Exposure Is A Good Thing…..

Australian class action against Merck in the federal court began 3-30-2009 in
Melbourne.

Merck is fighting this class action- risking the copious amounts of dirty laundry of
theirs being exposed to the world. Their confidence and ego as an entity are clearly
inflated.

Plaintiffs are led by Graeme and Peterson law firm. The judge is Chris Jessup.

Trial is expected to take a critical look at the autonomy, behavior, and marketing
tactics of Merck. Aspects of reports and articles from this trial since it started:

3-31: Merck employee David Loker had both his parents die while on Vioxx. David
considers Merck’s defense regarding Vioxxrightfully a bit too much to swallow.

Merck is being accused of ignoring clinical tests, which they did if the tests did not
favor Vioxx. Just because something is ignored or is not discussed certainly does
not mean it does not exist.

Vioxxlinked to CV events was acknowledged in 1998. Merck employee and

laboratory head Ed Scholnick was troubled and worried about research results
recently linking Vioxxto CV events in the year 2000.

Yet no action was taken by this man high up the corporate ladder of Merck, and
action should have been taken to save the lives of others.

4-1: Merck made a hit list of doctors who had to be neutralized and discredited due
to criticizing Vioxx, and recommended a course of action, which included
intimidation tactics as damage control.
The doctors were primarily researchers and academics, as Merck was seeking KOLs.
Key Opinion Leaders are coerced by Merck to present Vioxxwith intentional bias, as
Merck is paying them for this role with their company.

Merck’s culture is illustrated that seriously impinges on academic freedom. Mr.

Peterson is accused by Merck of not taking Vioxx months before his myocardial
infarction, based on filling of a prescription of Vioxx.

Not taken into account is the samples of Vioxx Mr. Peterson likely took in the months
before his MI.

4-2: Dr. Paul Anderson was unaware of the cardiovascular risk associated with
Vioxx, and would not have prescribed this drug had he known this association
existed. This overtly exposes Merck’s unbalanced representation of the qualities of
Vioxx.

4-9: Merck hires guest authors, such as scientists, doctors, and academics, for
research constructed by Merck, as well as Merck constructing entire journals that
are deceptive to others intentionally.

All data presented to others from such bastardization of the scientific method is
likely harmful to both health care providers and the patients who may take Vioxx as
a result.

4-15: Dr. John Dickman states that over the course of 3 years, the multiple visits by
Vioxx sales representatives never disclosed the risks of Vioxxand cardiovascular
events.

This is not unusual, as pharmaceutical representatives are only concerned with

increasing the number of prescriptions of products they promote to doctors.

Balancing their conversations with doctors regarding their promoted products

provides no benefit to the representative, and would be against their monetary
goal.
4-16: Aggressive sales strategies shared with the court implemented by Merck and
the marketing of Vioxx.

Sales representatives with Merck were directed to utilize objection handling cards if
anything negative about Vioxxwas brought up by a prescriber.

This, apparently, was felt necessary by Merck so that the sales representative would
not engage or research any negative qualities associated with Vioxx.

Merck implemented a highly sophisticated and well-resourced marketing campaign

that was able to minimize the awareness of safety risks that exist with Vioxx.

This included telling Vioxx sales representatives that cardiovascular risks being
associated with Vioxx is outright lies generated by competitors of Vioxx. This
seemed to comfort the Vioxx sales representatives, and sedate any concerns they
may have had about this very serious issue.

4-17: Merck implements quid pro quo with bribing targeted doctors so they will
prescribe more Vioxx. This in itself is illegal in the United States at times, as it
violates the federal Anti-Kickback statute.

Merck gives its sales representatives a ‘budget spend’, and requires them to
exhaust the budget within a certain time frame. So obviously Merck representative
are anxious to bribe doctors for this reason alone.

They determine such doctors by the prescribing data they have on each doctor due
to the AMA selling prescribing data to the pharmaceutical industry in the United
states that makes the American Medical Association about 50 million dollars a year.

4-18: Merck intends to bring a Vioxx human commercial to Australia to increase

market share of Vioxxat this location, which actually is Merck attempting to acquire
a new host for their damaging virus.
Also, again it is stated the obvious- that Merck insists on minimizing potential
adverse publicity while maintaining credibility of both Merck and Vioxx. With this
trial, Merck is maximizing adverse publicity and disintegrating the credibility of the
organization.

4-20: Merck creates an Arthritis Advisory board with the intent to mask this board
as a front group to gain support for Vioxxboth in Australia in Asia. This, they
believed, would have more credibility than Merck attempting to accomplish this goal
alone as a company.

One objective of this board, who was paid 2000 dollars each member at every
meeting by Merck, was to publically state that Vioxx was superior to similar drugs,
as well as offering positive advice about Vioxxto regulatory agencies.

The board’s members at times were used by Merck without their knowledge to
facilitate the profitable efforts of Merck regarding Vioxx.

While stating that this board was to educate others, it clearly was created to
promote Vioxx.

Front groups similar in nature to this one are often created by big pharmaceutical
companies to expand the diagnostic boundaries of a specific disease state to
increase the growth of their promoted product.

What they call brand conditioning really is disease mongering.

4-22: Merck scientist and senior VP of Merck’s research laboratories Alise Reicin
expressed concern about the CV issues associated with Vioxxin the year 1997.

Dr. Briggs Morrison, a colleague of this scientist, was aware through this email of the
Vioxx concerns 2 years before the drug got FDA approval in the United States.

4.24: Merck attempts to encourage their Vioxxsales representatives with ridiculous

songs. This is nothing short of cult-like behavior. Merck wants their sales
representatives to be passionate about a tangible object- Vioxx.
Merck wants them to be void of objectivity, as this will to be to the benefit of Merck.
The whole subculture of Merck seems to think that their vocations are some sort of
TV show or movie. Fictional. Not illustrating the importance of what they should
know and do.

4-24: Merck has hired a crisis management team and media relations firm to
supplement their own litigation communications team for this trial to save face.

This team and firm are largely failing, it seems. At this point, Merck is not going to
be able to offer interpretations of what is being presented in this trial about a month
old at this point.

4-28: Documents illustrate that Merck Vioxxsales representatives are extrinsically

motivated primarily by money, and this is what Merck wants their primary
motivation to be working for them. Helping the rich get richer can be deadly for
others.

Merck representatives, as with other pharmaceutical representatives in the United

States, rarely have a medical background or knowledge.

Merck knows this, so their training mainly consists of how to manipulate prescribers
and bribe them to grow the market share of products these representatives will
promote for them.

It is unlikely that these representatives understand coxII inhibition, the inflammatory

process, the disease state of osteoarthritis, or the fact that if something is a drug, it
has side effects. If a drug does not have side effects, it is not a drug.

4-29: Additional remuneration via dinners and nice hotels paid for by Merck for
selected and target doctors potentially or actually core to the growth of Vioxx.

It’s likely that Merck would not engage in such activities with doctors that are
catalysts for their monetary growth if such activities were not effective.
5-5: Merck makes the claim that clinical studies involving Vioxx are contradictory
often, and therefore Vioxxcannot be labeled a cardiovascular risk for patients.

Yet Merck proved beyond material extent that the evidence from these clinical trials
clearly showed that Vioxxdid in fact increase the risk of heart attacks for those who
take the drug.

Yet if Vioxx is making over 2 billion dollars a year for Merck, such concerns are of
little importance to the company.

5-6: Merck hired a heart expert in the United States to go to the Australian trial to
praise Vioxx and its benefits and safety- Dr. Douglas Vaughan. Vioxx was promoted
the safety of Vioxx through its sales representatives on every dialogue with a
prescriber, as well as superior efficacy that did not exist compared with other coxII
inhibitors and NSAIDS.

5-7: Elsevier in collusion with Merck’s deceptive marketing ploy by faking an

independent medical journal for the benefit of Merck’s Vioxx, and others.

Elsevier’s admission in this cronyism only happened when it was forced to do so due
to various factors that were going to become transparent.

Elsevier’s business model largely is directed at facilitating the marketing efforts for
companies like Merck. Normally this business model of theirs is quietly
implemented. This case is rare here.

5-7: Merck accused of making scientifically unsound claims generated from

corrupted and invalid studies created by Merck, as claimed by Vioxxcritic and
Rheumatologist, Les Cleland.

It appears the accusations are indeed with merit, as the evidence is overwhelming.
5-12: Merck convinces regulators, such as the FDA, to soften the warnings they
insist on putting on the Vioxxlabel now three years after the drug has been on the
market.

The FDA considers such companies as Merck ‘clients’, due in large part to what is
known as the PDUFA (Prescription Drug Users Fee Act).

Created to speed drug approvals and have drug companies pay the FDA to do so,
this act now accounts for over 50 percent of the FDA’s entire budget. The FDA is
supposed to strictly regulate, and not serve those entities that may harm others.

5-14: Merck attempts to stall safety and pricing probes about Vioxx. The reasons
are obvious.

5-23: The money spent by Merck for promotional tactics is illustrated. Merck, as
with other large pharmaceutical companies, spends more money on marketing than
they do on research.

The plans involving these tactics are approved by various marketing leadership of
Merck. Their strategies involving their tactics created with deliberate intent and
reckless disregard were implemented with complete autonomy.

6-8: Merck planned to set up patient loyalty programs to assure greater compliance
regarding such patients taking Vioxx.

This was developed by Merck simply so patients would take Vioxxfor a longer period
of time. Think of it as a superior version of direct to consumer advertising.

Merck, I believe, is relying on the apathy of others as information continues to be

shared from this trial.

Thank you Milanda Rout at “The Australian” for your dedication in sharing with the
world what is happening with this trial.
The Australian has done a wonderful job exposing what were tacit tactics utilized by
Merck to promote Vioxx.

This would not have happened in the U.S., I'm sad to say, this kind of exposure.

I launched Vioxxas a representative with Merck back in 1999.

Aside from looming patent experations from two of Merck’s ACE Inhibitor
hypertension drugs, Vasotec and Prinival, as well as their first statin drug, Mevacor,
this drug was very important to Merck for two other more concerning reasons:

One is that Lipitor, which was approved in 1997, rapidly acquired the lion's share of
the statin market (Merck has the lion's share of this class of medications with Zocor
before this happened).

Merck was not prepared for this rapid uptake of Lipitor, and this vexed Merck
greatly.

Secondly, Vioxxgot approved 6 months after Celebrex, and this concerned Merck.

Historically, the drug that is first in class that gains approval first will capture the
lion's share of the market, and maintain the lead over the competitors- in this case,
the Cox II class of medications.

Celebrex getting approval before Vioxxconcerned Merck as well. So the plans

implement read almost daily in The Australian are plans that were implemented in
the United States as well.

Merck was desperate, and clearly was willing to cross ethical lines to assure
Vioxxwould be the success that Merck needed it to be due to competition.
What we read about this trial that continues is accurate, even though merck is
saying in defense that most of we read is 'mis-statements', or embellishents.

What we read is true, and the ethically if not legally corrupt plans of actions
implemented by Merck were with deliberate intent and reckless disregard as they
continued to strive to gain additional market share with an unsafe drug of theirs.

Dan Abshear
Hi,

I just wanted to say a belated thank you for your lovely comments about my coverage of the Vioxx trial –
much appreciated!

I also note with interest that you were once a Merck sales representative – I would love to have a chat
with you (off the record if you prefer it) about your experiences at Merck with Vioxx if that would suit you. I
am interested in doing a more in-depth piece about the issues that the trial raised after the court process
has finished.

Thanks again,

Milanda Rout

Milanda Rout
The Australian
Level 2, West IBM Centre,
60 City Rd, Southbank, Victoria.
Ph: 0414 835 787
Fax: (03) 9292 2803