BECG – Assignment 2

Merck & the marketing of Vioxx

Perspectives on Utilitarianism and Egoism

Section B: Group 10
Sanket Sourav Bal- 19BM63012
Sagar Patel-19BM63032
Kanika Yadav-19BM63048
Dhawal Thacker-19BM63050
Aparna JR-19BM63084
 OVERVIEW
The role of the pharmaceutical Marketing Manager is a delicate balance of keeping all key
stakeholders happy, and maintaining compliance to government rules and regulations, all while
increasing the bottom line for the manufacturing company. The pharmaceutical industry should look
at the triple bottom line which includes the social, environmental, and financial performance which
involves obligations to the various stakeholders.

It is an industry which is based on benefiting mankind, however the vicious cycle of R&D costs and
developing new drugs plays an important part in it being expensive and applying for long patents.
Thinking about it, it is not ethically wrong; it becomes wrong when it limits itself to only being a
money making industry, exploiting the poor when there is an option available to provide cheaper
drugs to those who really need it and cannot afford them and hence forgetting the larger picture.

In the case of Merck, the company held core values of "preserving and improving human life" and
"being committed to the highest standards of ethics and integrity." But they gave more importance
to profit-making and self-interest than adhering to a moral code of conduct.

To explain the ethics behind this industry one can make use of the teleological ethics theory or the
consequentialist theory which states that the rightness or goodness of an action is not intrinsic to
that action but can only be judged by its consequence.

UTILITARIAN PERSPECTIVE
Utilitarianism is a theory of morality, which advocates actions that foster happiness or pleasure
and opposes actions that cause unhappiness or harm. It can be defined as providing the maximum
amount of happiness to the population that is affected. It holds that an action is judged as right or
good on the basis of its consequence and also suggests that the rightness of actions can be
calculated when there is greater pleasure over pain.

Patients with Rheumatic Arthritis (RA) suffer on a daily basis and Vioxx provides a superior efficacy
profile to help alleviate that pain. Also, these patients tend to have side effects such as ulcers which
require surgical procedures. Monetarily, these costs compound over the long run. For Merck to do
gradual investigations and eventually pull item from the market would not profit the public.

By keeping Vioxx on the market, the majority of those affected by RA could receive the proper
treatment. Merck would continue to see an increase in sales. By withdrawing the drug from the
worldwide market immediately, Merck forecasted to take at least a $2.5 billion blow to revenue (per
year)

Therefore, by continuing to market Vioxx, Merck would grow as a company.

Economically, this solution would continue to create demand and increase revenues. It would also
increase the supply needed, helping the pharmaceutical industry continue to grow. This would be
the ideal Utilitarian solution to receipt of an FDA warning letter, providing the maximum amount of
happiness to the population affected by the situation.

Merck can thus be said to have followed an act-based utilitarian approach, that is based on
providing the greatest balance of pleasure over pain for everyone.
On the other hand, while MI was only caused in a small percentage of the patients, who are already
at a higher risk, the end result can be as serious death. The evidence suggests that the benefit to
the majority of those affected is arguably much greater than those who would be at risk for MI.

The cost for Merck to do an incremental study to focus on the safety of Vioxx would be very
expensive and could cause Merck to pull Vioxx from the market, which would result in a huge hit to
their net revenue.

Interestingly, Merck has exhibited positive utilitarian behaviour in the past– eg: Merck decided to
give away the drug, called Mectizan, for as long as necessary at a cost of tens of millions of dollars
per year. This kind of principled decision making was inspired by the words of George W. Merck, the
son of the company’s founder: “We try never to forget that medicine is for the people. It is not for
the profits. The profits follow, and if we have remembered that, they have never failed to appear.
The better we have remembered it, the larger they have been.”

The ultimate retraction of Vioxx from the market can also be considered as adhering to the benefit
of the larger majority – and hence can be classified as being Utilitarian.

Conclusion: From a Utilitarian perspective, Merck should continue to market Vioxx, primarily due to
the benefit for people who can receive pain relief from this product with less GI events. This would
also keep the Merck Vioxx team employed, and would continue to bring in revenue which would
benefit the company, the stockholders and the pharmaceutical industry. There would be some
collateral damage to those who have the high MI risk, but in terms of the maximum amount of
happiness to those affected by the situation, this would achieve a Utilitarian solution.

As a compromise, Merck could have issued a press release that acknowledges the risk to the specific
target audience and confirm that they are working with key stakeholders to profile patients in
advance of issuing Vioxx therapy, to lessen the risk. Additionally, they could have included language
in their package insert and fair balance to indicate that Vioxx is contraindicated in high MI risk
patients. This would require additional work and education for the sales force to communicate
patient profiles with the HCPs and would decrease potential revenue since some patients would no
longer be able to use Vioxx. However, it would continue to benefit the majority of those affected in
this situation.

EGOISTIC PERSPECTIVE
Despite Merck being dedicated to safety of the patients, there was a conflict of interest present,
between safety and sale of the drug that was seen when people died due to the company being slow
to act in withdrawing the drug whilst the evidence of unacceptable risks was mounting. The
company was morally right with respect to teleological egoism, since the decision-makers were
pursuing their own interests of increasing the wealth of the shareholders.

In the first lawsuits against Merck that came to trial, evidence was presented to show that company
scientists had considered the potential heart problems with Vioxx as early as 1997. Company though
knowing it could potentially be harmful, still continued in the market for self-interest of company's
profit, ignoring the life threat it could pose to the consumers. This is an example of ethical egoism –
which holds that actions whose consequences benefit the user are ethical .

After initially resisting pressure by the FDA to include a warning on the Vioxx label, Merck finally
agreed in April 2002 to add the evidence of an increased incidence of heart attacks. However, the
language on the label emphasized, again, the uncertainty of the cause and recommended that
people at risk of heart attacks continue to use an anti-inflammant for protection. This can also be
categorised as Egoism. Still in the pursuit of profit, Merck did not even care to properly mention the
serious risk it could cause.

The excessive spending on marketing and providing vague guidelines to the salespeople (eg: the
obstacle handling guide, dodge ball Vioxx) over redirecting the funds into more R&D emphasises the
psychological tendencies to interpret evidence in ways that support one’s beliefs and interests –
Maybe even triggered by the belief that belief that because the activity helps the company, the
company will condone it and even protect the person who engages in it.

Despite its decision to remove Vioxx from the health care market, Merck continues to deny any
liability or wrongdoing for claims brought against it, which makes it much harder for people in
other countries to win law suits than if there had been a class action decision against them in an
American court. To this day, they still uphold the efficiency, overall safety and cardiovascular safety
of Vioxx. This is a further sign of deep-rooted egoism in the organizational culture.