1 Boring Old Man

 

^{Among the influences that led to the changes in things, one important one is the reps themselves. At one time, reps were required to have science backgrounds. Many docs actually respected them. They were replaced by script-based cheerleaders (seriously, that was something they looked for in recruiting) with no science background who were in it only for the money (there’s a famous story about a rep telling others to visualize doctors’ offices as buckets of money).}

In the trial, the first videoed Sales Rep was an attractive young blond woman named Lorri. She seemed almost dissociated or detached, answering questions quickly, obviously wanting the interview over. We’d see her Call-Notes, the brief notes they make with each call. She tried to avoid talking about selling Risperdal [off label] to Child Psychiatrists for kids, but after a couple of incriminating Call-Notes, she just gave up and answered the questions without emotion – "yes" "no." Some of the notes ended with the phrase "closed with…" We learned that each Sales Rep had a District Manager who kept the appraised of the sales pitch du jour and  who went with them on calls about every quarter.

The main deposition of a Sales Rep was Tiffany Moake in San Antonio – another attractive young woman who was in full defensive mode. We found out that she had a financial relationship with the Janssen lawyers who were representing her in the deposition. Tiffany had been a heavy hitter [they could apparently monitor the prescriptions written by their doctors]. They asked her up front if she’d sold Risperdal off label, or hosted "ice cream parties" for her doctors. She answered "no" to both. They then went through Call Note after Call Note documenting off label promotion and hosted "ice cream socials." They partnered with McNiell [a sister company that made Concerta, an approved drug. So they would "open with Concerta" on label and "close with" off label Risperdal. They had "Back to School" campaigns, flooded the clinics with "Risperdal Stuff," sold against Abilify for children, had sales contests, etc. etc. Throughout the questioning, Tiffany said, "that’s what it says" as if she hadn’t written the Call Notes herself. She was followed by Shane Scott, her District Manager. He denied promoting Risperdal off label too. He gave Tiffany high marks. When confronted with Tiffany’s off label Call Notes, andn pushed he did say, "I am concerned" – the only acknowledgement of the blatant off label promotion from a Janssen salesperson to that point in the trial.

On what would be the final day of the trial, we saw a video deposition of Tone Jones. He was a District Sales Manager in Houston from 2002 – 2009. Tone was recruited to Janssen right out of college when he didn’t make it to the NFL [quarterback for Oklahoma]. Out of the gate, he was a different witness. The Janssen lawyers had approached him as with Ms. Moake – paid testimony, represent him in the deposition, said something about company loyalty as a previous employee. He was offended and said "no." Later, when he was approached by the plaintiff’s lawyer, they offered him nothing, and he said "yes."

He answered the questions in an unemotional, matter-of-fact way – and his answers were quietly damning, famously saying, "You can’t be a billion dollar drug in a 1% market." They showed a training memo from his top Sales Rep, Laura Haughn, that said: "Child and Adolescent Psychiatrists", "Provide with treatment under 13", "Most diagnosed with behavior disorders or mood disorders", "No indications!!!", "Sell on symptoms not diagnosis". Did they target Medicaid? "Yes". Why? "Big Payer". Did they target the Drug Utilization Board? "Yes". Did they target the Pharmacy and Therapeutics Committee? "Yes". Did he recruit speakers? "Yes". Did they downplay the incidence of Diabetes? "Yes". Even after the warning letter? "Yes". How often? "On every call". Were all sales messages approved by Janssen? "Yes". Were these sales directives local or national? "National". They showed him an organizational chart of the Janssen Sales Department and an email chain about selling Risperdal for children that traveled all the way to the top and down again. His testimony was delivered quietly, but it was devastating [and sounded truthful].