AZ Call Notes Expose Secret Life of Seroquel Reps ... And It's Mostly Scandal-Free

Last Updated Sep 23, 2009 11:19 AM EDT

The release of AstraZeneca's sales rep call notes in the Seroquel litigation is mostly good news for the company. Bloomberg highlighted some grim anecdotes in its coverage -- one rep told a doctor that Seroquel did not cause diabetes and another offered doctors $1,500 "grants" -- but the majority of the notes are either innocent or ambiguous. BNET previously noted that AZ has put down 20 percent of the 10,381 claims against it and lost no verdicts. Its total costs are running at $232,003 per dismissal. In other words, despite the fact that AZ execs have been caught ghostwriting, hiding side effects, and trading sex for study results, the company may just pull this one out of the fire.

The worst part of the notes for AZ is probably the persistent selling position that doctors should prescribe higher and higher doses of Seroquel, up to 600mg. Reps never promoted the lower doses, even though many physicians were clearly starting patients on half or a third of that dose. It's a clear target for AZ: Regardless of the patients or doctors' needs, AZ wants the prescribed dose to be 600mg.

The notes also show that reps double-teamed doctors, and were often falling over each other as they stocked docs' sample cabinets. Many of the notes urge colleagues not to add to overflowing office drug cabinets.

There's also a fair amount of complaining about AZ's software, which frequently fails just as reps ask doctors to use it. (A typical note says "I could not get Touchstone up and running.")

One rep noted in 2005 that her doctor complained that female patients were putting on weight while on Seroquel. But weight gain is mentioned infrequently in the notes.

Doctors might be interested to see the call notes to examine the detail with which reps gather information on their lives. Sick days, car crashes, rudeness and vacations ("In portugal, returns nov 9th") are all noted.

What follows is a digest of the more amusing highlights. The typos are in the original. The redactions are usually doctors' names:

Dotti Yates: almost didn't get to sample here because they just got david's samples. i explained that mine would come in sometime next week. sent only 5 of each strength. delivered product messages

doctor signed for samples, but message poped up saying that there was a microsoft error. I saved signature, but the program shut down. doctor had already gone in to see patient. David just sample next week

samples are still good. Still has a box they haven't opened yet. Loved the seroquel pens and the ink has run out of all of them. wants more!

David Marshall: selected messages. pen would not sign. dr. walked off.

Anna Golden: dr still hasnt tried higher doses yet, sero efficacy at higher doses, wt neutral. trusted tolerability.

I:bipolar and migraine. SN: review target dose 600mg, 5 mg samples only available for [REDACTED], but okay on samples. dr wants to find out if luis silva still product manager for [REDACTED]. interested in getting funding for migraine conf in nov

I:migraine dr asked me why AZ not support her for the headache symposium in nov. will get [REDACTED] contact # so she can talk directly to them.

Jose Rafols: R/ Dr made me wait forever but then escorted me back to meet the GI. He introduced me and said some really kind words (imagine that). Dr received a letter from AZ about Sero's black bow warning and it kinda frightened him.I invited them out to lunch and we will further discuss the issues.

Rafols later took two doctors to the Capitol Grille. His notes continue:
R/ They go through samples like candy. I again explained that the samples are for new starts and to try to use the 7-Day coupons to offset giving away so many samples. He does see [REDACTED] as the best so I went straight to formulary advanatges

R/ Dr said he hates when reps come in and try to teach him chemistry or a slogan that the company has trained him/her to say. I of course took another route and said I just wanted to show him new studies showing differences among the PPI's. We go way back and he gave me time to present [REDACTED] and Sero. Please keep an eye on the Sero samples because the competition keeps moving the sample bin.

Computer battery went dead as he signed... there were no samples so dr. said he cant/wont Rx without them. Asked him maybe staff were taking them because the sampling doesn't seem right. He brought me in back and then he dictated... had conversation then set access lunch.

Andrea Hermann: detailed [REDACTED - 9] on EE. He's usual bull about smpls yatty yatty. [REDACTED - 9.5] didn't have time for a detail.

the wait to get in & the wait to see all the docs here is getting crazy. Quick messages to all. They were bone dry on [REDACTED]. I went over vouchers with them again.

mad house, but worth the wait b'c lots of docs in. Reminded them that [REDACTED] has the best acid control & asked for holiday heartburn sufferers.

Sylvia Parrott: SN: Dr just nodding his head when I was showing him the efficacy data on bipolar mania & schizophrenia, said just to show him what I wanted & not to ask him too many questions. once again not wanting to be specific about the choices he makes on what atypical he will use for a particular pt. C: asked Dr to go to S 1st. NCO: Why another atypical besides S?

SN: Dr was very rude to me. he did not give me opportunity to get into details of the Weiden reprint, so I left Dr a copy and asked him to review so he can perhaps give me his feedback/opinion on next visit, said for me not to bother asking him his opinion.

SN: Dr is totally rude with me, said he wouldn't go to any of my programs. barely listens to S message. says he knows how to treat with S.

Eric Garneff: Explained to him that sql offers you the opportunity to go up in dose without increasing side effects

Nancy White: went over bipolar dosing; already doing that regimen--------asked about [REDACTED - 11.1] speaking-it's out of the question; got very angry when I asaked! Does not want him doing any programs out of the office anymore.

(The "very angry" doctor later apologized to White's colleague.