"It is contrary to the U.S. Supreme Court's decisions. It is contrary to all the law on preemption. ... In addition to being contrary to the law of the land, it is also contrary to the Constitution of the United States."
Judge Higbee ended her comments by throwing cold water on any planned attempt by Merck's legal team to give the preemption argument a whirl, by telling them right-out in open court: "I am not going to allow you to use it."
Speaking to the Consumer Federation of America in March 2005, Senator Grassley, basically said the FDA can't be trusted to protect citizens against dangerous drugs like Vioxx because the agency is to "cozy" with companies like Merck.
Based on a clinical trial that took place in 2000, he told the audience, both the FDA and Merck were aware that heart attacks were 5 times more likely in patients taking Vioxx than among those taking a similar drug, but the FDA did nothing to change the labeling on the drug for nearly two years, while Merck aggressively marketed Vioxx on nightly TV.
Describing whistleblowers as "patriots" who risk their careers in the interest of public safety, Senator Grassley recounted the controversy over Vioxx that was fueled in large part by the efforts of FDA scientist, Dr David Graham, to shed light on the drug's potential risks.
Senator Grassley described how the FDA "disregarded and stonewalled" concerns raised by its own scientist. "Dr. Graham completed a study that found an increased risk of heart attacks and strokes in patients taking Vioxx," he told the Federation. "His immediate supervisor, however, dismissed this study as 'scientific rumor.'"
"The very same month that Dr. Graham warned the FDA of the cardiovascular risks of Vioxx," Senator Grassley continued, "the FDA approved the use of Vioxx for children."
He told the audience how the director of FDA's office of new drugs suggested that Dr. Graham water down his Vioxx conclusions and how Dr Graham replied that in good conscience he could not. "When Dr. Graham was asked to present his findings at my committee's Vioxx hearing," the Senator said, "he was also undermined."
News reports that day show that acting FDA Commissioner Lester Crawford called Dr Graham a "maverick who did not follow agency protocols."
"This statement," Senator Grassley told the Federation, "made on the eve of the hearing, could logically serve no purpose other than to intimidate Dr. Graham."
The Vioxx matter became the focus of the Senate Finance Committee, basically because of the drug's cost to public health care programs, and the Committee is responsible for oversight of the Medicaid and Medicare programs.
During a November 18, 2004, hearing, the ranking Democrat on the finance committee, Senator Max Baucus, discussed the tax dollars wasted on Vioxx: "In the 5 years that Vioxx was on the market, Medicaid spent more than $1 billion on the drug," he said.
In addition, he complained about the fact that government programs are now paying the medical bills for patients harmed by Vioxx. "Medicaid bears the cost of any additional medical care necessary when drugs cause injury," Senator Baucus said.
Merck's last CEO, Raymond Gilmartin, resigned on May 5, 2005, the same day that another Congressional Committee, the House Committee on Government Reform, released more than 20,000 pages of documents showing how Merck continued to promote Vioxx long after it was aware of the safety problems.
Documents released that day at a Reform Committee hearing on Merck's marketing practices, described in detail how Merck directed its 3,000-strong sales force to avoid discussions about the cardiovascular risks identified in the 2000 VIGOR study. During visits with doctors, sales reps were instructed to rely on a "Cardiovascular Card" that claimed Vioxx was actually protecting the heart rather than damaging it. The sales reps were specifically trained on how to speak, smile, and position themselves most effectively when talking to doctors.
If doctors asked about Vioxx increasing the risk, the sales reps were instructed to give them a pamphlet written by Merck's marketing department that claimed Vioxx was eight times safer for heart patients than similar pain medications, and omitted Merck's findings that Vioxx produced a 5-fold increase in the risk of heart attack and stroke compared with naproxen, the other painkiller used in the study.
The company's training efforts were obviously successful because Vioxx was approved by the FDA in May 1999, and the drug reached $2 billion in sales in two years, faster than any drug in Merck's history.
In 2000, the same year the VIGOR study was completed, Vioxx was the most heavily advertised drug in the US with $160.8 million spent on mass media promotion. And the blitz paid off well. In one year, retail sales of Vioxx rose from $329.5 million in 1999, to $1.5 billion in 2000, up 360%, according to a November 2001, report by the National Institute for Health Care Management.
For the same year, Pepsi only spent $125 million advertising its products. Vioxx also beat out Budweiser's spending of $146 million, and matched Dell Computer's ad expenditures of $160 million. And by far, the drug beat out Nike's advertising budget of $78.2 million for shoes, and Campbell soup's $58 million.
The increase in Vioxx sales from 1999 to 2000 accounted for 5.7% of the one-year increase in total prescription drug spending, more than any other single drug, the report said, and Vioxx was the 13th best selling drug in 2000.
In 2003, Merck upped the anti even more and spent 499.8 million on Vioxx promotion including the cost of sales reps detailing office and hospital-based physicians, advertising in medical journals and the retail value of samples passed out to doctors, according to IMS Health, Integrated Promotional Services in April, 2004. In return Vioxx saw growth of 24% and became the 6th best selling drug.
What's that old saying about the bigger they are the harder they fall?
Nowadays, instead of spending hundreds of millions of dollars promoting Vioxx, shareholders are paying hundreds of millions a year for attorney fees. As of December 31, 2004, in its 2005 annual report, Merck said it had a reserve of $675 million solely for its future legal defense costs related to Vioxx. And in the fourth quarter of 2005, Merck said it recorded another charge of $295 million to increase the reserve.
"This reserve is based on certain assumptions," the annual report said, "and is the best estimate of the amount that the Company believes, at this time, it can reasonably estimate will be spent through 2007."
There is no money listed anywhere in Merck's financial filings set aside to pay damages to any injured party, at least through 2007. The whole wad goes for Vioxx "legal defense costs."
And to think, Republicans have the nerve to say that personal injury attorneys who go up against attorneys with a war chest of close to $700 million a year are financial gluttons.
However, thanks to a helpful group of plaintiff's attorneys, going up against Merck in jury trials is getting bit easier. The group put together what they call a pre-made Vioxx trial package, complete with a guide to pursuing a claim against the corporate giant.
The package reportedly organizes and edits all of the information that shows Merck knew about the dangers of Vioxx but failed to inform consumers and includes the most damaging documents and evidence available against the drug maker. The package is offered on a small contingency fee basis and costs nothing until the lawsuit is won.
This month, Merck's legal eagles were hit up once again when the New England Journal of Medicine issued a correction to a paper it published last year on Vioxx that mistakenly said that heart risks only became apparent after 18 months. The Journal editors deleted the 18 month statements saying a statistical error by Merck undermined the evidence for them.
All through litigation thus far, Merck's main argument has been that the risk to patients from Vioxx did not begin until after 18 months of use, and with one sweep of the pen, the NEJM blew a hole in that defense.
But then juries are not buying into the 18 month defense in any event. In the first jury trial, in August 2005, the jury held Merck liable for the death of Vioxx victim, Robert Ernst, age 59, who died after only taking Vioxx for eight months.
Internal company documents introduced at the trial showed that Merck was aware of the problems with Vioxx as early as 1997. Attorney, Mark Lanier, showed jurors documents and e-mails to prove that Merck scientists knew about the cardiovascular risks (CVs), two years before the drug was approved.
For instance, one 1997 email written by Merck scientist Dr Alise Reicin, said: "The possibility of increased C.V. events is of great concern."
"I just can't wait to be the one to present those results to senior management," he wrote.
As evidence to prove that physicians were deliberately misled, the jury was shown a 2001 Dear Doctor letter, in which Merck specifically stated that in the largest study ever of more than 4000 patients taking Vioxx, only 0.5%, or about 20 patients, had incurred CVs, when in fact, 14.6% of the patients, or 590, had cardiovascular problems, according to a Merck report submitted to the FDA.
It was also proven at trial that in April 2001, the doctor who prescribed Vioxx to Mr Ernst, had received the letter with the fraudulent statistics.
Mr Lanier played a video for the jury that showed sales reps were told that Vioxx did not increase heart attacks and were trained to view doctors concerns about CVs as "obstacles" to be avoided or dismissed. Another training document told sales reps to play "Dodgeball" if doctors raised questions about CVs.
In a more recent on-going trial, on July 5, 2006, more damaging testimony against Merck was given by Dr Lemuel Moye, a professor of biostatistics at the University of Texas, in a California case filed by a 71-year-old, Stewart Grossberg, who told the jury that Merck's clinical trials conducted as far back as 1996, showed patients taking Vioxx were at risk for heart attacks and strokes, long before the drug went on the market, and that after reviewing the trials, he concluded that Vioxx carried more risks to patients than benefits.
But legal experts say that back in April 2006, Merck received the worst news possible when it lost an appeal to deny certification of a Vioxx-related class action lawsuit. They says the court's decision to certify third-party payers, like health insurance companies, HMOs, and unions, has to be the most disturbing development for the company to date.
By ruling against Merck, the court gave the OK to apply New Jersey's consumer fraud statutes to all members of the class, even to plaintiffs from states that have different laws. Experts predict that the consequences of this ruling will be profound and far-reaching, and the costs to Merck potentially staggering.
In light of the verdict in the April 2006, trial of Cona v Merck and McDarby v Merck, in which the jury said Merck violated New Jersey's consumer fraud statute because it misled physicians about the cardiovascular risks of Vioxx and concealed information about those risks from doctors, experts say, the appeals court's ruling might just turn out to be the nail in the coffin for Merck.
Christopher Seeger, the lead lawyer in the class action filed by HMOs, insurers, and unions, says that Judge Higbee, who is overseeing about 5,000 Vioxx cases, should apply the findings of this jury to the class action, which he said could be worth $10 billion.
Mr Seeger told Bloomberg News on April 5, 2006, that this was devastating for Merck: "This jury just said 'Yes' to consumer fraud, so I think we go right to damages."
Mr Seeger is referring to collateral estoppel a situation in which the judgment in one case prevents, or estops, a party from litigating the same issue in future cases. Because of the consumer fraud verdict, Mr Seeger contends that Merck may now be permanently bound by the jury's ruling.
Indeed, Bloomberg says, a judge could decide that the ruling that Merck failed to warn of Vioxx's risks could be applied to thousands of future trials in New Jersey, leaving the jury to decide only whether Vioxx caused specific heart attacks.
Barry Turner is an academic lawyer in the UK who has taught medical ethics and for a number of years has been involved in litigation activities related to the pharmaceutical industry.
He has been advocating the use of federal and state false claims statutes against Big Pharma for years. "I take the view that because of the harsh penalties imposed when these actions are successful," he explains, "that this is the legal strategy that will work against these people."
"PI suits," he says, "may very well be morally righteous but they will never make this industry change its ways."
"What is at issue," he continues, "is that companies factor litigation costs into 'research and development' and other costs of sales, so it does not hurt them to pay out in damages, what they already budgeted for."
"The Federal and State False Claims Act actions are different," he notes, "a drug company hit by a big one of these will have to pay out colossal amounts in fines and damages, hundreds of millions in most cases," he says, "and these come out of profits."
"Then the stock will go down," he explains, "and they can be hit again under the Sarbanes Oxley Act."
"And if anyone thinks that Sarbanes Oxley is feeble legislation," he says, "they can always ask the Enron executives."
"As well as defrauding the taxpayer," Mr Turners notes, "the consequences of these deliberate and deceitful acts hurts shareholders when the litigation causes serious downturns in stock value."
"This is a violation of Sarbanes Oxley," he says, "and sooner of later there will be a major action here."
In each of the cases Merck has lost, the juries have ordered the drug giant to pay large punitive damage awards, creating additional problems for the company. Punitive damages are awarded to punish a defendant and deter future misconduct. They are not covered by insurance because the conduct is an intentional act on the part of the insured; and the intent of punitive damages would be lost if a defendant could avoid payment simply by buying more insurance.
In the state of New Jersey, punitive damages are allowed to be as much as 5 times the amount of compensatory damages. The Texas $229 million punitive damage award against Merck, even when reduced, will still be about $26 million. Legal analysts say no company could avoid financial ruin if ordered to pay tens of thousands of $26 million punitive damage awards.
Punitive damages provide a basis for a derivative lawsuit seeking damages for conduct that compromised the value of the investments of shareholders. These types of lawsuits are being filed for much less than what Merck pulled with Vioxx.
For instance, in March 2005, a class action lawsuit was filed in the US District Court for the District of Massachusetts, on behalf of shareholders in Elan Corp PLC, after the company's withdrawal of the multiple sclerosis drug Tysabri, with many of the same allegations that can be made against Merck.
The complaint alleges that Elan failed to disclose and misrepresented material adverse facts in connection with Tysabri including serious immune-system side effects and that the information was concealed in order to fast track Tysabri for FDA approval.
In any event, notwithstanding that Merck continues to contend that it will try every single case, legal analysts say, state courts will never be able to handle the trials for the lawsuits already filed, much less the additional cases still being filed on a regular basis.
"At some point courts are going to be clogged with these cases and judges will start to put pressure on Merck and the plaintiffs to settle these cases," according to John Leubsdorf, professor of law at Rutgers Law School, on CNN Moneyline on April 26, 2006.
"The only scenario in which they won't settle," he says, "is if they win so much that all the plaintiffs go away."
But experts say that is definitely not going to happen.