The public got an extraordinary glimpse Thursday into the world of drug marketing, as lawmakers released confidential Merck documents that detail how a sales army of 3,000 aggressively pushed the multibillion-dollar drug before it was pulled from the market last fall because of heart attack risks.
Also, in an unexpected move, Merck's chief executive, Raymond V. Gilmartin, announced Thursday he was stepping down. Merck named Richard T. Clark to replace him.
Instructions to the company's sales crew were as detailed as how long to shake a physician's hand — three seconds — and how to eat bread when dining with doctors — "one small bitesize piece at a time."
Sales representatives were offered $2,000 bonuses for meeting sales goals, and worked in campaigns with such code-names as "Project Offense" to try to boost sales even as regulators were about to increase warnings on the drug's label.
Don't bring up the heart risks, warns a Feb. 9, 2001, memo.
And when doctors asked about those risks, the Merck sales reps were to refer to a "cardiovascular card" with data suggesting that Vioxx could be safer than other anti-inflammatory drugs. Yet the card, also released Thursday, doesn't include the very study that raised the first warning signal that Vioxx could harm.
"The Cardiovascular Card is an obstacle handling piece," says an April 2000 memo to Vioxx sales reps, written just after the first heart-related research began trickling in. It "will allow you to set the record straight with your physicians."
The documents were released at a hearing of the House Government Reform Committee.
Merck Vice President Dennis Erb defended the company's handling of Vioxx, noting that it promptly released details of studies that first raised the specter of heart damage — and followed up by performing the study that ultimately doomed the drug.
"We believed wholeheartedly in the safety of Vioxx and that Vioxx was an important treatment option," he said. "My own father was a regular user of Vioxx until we voluntarily withdrew it from the market."
But even as scientific debate about Vioxx's heart risks began in 2000, sales of the painkiller steadily soared, to $2.5 billion in 2003.
"Why did doctors write so many Vioxx prescriptions even as evidence of harm mounted?" asked Rep. Henry Waxman, D-Calif.