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MD Kickbacks

The pretense of Merck's marketing programs was reflected by tutorials
and preceptorships the drug manufacturer conducted purportedly for
training its sales reps.  In reality they were designed to pay
kickbacks to physicians for listening to Merck's repeated sales
pitches and for writing prescriptions for Merck drugs.

Tutorials

Merck, during the time covered by Mr. Steinke's complaint, would pay
$250 to each physician each time the physician "tutored" Merck sales reps,
even though the drug manufacturer's sales staff is renowned for being the
best-trained in the industry.  Merck sales reps are college-educated,
required to undergo 10 weeks' intensive training in West Point,
Pennsylvania, and pass a minimum of 15 out of 18 tests the company
administers during that training.

For example, one physician was paid $250 for each of nine times the
doctor tutored sales reps during an eight-month period.  Merck
records examined during the investigation revealed that this physician
tutored the same sales representative four times, once in May, once in
July and twice in August 2000.

Merck ensured that its tutorials were rigidly scripted for its sales
reps.  For example, one script had as its third question to the
physician (where the doctor is supposed to be training the Merck sales
rep), "What additional information would you need to encourage you to
prescribe more Maxalt® (Rizatriptan, treatment of migraine headaches) for
your patients?"

At one point, a sales rep questioned the purpose of Merck's tutorials,
asking whether they were "legal to use," commenting that "[m]y
understanding of tutorials from what we have discussed in our previous
meetings is something totally opposite."

Preceptorships

Merck's preceptorships were "enhanced" versions, in Merck's own words,
of their tutorials.  A sales representative in a Merck preceptorship
was supposed to spend a half or full day "shadowing" the physician as he
or she treats patients.  In one case, a Merck sales rep managed to
complete eight preceptorships in one day; another sales representative was
involved in 91 preceptorships in eight months.  In another example, a
physician was paid 22 times by Merck at $250 a session, and seven times at
$300 a session, for preceptorships from January to September 1999.

Michigan Statistics

In Merck's Michigan region alone more than 3,400 tutorials were
conducted in nine months, resulting in physician payments of more than
$1.2 million.  Additional field expenses, which included dinner and
entertainment, likely doubled the total
cost.

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