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Medicina alopata, concerne farma, vaccin, boli cronice, coruptie

“Complexul” industrial farmaceutic – un joc murdar Partea a doua – Intimidarea şi discreditarea

Posted by Qui bono pe 5 Martie 2010


“Complexul” industrial farmaceutic – un joc murdar

Partea a doua – Intimidarea şi discreditarea


Care sunt metodele şi strategiile concernelor farma? Care este strategia lor de “joc”? Acuma, bineînţeles că adversarii nu trebuie să ştie ce discută antrenorul cu echipa lui înaintea jocului, care este tactica de joc adoptată, armele secrete, etc. Ştim asta din orice joc, mai ales din cele de echipă. Astfel că este foarte greu de pătruns în interiorul unui cartel, la nivelul decizional, pentru a afla “secretele”, pentru a afla care sunt principiile de bază ale strategiei de “joc” a concernelor farma.

Totuşi din fericire a existat în ultimii ani un caz celebru, desfăşurat în justiţie,în care un mare concern farma a fost condamnat la substanţiale amenzi. Şi aceasta în baza unor documente care ulterior au apărut şi public. Este forba de concernul Merck şi de preparatul VIOXX.

(Printre alte surse vezi http://childhealthsafety.wordpress.com/2009/10/12/merckdestroydoccritics/ )

Primul principiu : “Distruge doctorii care critică oriunde s-ar afla”

Printre dovezile folosite în instanţă în cazul VIOXX, există şi o listă cu 36 de medici cunoscuţi şi bine preciaţi în rîndul specialiştilor din USA, care trebuiau neutralizaţi, deoarece fie lucrau pentru alte companii care vindeau preparate similare, fie aveau o poziţie critică faţă de produsele Merck, respectiv faţă de VIOXX. Lista originală poate fi văzută în Site-ul bibliotecii universităţii din California, şi o puteţi de asemenenea vedea ca document pdf (Acrobat Reader), http://dida.library.ucsf.edu/pdf/oxx02y10

Această listă a apărut în cadrul procesului intentat firmei Merck, proces în care unii angajaţi ai firmei au recunoscut că acestă listă era concepută în cadrul acţiunii mai largi de a “interfera cu punctele de vedere academice”. Iata şi E-Mailul original:

To: Johnson, Sherrin E

From: Baumgartner, Susan

Cc ZZYarbrough, Caroline D9/24/01 KAS

Bcc:

Date: 1999-07-23 18:44:43

Subject: Physicians to Neutralize

Attached is the complete list of 36 physicians to neutralize with background information and recommended

tactics. You will notice that some have already been „neutralized”. The physicians listed in my previous e-mail

represent a subset of these physicians who we would like to get involved in Merck clinical research. Please let

me know if you need any additional information. I thought you should be aware of our most challenging (and

also most vocal) national and regional physicians.

Susan

Attachments:

neutralize.xls

Într-unul dintre E-Mailurile interne, unul dintre angajaţii firmei Merck scrie textual: “Trebuie să-i căutăm şi să-I distrugem oriunde s-ar afla.”

Email from Green to Gertz re: William Harvey research conference

To: Gertz, Barry J.

From: Greene, Douglas Alan Cc Bcc:

Date: 2001-10-15 11:12:34

Subject: RE: William Harvey Research Conference

“we may need to seek them out and destroy them where they live….”

Merck a ameninţat sau intimidat opt investigatori (cercetători) clinici, a căror mărturie este consemnată în proces. De asemenea au existat încă multe alte dovezi de cazuri în care Merck a încercat să distrugă profesonal sau să pună în pericol cariera unor academicieni care nu recenzaseră favorabil produsele firmei.

Alte documente au arătat că Merck a ascuns intenţionat rezultatele unor studii care arătau că pacienţii suferă de daune aduse ficatului prin folosirea medicamentaţiei contra colesterolului, că a reţinut şi nu a dat publicităţii datele altor studii care arătau ineficienţa medicamentaţiei contra colesterolului, că a deversat vaccinuri expirate şi alte chimicale folosite în procesele de producţie în reţeaua de apă potabilă, că a deschis conturi în străinătate pentru a evita plata taxelor fiscale pentru sume care se ridicau la miliarde de dolari, precum şi pentru publicarea de articole laudative, scrise de angajaţii firmei Merck, care erau publicate în jurnalele medicale “peer-reviewed” ca fiind realizate de cercetători independenţi (fraudă ştiinţifică-asupra acestei metode vom reveni puţin mai târziu).

Dr. Andrew Wakefield, un medic britanic care a efectuat o serie de studii care arătau că există o legături directă între vaccinul MMR (rujeolă-oreion-rubeolă) şi cazurile de autism spunea despre toate aceste metode: “Aceasta nu mai este conspiraţie, ci poliţie corporatistă”. Ca urmare a studiilor întreprinse, Dr. Wakefield a fost supus unei avalaşe de calomnii, a fost dat afară din spitalul din Anglia unde lucra şi suspus unor multiple presiuni şi intimidări!

(vezi interviul cu postul TV CBS – 9 Octombrie 2009 –

[CBS News – Research Links Kids Vaccines & Brain Damage – October 9, 2009 childhealthsafety – http://childhealthsafety.wordpress.com/2009/10/09/cbs-news-research-links-kids-vaccines-brain-damage/ .]

Guvernele cer părinţilor şi pacienţilor să aibe încredere în siguranţa vaccinurilor ca cele MMR sau medicamentelor ca cele produse de Merck. Dar trebuie să fii nebun să oferi încredere unor producători care folosesc astfel de metode!

Iată în continuare Lista medicilor care trebuiau distruşi, cu informaţii asupra lor şi cu metodele recomandate pentru anihilarea lor (în original în limba engleză): puteţi descărca şi  documentul original pdf

Lista doctorilor care trebuiesc neutralizati

NUMELE

Informaţii furnizate de specialiştii A&A (cu comentarii adiţionale de la National HSAs, RMDs,TBG, etc.)

Recomandări (suplimentar continuarea supravegherii la specialişti şi la HSAs)

Altman, Roy Extremely influential physician in the rheumatology community; major thought leader in the field; very poor relationship with us, dating back to the early 1980s; a task force has been formed to try and bring him back to neutral in his perception of us; personal visit by Bruce Freundlich; bad feelings from FOSAMAX, but wants to be perceived as non-biased; submitted for a grant through Bruce; recommend a brainstorm with local reps OSRs and A&A specialists for tactics and may also try Jim Kessinger (past Fosamax launch manager covering Altman) for ideas; provide OARSE funding every year „Show me the money'”- Clinical Trials

– Funding >$50,000 Rheum Fellowship Program

– Task Force to continue to work with him

Task force in place – Dr. Bruce Freundlich, SBD (J.G.) RMD K. Edwards, M. Halpin & local reps

Arakawa, Ken C. # 1 writing branded NSAID user in the state as well as the #1 prescriber of Celebrex; local rheumatologists respect him for his reputation and talent in the field; advocate for FOSAMAX and has given a couple lectures in the local area; left out of the various meetings over the last year and a half (including consultant meetings) while a few of his colleagues have attended these meetings; really wants to attend a Consultants’ Meeting to get up to speed; very satisfied with the manner in which Searle/Pfizer have kept him in the loop with information and data on Celebrex post-launch through to the present; feels that their presenters have been very biased and feels like they would like him to be the same way; has written 127 prescriptions for Celebrex according to the February data; has given two lectures for Searle/Pfizer but is somewhat disgusted by the use of Dr. Singh in the area (Dr. Singh came to Hawaii last year and presented against the use of COX-2, but recently changed his story); currently disgruntled; Hawaii is leading the uptake of Celebrex – Consultant Meeting – any place in USA / international

– SBD / RBG VP-level visit as first step

Berney, Steven

NEUTRALIZED

Not quite anti-Merck; major advocate for Searle/Pfizer; Searle/Pfizer set up a very large Preceptorship Practicum at Temple with Dr. Berney and using him extensively throughout the Mid-Atlantic as a speaker; initial presentations not balanced and sometimes promotional for Celebrex; continuing work by HSAs; participating in our preceptorship/tutorial initiatives; willingness to speak for Merck when VIOXX is launched; however, suspicious of his relationship with the Searle/Pfizer camp; may be harboring some bad feelings toward Merck due to a perceived under- utilization as an advocate for FOSAMAX and not being selected as a clinical study site for VIOXX; excellent speaker; attended National Consultants’ Meeting, but has not been given as much attention as others at Perm nave gotten; outstanding feedback on recent program in Cleveland; CME faculty Clinical studies

Probably does not belong on this list

Box,

Jane and Pat

Key rheumatologists within the Charlotte area; large writers; not advocates for FOSAMAX; hard to approach in the office setting (Jane is much

more approachable than her husband); research department in the office and do a ton of research projects (National HSA working with them); currently doing studies for VIOXX; working with Searle in the hospital setting

Continue to support with clinical studies

Visit by Dr. Greg Geba, CDP

If continue to support, will be neutralized

Calabrese, Len Nationally respected for work in arthritides related to Hepatitis C and HIV; has been on Charlotte’s Advisory Board and has been involved in Merck studies; presentations of the data for Celebrex have been very powerful and he has down-played issues related to sulfa and P450; may be just as enthusiastic for Merck once he is speaking for VIOXX; have made many attempts to get him involved in national level programs – all to no avail; already exposed to MRL researchers; filled out P&T request and wrote 6-page letter to get VIOXX on formulary at Cleveland Clinic Cfield renort 7/22/99Ì Visit from Lou Sherwood might be useful. Visit from upper sales or marketing management not necessary.
Caldwell,

Jacques R.

Eighth largest prescriber of NSAIDs in the SERBG; he and his partner virtually control one of the „must win” clusters in the SERBG; this cluster has historically been a „poor launching” cluster; runs a very extensive Rheumatology practice in central Florida which encompasses a huge clinical trial arm as well; very much sitting on the fence right now with the competitive agent, because of his relationship with them over the past five or six years Clinical Trials – Visit from RMD (if he can deliver trial then we are OK) and a visit from VP is not required
Condemi, John J.

NEUTRALIZED

Thought leader in the community and Upstate NY; speaking on behalf of Searle as an advocate and investigator; recently enrolled him in a clinical trial (RA) after many months of promises and hard effort; not entirely certain this wasn’t too little, too late; speaking to community

physicians at programs sponsored by Rochester Blue Cross Blue Shield (80% market share in a 90% managed care market); have not been in

attendance at these meetings, but can imagine that VIOXX has not been mentioned nearly as often as Celebrex; has trained many of the RHU in the Upstate area and is considered the expert by many (thus, the reason BC/BS has used him as a speaker); has done studies on FOSAMAX and SINGULAIR but for some reason was slighted by us for VIOXX; wants to be involved with VIOXX

Provide scientific information; research; interested in NSAID-induced asthma; provide investigator slides to balance presentations; personal visit

by a „heavyweight” from MRL or CDP (Greg Bell or Greg Geba) to discuss where we want to go with VIOXX; could work with him to develop a clinical pathway for COX-2 inhibitors in a managed care setting; panel with Dr. Singh of Stanford and some others to focus on

pharmacoeconomic studies which verify reductions in PPI or H2 blocker use

– He is in a clinical trial

– He is attending a program given by Dr. Geba

– Speaker-doing a good job

Dietz, Frederick

NEUTRALIZED

Investigator site for both VIOXX and Celebrex; participated in preceptorships and tutorials; spoke for us but has been less than enthusiastic

during talks; Searle uses him extensively for speaking and research; Managed Care Group (PCS) is definitely not Merck friendly, and Dr. Dietz does nothing to help the situation; not totally anti-Merck but feels that Merck overprices their drugs especially if we feel we have a superior product; he also said that, if Merck prices VIOXX over Celebrex, he will definitely be against putting it on the Health Systems formulary; he also said that if it is priced as little as 5% less than Celebrex then his faith in Merck’s mission statement will be restored and he will champion the cause to get it on formulary; PCS is the big fish in Rockford and, if VIOXX is not put on formulary, there will be little market share gained; Rockford clinic should be involved in future studies for VIOXX involving Alzheimer’s and colon cancer, as well as comparison studies vs. acetaminophen and Celebrex; good relationship with NAE;     attended National MC Consultants’ Meeting; interested in AD studies

Now an Advocate; clinical trials

Dillin, William

Director of a nationally renowned group of 19 Orthopedic Surgeons located in private practice in the Los Angeles area; group has three offices; treats all of the major sports teams in Los Angeles, including the Lakers basketball team and the Dodgers baseball team as well as the high profile members of our society; see private pay patients as well as a plethora of HMO patients; formulary status is not an issue in their prescribing habits; ranked #1 in the cluster and 10 other members of his group are also targeted as high prescribers; local and national impact; virtually impossible to see Dr. Dillin, but I was successful in scheduling a tutorial with one of his partners Weekend Consultants’ Meeting in an elegant location (New York, Hawaii) or a 5-day International Meeting with the top thought leaders on pain management

– Visit from L. Méndez or M. Thomas to open door. Would prefer to stay with Specialty Senior Management

Ettlinger, Robert

NEUTRALIZED

Conducted studies for Merck and Searle; scheduled to conduct studies for PD with their COX-2 inhibitor; regional speaker for Searle; wants national recognition; very large practice; #3 in territory (Washington, Idaho, Montana) for branded prescriptions and #2 for total NRXs;

rheumatology consultant for Régence Blue Shield of Washington (1.5 million+ lives) and has made recommendations for Arava and Enbrel; reports to Linda Sturm, Associate Director of Pharmacy Services; extremely important for VIOXX to get on the Régence Formulary; excellent speaker and is well known in the area; his partner, George Krick, is number 4 in territory for branded and total NRx prescriptions; being heavily

courted by Searle and Pfizer

Currently a speaker, doing 2 launch symposia

– He is participating in a number of clinical trials

– Invite him to NY or NE meeting in the future

– Keep him busy – Advantage

Gibofsky, Allan Highly influential physician at HSS,    officer in ACR. Staunch Searle advocate, used often for speaker programs. Likes to use his law degree to intimidate physicians in the audience-will often suggest that not using a certain product is like committing malpractice. Very skeptical of data for VIOXX. Feels that we are hiding our safety data for the 50 mg dose. Very difficult for the HSA to work with. Needs to speak directly with an MRL physician to discuss the data (B. Daniels knows him)
Goldstein, Jay Member of the GI department; member of the Adverse Reaction Committee for Celebrex; spoken on several occasions; presentations are biased and sometimes contain inaccurate information; shown extreme indifference to correcting his information; definitely anti-Merck; has national impact as Pfizer and Searle are scheduling him all over the country; works very closely with Searle and will deliver biased messages in Searle- sponsored events but is balanced at GRs, etc.; met with Greg Bell; will present data for VIOXX at GRs; good advocate for the class; would proceed with caution in using as a speaker or in giving research grants, unsure of how he would handle results; needs similar treatment to Lee Simon based on close relationship to Searle – High-level senior team to establish next steps and also include Nat HSA and A&A Specialty Managers

– The goal is to get him to neutral

Hamburger, Max

ADVOCATE

Senior partner of Rheum. Assoc, of Long Island, one of the largest private practice groups in the US (eight members, high prescnbers in NE

RBG); formed private practice Rheum. IPA (total membership of approximately 40 practices covering Nassau, Suffolk, Queens, Brooklyn, and Staten Island; currently enrolling MDs in Bronx and New Jersey; MDs emolled aire all high volume prescribers and huge adopters of Celebrex); seeking support from the pharmaceutical industry for IPA; companies that provide funding will receive preferred status with its members and those that do not will have trouble accessing the EPA members; first endeavor is to put together a „Standards of Care” retreat meeting to develop

a document that will serve as their manifesto (to include a drug formulary and how the members will treat certain diseases, preferred

medications); price tag is $25,000 to support this meeting and to have access during it; preliminary meeting with Mary Tilger, Al Weiss, Dr. Hamburger and Dr. Tiger; follow-up meeting on May 3; Pfizer/Searle are signed on to the „Standards of Care” retreat; wants to work with Merck

Financial support of private practice rheumatology – (has taken place)

Has been turned around.

Holt,

Stephen D.

Little Rock Diagnostic Clinic, Rheumatology group, consists of seven A+ rated physicians and is the largest single concentration of

Rheumatologists in the entire state; while all of the physicians do not get along well together, Dr. Holt is very out-spoken; Searle advocate and speaker for Celebrex and considers VIOXX a „me-too” product; he said that VIOXX would have to be substantially less expensive, or be able to show superior efficacy to Celebrex (he said that the superiority would not just be based on the PI since he is aware of the underlying factors that drove the wording of the Celebrex PI); most out-spoken advocate for Celebrex in my territory and has considerable influence with his referral physicians; not well known outside the state of Arkansas and not in the call deck of the National HSA; believe he is participating in the ADVANTAGE trial

– Clinical Study

– Invitation to Consultants’ Meeting; Regional or National

– No need at this time for senior-level team to approach

– Local time is sufficient at this time

** He has moved in our direction. He is now accessible.

Humphreys, Craig Strong Searle advocate with local and possibly regional influence, high prescriber in the highest potential market of the nation, attended Searle workshop in San Francisco with his nurse, lunches and preceptorship set up, raves about Searle reps and Celebrex, does not want honorarium for preceptorship and would be offended if offered grant money, wants studies and to attend science meetings, influenced by peers in group he works with, heavily involved in research Research suitable for an ORS, invite to Consultants’ Meeting (other than Orlando)

Clinical Trial

– On the way to being neutralized

Huston, Kent Highest-ranked physician in KC Metro area; speaking for Searle, along with conducting numerous Searle clinical studies; attended several top Searle National Meetings; very Searle friendly; not placed as an investigator for VIOXX; declined 1998 Regional Consultants’ Meeting because not available; he has repeatedly asked to attend other Merck meetings of any significance; interest in osteoporosis and arthritis; receptive to

published data and speaking for Merck in the local community once VIOXX is approved; busy community physician; access difficult; Specialty Representative has point responsibility…HSA in support role re: slides and information retrieval

Invitation to Merck Consultant Meetings; product experience; research (significant trials, not ADVANTAGE)

– Visit from RMD or Dr. Greg Bell

– Clinical Trials

Kantor, Seth NEUTRALIZED Speaking for Searle; says that Merck never invites him to anything; not invited to Rheumatologist Consultants’ Meeting; not involved in any studies; requires very large honorarium to talk; CME faculty; speaks for Fosamax – Invitation to Merck event

– Presently will be attending Chicago CME Faculty Meeting

– CME Speaker

– Invite to Consultant Meetings or Merck event

Kay, Jonathan

NEUTRALIZED

Speaking extensively for Searle; national/regional speaker (>30 talks in the last six months); in a recent talk, deliberately said he could not speak about VIOXX because the drug was not approved, then discussed key competitive points for Celebrex and their disadvantages to VIOXX (limited their weaknesses); wants info on our strategies for formularies/pricing; got Celebrex on Lahey Clinic formulary; asked for studies and information we can’t get; irritated that he was not contacted for more studies for VIOXX, but MRL concerned with ability to enroll patients; reputation for being bought by Searle; more balanced in presentations in the past and responds that he has not received information on VIOXX; turned down the Laguna Nigel meeting; advocate for FOSAMAX, worked well in the past with Merck; helped draft NDA filing for Celebrex; recently picked up for MK-663 which has improved his attitude; excellent speaker, very COX-2 positive; need to support endeavors with Lahey Clinic, such as Rheumatology Rounds; good friends with Brace Freundlich; very credible; cannot afford to lose him; using him as a speaker should greatly improve the situation – Invitation to Merck event

– Presently will be attending Chicago CME Faculty Meeting

– CME Speaker

– Invite to Consultant Meetings or Merck event

– He is neutral to positive

– Follow-up by Bruce, Paul and Flemming

– Continue to support with talks and clinical trials

– No need to bring a senior team at this time

Knapp, Charles Strong Searle advocate, regional impact, high prescriber, utilized heavily as Searle advocate, attended Searle meetings and speaker workshops, preceptorships and lunches set up, scheduled to speak for Merck, has attended Merck Consultants’ Meetings, positive response to Consultants’ Meeting, enjoys learning more and attending Consultants’ Meetings, wants studies RA Clinical Study or 663 Study

If we can do above, he will be neutralized

Lauderdale,

Vance

Director of the P&T Committee at the Rush Health Plan; clearly in Pfitzer/Seatles camp; numerous attempts to contact the doctor; short and curt when contacted; reported that he supported Celebrex at the preliminary P&T committee meeting; High-level influencer, not a speaker for either company Include in Consultants’ Meetings or Medical Meetings to have more exposure to Merck than we are able to give at a local level

– Visit from new NAE in regards to providing most up to date information on VIOXX

– Higher level senior team to contact and determine next steps. Greg Bell, MD + VP Level + SBD

Lawson, Jeffrey Most influential rheumatologist in the state of South Carolina. He is in Searle Camp and speaks for them. Fall out with Merck about two months ago in regards to another doctor in his office that was being supported by Merck. Gillian Cannon and Jo Jerman are currently involved. Continued Visits From:

– SBD /RBG VP

– Greg Bell to call and clarify and answer clinical questions

– Get a senior-level clinical visit

– Currently doing research for us

–  Best  we can do now is neutralize

Lindsey, Stephen

NEUTRALIZED

Not anti-Merck; however, he most closely fits the desired description; his facility has had a Celebrex study; has not been confirmed for a study for VIOXX to my knowledge; high influence within Ocshner System (P&T committee); submitted his name for the ADVANTAGE trial, but there

were some regulatory issues that have not been worked out at this time; not sure why they have not been contacted for study participation; wants to attend advisory meetings and participate in research; has been visited by a RMD; serves on MC Advisory Board; somewhat argumentative at the Board Meeting but has been treated well by Merck; Bruce Freundlich knows him well; excellent speaker and in our camp; held off acceptance of Celebrex on formulary at Oschner pending approval of VIOXX; feels that they need to have a C-2SI on formulary and wants to review data for VIOXX; cost is an issue

Research (ADVANTAGE, VIGOR, etc.); invitation to Merck thought-leader event; personal visit from MRL or Marketing

– Currently on Advantage

– Needs to be on a larger clinical trial with VIOXX or 663

– Consultants Meeting

– Visit from MRL or CDP senior-level (Dr. Geba / Dr. Bell)

– RMD is presently on this team

MacMillan, James

DISCREDIT

National impact; speaking extensively for Searle/Pfizer (200 days this year); numerous reports of biased and inaccurate presentations; sees few patients; Regional HSA asked him to tone down his biased presentations; gathering information on VIOXX from the Internet; one of Searle’s most frequently used speakers across the nation (and loyally devoted); often claims to be more than he actually is (Rheumatologist, affiliation with Hershey Medical Center, etc.); loose cannon; written transcript of a talk was like an advertisement for Arthrotec; no way to win him over and frankly would not want this type of person speaking for my product; visit from Leo and Bruce (field report on 7/20/99) – attended consultants’ meeting last year, investigator for VIOXX and MK-0663, wants us to help him be balanced Strong recommendation to discredit him
Mandell, Brian

NEUTRALIZED

Geographical impact: physicians at Meredia Hospitals and Cleveland Clinic Program; scheduled for Grand Rounds in Toledo; not anti-Merck (actually Merck-friendly), but will only present data for approved products or information from peer-reviewed literature; will speak for Merck and was very receptive at the National Consultants’ Meeting; met with Bruce Freundlich; trying to get him a gout study; neutral publication on C-2SIs because wants to see published data Needs data; does not belong on the list. He will be a good advocate once we have some published data for him to review. There is nothing else that he needs.
Martin, Richard W. Senior partner in Arthritis Education and Treatment Center; practice is currently recruiting another Rheum; sees patients in private practice part- time and devotes the rest of his time to research and teaching; practice has a DXA and does osteoporosis screening; upset with the way we marketed FOSAMAX and with the NORA study; brother-in-law is the Pfizer rep; Grand Rapids market, while the second largest city in the state, is very underserved with specialists (only two Rheum practices and four Rheums practicing in the area); practice located in a Spectrum Health Building (Spectrum Health created by recent merger of Blodgett and Butterworth Hospitals and Priority Health HMO) is very influential and will have a strong effect on local PCP prescribing habits; visited by Greg Bell; submitted data on his practice requesting to be considered for studies and has yet to hear from Merck on his request; did not submit his name for the ADVANTAGE trial as he would like to be considered for Phase II trials and would be offended if offered a seed study; only wants to be considered for studies if he is guaranteed authorship and if Phase II or III Looking for CDP or MRL Study

– Visit from a high level senior team not necessary

– Greg Bell + VP Level + SBD

Moskowitz, Roland Geographical impact: physicians at Bedford Hospital, Geauga Hospital, Brown Memorial Hospital Geneva, Providence in Sandusky, symposium scheduled April 21, 1999, at Lake West Hospital; more balanced in presentations recently; Searle Advisory Board; good speaker and would consider using him to speak; have tried to involve in national programs, but he turned down even CME curriculum development because of his involvement with Searle Speaker

– He is being developed by G. Foster / T. Williams and has talked for us at this time

– Schedule (3 to 4) Grand Rounds in July (PA)

– Could be open to do research in the future

– Invite to Consultant Meetings

Palmer, William # 2 physician in call deck; somewhat national impact, definitely regional and local; has done some talks for Searle and Pfizer for Celebrex; has agreed to speak for us and said anyone in his office would probably speak for us; made a snide comment about the Rheumatologist in Lincoln, NE, so I’m a little nervous it may offend him when we bring Weaver in to Omaha at launch; negative and somewhat hostile; receptive to us bringing in Walter Briney from the Denver Arthritis Center; very interested in doing clinical trials for Merck, but he seemed to be a bit offended by the offers for the trial he was given (maybe the ADVANTAGE trial) Research (selected trials of significance – large and well-respected); invitation to Consultants’ Meeting

– SBD scheduled to visit with A&A Specialty

– Visit from CDP or MRL (Dr. Geba)

Petti, Michelle National and international reputation; well-respected; excellent speaker; currently speaking for Celebrex; would like to participate in a Merck

study and be more involved with Merck; feels slighted about not having been invited to participate in previous studies for VIOXX; refused to meet with National HSA for over a year; targeted by Bruce Freundlich; grant to attend EULAR from marketing; in recent meetings, says she was head of FDA Advisory Board, has seen data and feels Merck will not get RA indication because of toxicity and dose-related adverse effects; visit from Ken Truitt on July 21

Research (research at Hopkins is going through Dr. Fred Wigley)

– Clinical Trials

– Visit from MRL (Beth); Visit from Bruce Freundlich, RMD / K. Bille / P. Davis

– Would prefer a $ 10,000 grant – we are currently waiting for HER proposals to conduct a study

– We are not looking to have her speak at this time

Pincus, Ted Strong Searle advocate, national impact, speaker, Searle and Merck investigator, has spoken for us, wants studies and grants, somewhat receptive

to lunches and preceptorships, influenced by peers, friends with Phil Needleman; involved in early curriculum development meetings; recently

given a grant for library update with fellows and also a grant for EULAR

Research, grant

Warning in regards to what we do since he is a big Searle advocate

– Visit by senior-level clinical VP, SBD with Nat HSA

– He can be neutralized (Currently doing study in RA) – more studies will help

Rosenstock, David Very influential physician in the area; ranks #6 out of 82 physicians; does not visit with representatives on a regular basis; very pleasant physician, but it is very difficult to see him; feedback consistent among other representatives in the area; participating in clinical study for Celebrex; well respected in the medical community; patients are extremely important to the physician; interested in clinical studies; busy community physician…not called on by HSA – Invitation to Merck event with other influential physicians; research on OA or RA

– Visit from senior-level clinical person (Dr. Geba)

– Visit by SBD Alex Petrovich

– He is currently negative

Sanders, Reginald Very big in geography; 2400 prescriptions per year; also known nationally; writes for a lot of the Rheumatology Textbooks (Chapters); also

known for lecture series; difficult for me because of the constant turn-over in representatives in his office (even though the representatives have

been there for 8 months, he still views them as „new”); feels that he cannot trust Merck on a corporate level and, therefore, cannot put his trust in his representatives; currently speaking for Searle on Celebrex; interest in society meetings; wants consistency with representatives; puts patients first

– Senior-level climcal person (RMD)

– RBG VP or SBD

– He is currently negative

Scarpa, Nicholas

Largest writer of NSAIDs in territory; works very closely with Searle as a lead investigator; speaking on behalf of Pfizer/Searle 36 times this June for Celebrex; often quotes himself as a member of their team; national and regional impact; involved in investigational work with Celebrex and the next generation COX-2 inhibitors; HSAs have promised speaking opportunities in the future; very much wants to be a partner with Merck, but feels an obligation to Searle (has signed a speaking contract with Searle); feels shunned and ignored by Merck; very interested in doing extensive investigational work; wants to feel important to Merck; influenced by well-versed representatives, national thought leaders and MRL wants opportunity to become part of the Merck team and wants to be recognized as a thought leader Use in many speaking engagements; investigational research; provide climcal data; at least $20,000 for speaking engagements for the remainder of the year; personal visit from MRL/CDP/RMD

– Clinical trials

– He is in the Advantage Trial

– Recommend L. Sherwood meet with him and G. Bell, also RBG VP

Simon, Lee National speaker; long-standing relationship

witn Seatle due to pre-lunch work on  celecobix; extremely pro-COX-2, emphasizes their superiority in talks; can hurt us if not involved with us; scheduled for almost 150 talks (primarily Searle/Pfizer) nationally and volume of one-sided messages of concern; has softened his messages with slides on VIOXX and updates on our FDA advisory meeting; included in two local dinner programs to date; very pleased with his involvement but would still like to be a part of the science and information process; wants to be involved in a clinical trial and wants slides; insatiable desire to be the most informed person and loves „inside” information; recently voiced strong opinions about weakness of data for VIOXX; not a candidate for MK-663 or MK-966 RA;

Merck advocate for Fosamax and friends with Lou and Bruce; would be a serious mistake to involve him in our science; more balanced

presentations recently; HSA has worked extensively with him; Bruce, Charlotte and Caroline have spent time getting to know him better and understand how to work with him; Elliot met with him the week of June 28 – message from Lou was effective, concerned about way he was being

Provide information about VIOXX for bis presentations; research (possibly rofecoxib vs, celecoxib); estimated $5,000 (at least) to help fund an

October 7-9 symposium on COX-2 inhibitors in Boston (several thought-leaders to present during the two days, working with Dwight Robinson, M D from Mass General on this program); send someone from MRL to present to the BI/Deaconess rheumatology community on rofecoxib (requested back in January, but MRL was not able to participate; Elliot Ehrich is Lee’s first choice); CDP study for VIOXX (e.g., APAP study) that will not provide him with confidential info

– Beth gave slide set

– Lou Sherwood will call next week (June 28)

– Lou Sherwood has met with / F. Ornskov (2 Dinners)

– Regular calls are being made with him

– D Hartenbaum has also met with him

– Flemming said that MRL/CDP did not want in clinical trials

Stillman, Tom Rheumatologist, had been a member of Advisory Board for Merck, very opinionated and stubborn, speaking for Searle/Pfizer and concentrating on adverse renal effects of Vioxx, believes greater selectivity of Vioxx = higher propensity for renal side effects, has met with Greg Bell to discuss issues, still has not changed his opinion, 60+ talks scheduled for Searle/Pfizer, sees himself as being very positive toward COX-2 class but tends to point out what he believes are negative effects of Vioxx, had been scheduled to do talks for local reps post-launch but all were cancelled by reps, was very upset by this action, wants to spin sulfonamide issue Visu by senior management, talk with MRL to address clinical concerns, Nat. HSA and A&A Spec. Rep. continue to provide data to address

concerns, utilization as speaker in small, controlled programs to repair relationship with Merck ( tutorials, preceps, roundtables ), continue to monitor talks given for Searle/Pfizer

Williams, Gary

NEUTRALIZED

Nationally recognized speaker and thought leader; has spoken for the ACR and hospital grand rounds programs nationally; involved as a

keynote speaker for Searle and Pfizer in the launch of Celebrex; participated in a number of COX-2 talks for Celebrex and has done extensive clinical research for Searle, but he has remained very balanced and neutral; self-proclaimed COX-2 advocate; expressed interest in working with Merck and VIOXX; Scripps Institute, the most influential managed care organization in San Diego, has a long history as a leader in the area of arthritis and rheumatic diseases; Scripps is the largest medical group in San Diego and, therefore, targeting Dr. Williams will assist us in obtaining favorable formulary status

Meeting in San Diego to allow the opportunity to interface with a number of other influential physicians and speakers within Scripps like Dr.

Kozin, Dr. Pischel, and Dr. Schulman (This meeting has taken place)

– Next visit by Rich Randall

– He is presently a speaker and in Advantage Trial

– Keep him active as a speaker

Zalkowitz, Alan #1 Celebrex writer in Northern NJ and  #4 in NE; regional impact; active investigator and speaker for Searle; says he has been treated very well

by them; will speak for us only at certain restaurants and high honorarium; enrolled in Advantage (not happy with how he was treated; said the meeting in Miami lacked class, had no good speakers, was a waste oftime,and felt as though a lot of his questions were left unanswered; Searle investigator meetings were 100% better, more educational/informative, addressed physicians’ needs and superior accommodations; will forgive us for „this one mistake”, but expects to be treated better; several preceptorships for both arthritis and FOSAMAX; likes to feel important, to be informed, and to associate with important people; thought leader within large group practice and also in the community/state; receptive to preceptorships; Chief of Rheum for several years at Valley Hosp. in Ridgewood, NJ; new Chief is David Arbit, partner in his practice; another member of their group, Jeffrey Danzig recently took over his role as Pres, of NJ Assoc, in Medicine and does consulting for several large HMOs

Personal visit from MRL; research (VIOXX vs. Celebrex; Phase IV studies); provide patient information (requesting brochures to be on acute pain and OA); visit to Merck facility to interact with MRL and Marketing

– Will start Advantage, however, it looks like he was not impressed with Advantage. He did go to Advantage Meeting in Chicago and felt it

was not a trial for him.

– He is RX VIOXX. He is neutral at this time.

– Recommend L. Sherwood or G. Bell – he need the VTP Treatment. He needs to be visited by a clinical person. RBG VP visit.

– He is a good local writer, does not have national influence

Needs closer attention by local team.

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