By Steve Metzer
The Journal Record
NORMAN – Drugmaker Johnson & Johnson employed a marketing and sales campaign “breathtaking” in its scope and sophistication in order to build its Duragesic prescription painkiller into a billion-dollar brand, an expert in marketing testified in court here Monday.
Renzi Stone, chairman and chief executive of Saxum, an Oklahoma company described as expert in “executing campaigns that motivate audiences to action,” testified in the state’s case against Johnson & Johnson and its subsidiary Janssen Pharmaceuticals. Oklahoma Attorney General Mike Hunter filed suit against the companies in 2017, alleging they and others created a “public nuisance” through deceptive marketing that encouraged over-prescription and an oversupply of opioid-laced medications that resulted in an epidemic of abuse.
An earlier witness employed by J&J and attorneys for the company have insisted throughout the trial that thousands of calls made on physicians by J&J representatives were for “educational” purposes only. However, a review of internal company documents by Stone and Reggie Whitten, an attorney for the state, showed the company adopted an “elegant” and elaborate strategy to get Oklahoma doctors to write more and more prescriptions. The apparent goal, Stone said, was to drive up the company’s share of the prescription painkiller market and ultimately to reap higher profits.
“Frankly, I was blown away and impressed. The marketing materials, the depth of research, the significance of stakeholder mapping, the creation of budgets, the size of budgets, the quarterly review (of results) – it’s breathtaking. It’s impressive,” Stone said.
Stone was asked several times as he and Whitten looked over a number of documents to watch for the word “educate.” Though it did appear, Stone said his conclusion was that J&J’s use of the word “influence” was much more important to note.
“The goal in every document I reviewed was market growth, more market share, more prescriptions of Nucynta and Duragesic (drugs),” he said. “I did not see (education) as core to what was happening in the documents that I reviewed.”
In fact, in the case of at least one document, Stone said it appeared to him that J&J had become more aware around 2002 that the public was becoming more educated about risks of opioid addiction, so it strategized for ways to overcome that “barrier” to selling more drugs.
The documents reviewed were replete with marketing words and phrases, Stone said, like “barrier” (referring to a perceived impediment to greater sales), “target” (doctors subject to sales pitches), “hook” (a message perceived as the most compelling in a sales pitch), and “opinion leader” (a colleague or other expert seen as likely to sway a doctor). The documents also included “target language” chosen especially to appeal to patients, Stone said.
The witness also commented on elaborate “influence maps” detailing strategies for increasing drug sales. One document revealed the company’s goal to increase sales of Duragesic by 28% from 2001 to 2002, which would have represented an increase in profits from $543 million to $629 million. At the time, the company was pushing to make the drug a billion-dollar brand. One strategy employed, Stone said, was to target certain physicians who had already responded well to J&J’s marketing.
“There is a target physician,” Stone said. “That person is someone they know who has already been a high prescription writer.”
He said he has reviewed marketing plans for Oklahoma used by other national brands that weren’t nearly as well-researched or complex as the one employed in the state by J&J.
Other testimony Monday was provided by a health policy scientist who has published articles about pain treatment and the use of prescription drugs. Dr. Aaron M. Gilson said work that should have been done primarily to educate and advance research was used by drug companies instead to drive sales. He said he was sorry that his association with the pharmaceutical industry “reflected poorly” on his credibility.
For the past two weeks, lawyers representing the state have laid out a case that the drug companies funded organizations like the American Pain Society to oversell the efficacy and undersell the risks of opioids. Gilson was once a member of the American Pain Society, which acted recently to dissolve itself after allegations that it acted in league with drugmakers simply to promote opioid use.
Gilson, who testified in the case by way of a taped deposition, was asked to comment on marketing materials and other literature and internal documents of opioid manufacturers, including one that included a statement from an article that the witness described as outdated: “The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.” While he pointed out during questioning by an attorney representing J&J that other factors, such as illegal “diversion” of drugs for non-prescribed use, should factor into the opioid abuse epidemic, he said the use of materials provided by academics also played a role.
“It’s true that anyone who had association with the industry, that (it would) reflect poorly on anyone who has done work in the pain management field because of that association,” Gilson said. “I’m sorry that it has undermined the credibility that we had and that this work was supposed to entail. This work was policy research done by and submitted by someone who saw its importance professionally that those medications would be used appropriately. … We formed this focus group because of that. … It’s disappointing that that has been compromised.”