How low will a drug company go to market drugs?

Peer Pressure

Remember Vioxx? It’s been awhile, but it’s hard to forget this appalling episode in drug company misbehavior.

Thousands of people died. You don’t get much worse than that.

After Merck (the maker of Vioxx) paid out nearly $5 billion in 2007 to make thousands of lawsuits go away, I figured that was pretty much the last we’d hear about the Vioxx fiasco. But unexpectedly a curtain recently parted and we got a glimpse at one more little detail that reveals just how completely unscrupulous drug makers can be when they gear up for a no-holds-barred, scorched earth marketing blitz.

Dirty business down under

In 2003, an Australian man named Graeme Peterson had a heart attack, which he survived. At the time, he probably didn’t suspect his Vioxx use might have played a role. But when Vioxx was removed from the U.S. market in 2004, Mr. Peterson found out what Merck executives had already known for sometime: Vioxx sharply increased heart attack risk.

Mr. Peterson sued Merck, and his trial is finally underway. And it reminds us of one of the key reasons drug makers like to settle out of court: It keeps embarrassing details buried.

But not this time.

In the course of Mr. Peterson’s trial, a news reporter for The Australian discovered that Merck executives had created a journal titled Australasian Journal of Bone and Joint Medicine, published from 2000 to 2005. To any casual observer (such as a busy doctor, for instance), the AJBJM appeared to be exactly what it presented itself to be: a legitimate, peer-reviewed medical journal.

In fact, according to an experienced medical editor, it was nothing more than a marketing tool, filled with articles and studies that sang the praises of Merck products such as Fosamax and Vioxx. Peer review was minimal, if it existed at all.

In covering this story, The Scientist included this quote from Peter Lurie, deputy director of the public health research group for Public Citizen: “Even for someone as jaded as me, this is a new wrinkle.”

But wait – it gets better.

Everybody loses

Probably the most remarkable aspect of Merck’s fake “peer- reviewed” journal was the publisher: Exerpta Medica, a division of Elsevier.

The average guy on the street has probably never heard of Elsevier. But in the world of scientific and medical publishing, Elsevier is a massive, widely respected, international publisher that’s been in business for more than a century.

In other words, just about any doctor who saw the Elsevier imprint would not question the validity of the Australasian Journal of Bone and Joint Medicine. Elsevier gave the journal credibility and respect. And Merck’s blatant violation of ethics gave Elsevier execs a black eye for their trouble.

Will we be surprised to see more sucker punches in Merck’s future? Not a bit. I doubt there are any ethical boundaries this company won’t trample if they decide to deliberately mislead consumers, doctors, researchers, the media, the legal community, the medical publishing community…have I missed anyone?

Sources:

“Merck Published Fake Journal” Bob Grant, The Scientist: NewsBlog, 4/30/09, the-scientist.com
“Ethics of Peer Review: A Guide for Manuscript Reviewers” Sara Rockwell, Ph.D., Yale University School of Medicine, Published by the Office of Research Integrity, U.S. Department of Health and Human Services, ori.dhhs.gov