The U.S. cases allege that Nuvaring has a propensity to cause potentially lethal blood clots because it delivers a constant, ongoing dose of hormones instead of the rising-and-falling doses experienced by women who take a birth control pill. Although it was not a secret that Merck was litigating over Nuvaring, few people noticed a German-language report in Switzerland last year that claimed there were 40 deaths "in round figures" contained in the FDA database of adverse events associated with the drug. The database contains unconfirmed reports that vary wildly in quality, so the true number of deaths will likely be lower.
Merck has grown sales of Nuvaring into a respectable business. Although it is a niche product -- not all women want to use a suppository -- it had $559 million in sales last year (see page 53).
The Swiss report notes that there were about 130 deaths associated with another contraceptive device that also delivers a constant stream of hormones -- Johnson & Johnson's Ortho Evra birth control patch. J&J settled litigation over that brand in 2008. It remains on the market but J&J no longer actively promotes the drug. The FDA has yet to publish the results of a lengthy review of the product.
In the Estonia video, which appears to have been shot with a cellphone, doctors are shown being served alcohol before sitting through a Merck presentation on Nuvaring that featured dancers waving outsize Nuvaring devices. The report says no risk information was provided to doctors:
In the video, a speaker is heard saying that "Nuvaring is suitable for absolutely everyone--" and then merry gynecologists take part in a sing-along to popular tunes rewritten to feature NuvaRing.Sponsored medical education seminars are supposed to contain serious research content. When the reporter finally identified herself to a Merck exec and asked for an interview, the exec told her to go to hell:
In the end, an MSD manager, after being asked for an interview, twice tells journalist Kadri Jakobson to minge kuu peale ("Go to the moon," but closer in spirit to "Go to hell").Related: