By Milanda Rout
AN international drug company made a hit list of doctors who had to be “neutralised” or discredited because they criticised the anti-arthritis drug the pharmaceutical giant produced.
Staff at US company Merck &Co emailed each other about the list of doctors – mainly researchers and academics – who had been negative about the drug Vioxx or Merck and a recommended course of action.
The email, which came out in the Federal Court in Melbourne yesterday as part of a class action against the drug company, included the words “neutralise”, “neutralised” or “discredit” against some of the doctors’ names.
It is also alleged the company used intimidation tactics against critical researchers, including dropping hints it would stop funding to institutions and claims it interfered with academic appointments.
“We may need to seek them out and destroy them where they live,” a Merck employee wrote, according to an email excerpt read to the court by Julian Burnside QC, acting for the plaintiff.
Merck & Co and its Australian subsidiary, Merck, Sharpe and Dohme, are being sued for compensation by more than 1000 Australians, who claim they suffered heart attacks or strokes as a result of Vioxx.
The drug was launched in 1999 and at its height of popularity was used by 80 million people worldwide because it did not cause stomach problems as did traditional anti-inflammatory drugs.
It was voluntarily withdrawn from sale in 2004 after concerns were raised that it caused heart attacks and strokes and a clinical trial testing these potential side affects was aborted for safety reasons.
Lead plaintiff Graeme Peterson, 58, claims the drug caused him to have a heart attack in 2003 after he took it for back pain and arthritis every day from May 2001.
Merck last year settled thousands of lawsuits in the US over the effects of Vioxx for $US4.85billion ($7.14 billion) but made no admission of guilt.
The company is fighting the class action in Australia.
The Federal Court was told yesterday that Merck wanted to gain the backing of researchers and doctors – or “opinion leaders” – in the fields of arthritis to help promote the drug to medical professionals when it was launched in 1999.
Mr Burnside said internal emails in April 1999 from Merck staff showed the company was not happy with what some researchers and doctors were saying about the drug.
“It gives you the dark side of the use of key opinion leaders and thought leaders … if (they) say things you don’t like to hear, you have to neutralise them,” he said. “It does suggest a certain culture within the organisation about how to deal with your opponents and those who disagree with you.”
The court was told that James Fries, professor of medicine at Stanford University, wrote to the then Merck head Ray Gilmartin in October 2000 to complain about the treatment of some of his researchers who had criticised the drug.
“Even worse were allegations of Merck damage control by intimidation,” he wrote, according to Mr Burnside.
“This has happened to at least eight (clinical) investigators … I suppose I was mildly threatened myself but I never have spoken or written on these issues.”
Mr Burnside told the court Dr Fries went on to describe instances of intimidation, including one colleague who thought his academic appointment had been jeopardised and another who received phone calls alleging “anti-Merck” bias.
Dr Fries said in the letter that Merck had been systematically playing down the side effects of Vioxx and said the company’s behaviour “seriously impinges on academic freedom”. The court was also told a rheumatologist on Merck’s Australian arthritis advisory board was angry he did not find out about Merck’s decision to withdraw Vioxx until an ABC journalist rang to tell him. Mr Burnside said James Bertouch wrote to other members of the board saying he was “extremely disillusioned” with the company.
“In every possible way the company exerted itself to present the impression to the world at large that Vioxx did not provide any increased cardio risk … when (a) it probably would and (b) it probably did,” he wrote, according to Mr Burnside.
Peter Garling, acting for Merck, accused Mr Peterson of not taking the drug Vioxx in the months leading up to his heart attack in December 2003.
He said Pharmaceutical Benefits Scheme figures showed he did not fill a Vioxx prescription for the drug in the two months before his heart attack.
Mr Garling put to Mr Peterson during his cross-examination that this was because he had retired from his job as a safety consultant and therefore he did not need to take Vioxx because his back pain lessened.
Mr Peterson denied this meant he was not taking the drug.
“No, I wouldn’t accept that at all,” he said. “I can remember taking Vioxx regularly.”
The trial, before Justice Chris Jessop, continues.
Aftermath News 
