In answer to a reader, over at CafePharma. . . .

April 16, 2008 · Leave a Comment

These questions deserve more-complete answers — and so, I’ll return later today, to provide ‘em, but this is the thumbnail version I gave, just now, on CafePharma’s boards:

From: Anonymous — Today, 08:39 AM

“….thank you for your fine work…I’m a big fan of yours from the Yahoo! board.

What I can’t figure is how you know so much about SP…did you work there? Or are you a journalist?

What do you make of Bots’ report dated Jan 2007 which said that the data were ‘fine’? Why did it take 10 months to convene the infamous end-point changing advisory board after that? Does that sound like a delay to you? But what is the problem, since delaying the data isn’t illegal?

Thanks”

My answers, for now, are below, in green — other duties call me, at the moment — but, I will return to more fully flesh these answers out, with links (and some editorial asides):

Smile — I’ve NEVER worked for Schering-Plough; I am NO journalist. Did you ever see “Three Days of the Condor“?

I am a. . . . reader, I guess. I just read. . . everything. I’ve spent some time really “reading up” on SGP, over the past three months.

Now, your questions do deserve answers, and I do have my opinions(!), but I want to be careful not to libel/defame any private person. I do think Dr. Bots was right. I think the data were “fine.” I think it likely that Schering and Merck just didn’t “like” what the data pretty-plainly implied. Note that I’ve echoed, and amplified, Sen. Grassley’s publicly-aired concerns that the very-likely outcomes from even the “blinded” data, were discernible to a medically-trained eye, long-before the data were actually, formally, unblinded.

So, I think — emphasis on “think“, here — Schering and Merck asked to have the data “refined” — to try and tease some statistically-significant outcome, from it. But even the expert panelists then later agreed, on November 16, 2007, that it was likely that any variance in the “blinded data” could be the result of pure chance, not treatment/control arm outcomes. In a word — the study had utterly failed to show any benefit — in my humble opinion, of course(!).

I’vell likely posted answers to your specific questions on my blog, where I can links to each piece of authority, for each statement, above.

Now, I will say that — as a matter of law — even innocently delaying such data, and then selling stock to the public at $27.50 (near the high-price for the year!), is generally-frowned upon, over at the SEC.

Note that Schering sold $3.8 billion of equity, and another ~$4 billion of debtright in the middle of this “entirely innocent delay” on a project that impacted (or should I say sustained) 60-plus percent of Schering’s 2007 profitability. That much is entirely undisputed — and fascinating, no?. . . .

Hopefully, I’ll be back soon, to add to this.

Categories: CafePharma Bots ENHANCE delay $3.8 billion offering Vyt

Raplon — Not Discoverable on Diligence, by Schering-Plough(?). . . .

April 16, 2008 · Leave a Comment

One note, though — because the Organon Qui Tam/False Claims Act matter was so tightly-sealed, it is not likely that Schering, or its bankers — even with pointed inquiries — could have uncovered that this mess had become civil litigation, and a criminal inquiry, prior to acquiring the Organon businesses. Remember, now, the case was not ordered unsealed until February 2008.

Just for what it’s worth. . . .

However. . . . it remains an entirely open question as to whether the 1999 to 2002 Raplon documents — the FDA submissions, and the related back-up files, for example — still remained in the permanent file archives at Organon. It would have been customary to have a junior associate (for Schering) walk through each material FDA approval file-jacket, inside Organon’s HQ, prior to paying $14.4 billion for it.

The interesting question will be “How much of what Dr. Feldstein alleges was there. . . is still there?”

We will learn, in the coming months, I suspect.

Categories: Raplon Schering Organon criminal inquiry due diligence

It seems the Pre-Acquisition Organon matter WAS Criminal. . . .

April 16, 2008 · Leave a Comment

From a review of the Boston case file, it is clear that a criminal investigation of the predicate facts was underway at various points between 2002 and 2005, at least.

Once the case was transferred to New Jersey, and eventually unsealed, what was a Qui Tam Act suit, was amended to simply assert False Claims Act violations. Here are some of the salient details from the as amended, and unsealed, complaint. [I am still working up a narrative that explores the balancing of interests previously at-play in this case -- on the one hand, the fundamental right of each litigant to be present -- and at least witness -- proceedings on his case, versus the preventing of a leak, or other form of compromise, of a then-pending criminal investigation, on the other -- back later with that.]

. . . .4. Dr. Feldstein, individually and on behalf of the United States of America, seeks relief pursuant to 31 U.S.C. § 3729, et seq., commonly known as the False Claims Act. Pursuant to 28 U.S.C. § 1331, this Court possesses subject matter jurisdiction over this claim because it presents a question of federal law. . . .

6. For many years, Organon expended enormous time, money and resources developing and ultimately obtaining regulatory approval for a neuromuscular blocking agent known as Raplon. Raplon was designed to paralyze a patient’s throat area to allow the painless insertion of an endotracheal tube into a patient’s trachea. An endotracheal tube is designed to facilitate the administration of oxygen and anesthetic agents to patients during surgical or obstetric procedures.

7. On August 18, 1999, Raplon received regulatory approval from the United States Food and Drug Administration (the “FDA”). Organon subsequently engaged in extensive efforts to market Raplon to physicians in the United States and abroad.

8. Organon hoped that Raplon would be superior to its competitor drugs because it induced paralysis so rapidly. For example, Raplon would paralyze a patient’s throat area more quickly than the drug most often used, succinylcholine, an older generic drug that competed with Raplon.

9. Raplon, however, sometimes produced an unexpected serious, and sometimes fatal, side effect which met the definition of a serious adverse event (“SAE”) as set forth in the FDA regulations. Certain individuals would suffer severe respiratory problems and, at times, even, “chest rigidity” after receiving Raplon, nothing like a brief bronchospasm (a condition that occurs when a patient’s bronchial tubes close and prevent breathing.)

10. The SAEs generated by Raplon were unique in their severity when compared with similar drugs of its class. The seriousness of these episodes was described as “like having a clamp over the airway” or “the chest felt like concrete”. These SAEs would cause a patient’s entire thoracic region to contract so completely that it became extremely difficult or impossible for physicians to ventilate patients. In certain instances, physicians were unable to reverse the condition before the patient succumbed from a lack of oxygen.

11. On May 31, 2000, Organon hired Dr. Feldstein to serve as Associate Director of Medical Services for Antithrombotics. During his employment, Dr. Feldstein acquired nonpublic information concerning the clinical problems associated with Raplon. This included evidence that Organon had knowingly concealed information and made misrepresentations to the FDA during and after the regulatory approval process concerning SAEs caused by Raplon. . . .

12. In early 2001, Organon’s Associate Director of Anesthesiology, Dr. Daniel Sack, informed Dr. Feldstein that Raplon had caused numerous SAEs and multiple deaths since its approval. Dr. Sack also disclosed to Dr. Feldstein that he was in possession of a private e-mail suggesting that personnel at Organon knew prior to Raplon’s approval by the FDA that Raplon caused SAEs.

13. The e-mail was prepared by Organon’s Director of Hospital Products, Dr. Jonathan Deutsch, and sent to Organon’s Vice President of Medical Services, Dr. Deborah Shapse, prior to the FDA’s approval of Raplon. Dr. Sack discovered the e-mail on Dr. Shapse’s laptop computer after Organon had reassigned the laptop to Dr. Sack for his use. . . .

16. The e-mail also indicates that “Michael may be correct in not wanting to draw attention to bronchospasm.” (emphasis added). Upon information and belief, Michael is a reference to Michael Novinsky, Organon’s Head of Marketing.

17. Dr. Feldstein also discovered that the reference in the e-mail to the Dallas meeting was related to a meeting of the investigators involved in Raplon’s US Phase III Pivotal trial at which Organon disbursed topline data. . . . The investigators understood that these SAEs were caused by Raplon, even though they had used a double blinded trial, because the investigators never experienced this type of SAE during the many years they had worked with the comparator drug succinylcholine. . . .

19. After reviewing other internal, non-public documents and Organon’s various submissions to the FDA, Dr. Feldstein concluded that Organon had failed to disclose to the FDA instances and the severity of the SAEs associated with Raplon both before and after obtaining FDA approval. Upon information and belief, Organon’s submissions to the FDA contained numerous quantitative and qualitative misrepresentations concerning Raplon’s propensity to cause SAEs, which were purposely labeled only as expected and non-life threatening adverse events (“AEs”), such as coughing or wheezing, bronchospasm and other airway symptoms, contrary to the FDA and CFR definitions.

20. Moreover, after receiving FDA approval, Organon never advised doctors or patients of the potential for SAEs in any labeling or package insert and never had a treatment protocol in place prior to or even after launch. . . .

21. The extent of the danger posed by Raplon came to light following its approval by the FDA. In or about August 1999, physicians began reporting instances of SAEs related to Raplon to Organon’s safety department. Organon disingenuously suggested that the cause of these SAEs might have been related to the incorrect insertion of endotracheal tubes by physicians when it knew that Raplon was the true cause.

22. Many individuals died from Raplon. Additionally, reports from physicians indicate that Raplon also caused a significant number of non-fatal cases of SAEs in patients which, in turn, led to innumerable surgical delays, cancellations and/or other unnecessary medical expenses associated with treating same.

23. Organon’s actions have caused false claims to be submitted to and paid by Medicare and Medicaid, which are agencies of the United States government. Raplon’s approval by the FDA was invalid because it was obtained by Organon as a result of a willful failure to disclose and/or through the use of fraudulent and/or deceptive information. Organon, therefore, caused many hospitals, physicians and/or patients to submit false reimbursement claims to Medicare and Medicaid associated with Raplon they otherwise would not have been able to submit. Moreover, Medicare and Medicaid would not have reimbursed hospitals, physicians and/or patients for the use of Raplon had those agencies known that the FDA approved Raplon without the benefit of adequate disclosures regarding the potential for SAEs. Organon’s actions also have caused Medicare and Medicaid to pay for medical costs associated with treating SAEs that never would have been incurred had adequate disclosures been made. . . .

As ever, there will be is now more to come, on this.

Categories: Feldstein Organon Raplon 2001 1999 2005 Schering crimin

In answer to a reader, over at CafePharma. . . .

April 16, 2008 · Leave a Comment

These questions deserve more-complete answers — and so, I’ll return later today, to provide ‘em, but this is the thumbnail version I gave, just now, on CafePharma’s boards:

From: Anonymous — Today, 08:39 AM

“….thank you for your fine work…I’m a big fan of yours from the Yahoo! board.

What I can’t figure is how you know so much about SP…did you work there? Or are you a journalist?

What do you make of Bots’ report dated Jan 2007 which said that the data were ‘fine’? Why did it take 10 months to convene the infamous end-point changing advisory board after that? Does that sound like a delay to you? But what is the problem, since delaying the data isn’t illegal?

Thanks”

My answers, for now, are below, in green — other duties call me, at the moment — but, I will return to more fully flesh these answers out, with links (and some editorial asides):

Smile — I’ve NEVER worked for Schering-Plough; I am NO journalist. Did you ever see “Three Days of the Condor“?

I am a. . . . reader, I guess. I just read. . . everything. I’ve spent some time really “reading up” on SGP, over the past three months.

Now, your questions do deserve answers, and I do have my opinions(!), but I want to be careful not to libel/defame any private person. I do think Dr. Bots was right. I think the data were “fine.” I think it likely that Schering and Merck just didn’t “like” what the data pretty-plainly implied. Note that I’ve echoed, and amplified, Sen. Grassley’s publicly-aired concerns that the very-likely outcomes from even the “blinded” data, were discernible to a medically-trained eye, long-before the data were actually, formally, unblinded.

So, I think — emphasis on “think“, here — Schering and Merck asked to have the data “refined” — to try and tease some statistically-significant outcome, from it. But even the expert panelists then later agreed, on November 16, 2007, that it was likely that any variance in the “blinded data” could be the result of pure chance, not treatment/control arm outcomes. In a word — the study had utterly failed to show any benefit — in my humble opinion, of course(!).

I’vell likely posted answers to your specific questions on my blog, where I can links to each piece of authority, for each statement, above.

Now, I will say that — as a matter of law — even innocently delaying such data, and then selling stock to the public at $27.50 (near the high-price for the year!), is generally-frowned upon, over at the SEC.

Note that Schering sold $3.8 billion of equity, and another ~$4 billion of debtright in the middle of this “entirely innocent delay” on a project that impacted (or should I say sustained) 60-plus percent of Schering’s 2007 profitability. That much is entirely undisputed — and fascinating, no?. . . .

Hopefully, I’ll be back soon, to add to this.

Categories: CafePharma Bots ENHANCE delay $3.8 billion offering Vyt

Raplon — Not Discoverable on Diligence, by Schering-Plough(?). . . .

April 16, 2008 · Leave a Comment

One note, though — because the Organon Qui Tam/False Claims Act matter was so tightly-sealed, it is not likely that Schering, or its bankers — even with pointed inquiries — could have uncovered that this mess had become civil litigation, and a criminal inquiry, prior to acquiring the Organon businesses. Remember, now, the case was not ordered unsealed until February 2008.

Just for what it’s worth. . . .

However. . . . it remains an entirely open question as to whether the 1999 to 2002 Raplon documents — the FDA submissions, and the related back-up files, for example — still remained in the permanent file archives at Organon. It would have been customary to have a junior associate (for Schering) walk through each material FDA approval file-jacket, inside Organon’s HQ, prior to paying $14.4 billion for it.

The interesting question will be “How much of what Dr. Feldstein alleges was there. . . is still there?”

We will learn, in the coming months, I suspect.

Categories: Raplon Schering Organon criminal inquiry due diligence

It seems the Pre-Acquisition Organon matter WAS Criminal. . . .

April 16, 2008 · Leave a Comment

From a review of the Boston case file, it is clear that a criminal investigation of the predicate facts was underway at various points between 2002 and 2005, at least.

Once the case was transferred to New Jersey, and eventually unsealed, what was a Qui Tam Act suit, was amended to simply assert False Claims Act violations. Here are some of the salient details from the as amended, and unsealed, complaint. [I am still working up a narrative that explores the balancing of interests previously at-play in this case -- on the one hand, the fundamental right of each litigant to be present -- and at least witness -- proceedings on his case, versus the preventing of a leak, or other form of compromise, of a then-pending criminal investigation, on the other -- back later with that.]

. . . .4. Dr. Feldstein, individually and on behalf of the United States of America, seeks relief pursuant to 31 U.S.C. § 3729, et seq., commonly known as the False Claims Act. Pursuant to 28 U.S.C. § 1331, this Court possesses subject matter jurisdiction over this claim because it presents a question of federal law. . . .

6. For many years, Organon expended enormous time, money and resources developing and ultimately obtaining regulatory approval for a neuromuscular blocking agent known as Raplon. Raplon was designed to paralyze a patient’s throat area to allow the painless insertion of an endotracheal tube into a patient’s trachea. An endotracheal tube is designed to facilitate the administration of oxygen and anesthetic agents to patients during surgical or obstetric procedures.

7. On August 18, 1999, Raplon received regulatory approval from the United States Food and Drug Administration (the “FDA”). Organon subsequently engaged in extensive efforts to market Raplon to physicians in the United States and abroad.

8. Organon hoped that Raplon would be superior to its competitor drugs because it induced paralysis so rapidly. For example, Raplon would paralyze a patient’s throat area more quickly than the drug most often used, succinylcholine, an older generic drug that competed with Raplon.

9. Raplon, however, sometimes produced an unexpected serious, and sometimes fatal, side effect which met the definition of a serious adverse event (“SAE”) as set forth in the FDA regulations. Certain individuals would suffer severe respiratory problems and, at times, even, “chest rigidity” after receiving Raplon, nothing like a brief bronchospasm (a condition that occurs when a patient’s bronchial tubes close and prevent breathing.)

10. The SAEs generated by Raplon were unique in their severity when compared with similar drugs of its class. The seriousness of these episodes was described as “like having a clamp over the airway” or “the chest felt like concrete”. These SAEs would cause a patient’s entire thoracic region to contract so completely that it became extremely difficult or impossible for physicians to ventilate patients. In certain instances, physicians were unable to reverse the condition before the patient succumbed from a lack of oxygen.

11. On May 31, 2000, Organon hired Dr. Feldstein to serve as Associate Director of Medical Services for Antithrombotics. During his employment, Dr. Feldstein acquired nonpublic information concerning the clinical problems associated with Raplon. This included evidence that Organon had knowingly concealed information and made misrepresentations to the FDA during and after the regulatory approval process concerning SAEs caused by Raplon. . . .

12. In early 2001, Organon’s Associate Director of Anesthesiology, Dr. Daniel Sack, informed Dr. Feldstein that Raplon had caused numerous SAEs and multiple deaths since its approval. Dr. Sack also disclosed to Dr. Feldstein that he was in possession of a private e-mail suggesting that personnel at Organon knew prior to Raplon’s approval by the FDA that Raplon caused SAEs.

13. The e-mail was prepared by Organon’s Director of Hospital Products, Dr. Jonathan Deutsch, and sent to Organon’s Vice President of Medical Services, Dr. Deborah Shapse, prior to the FDA’s approval of Raplon. Dr. Sack discovered the e-mail on Dr. Shapse’s laptop computer after Organon had reassigned the laptop to Dr. Sack for his use. . . .

16. The e-mail also indicates that “Michael may be correct in not wanting to draw attention to bronchospasm.” (emphasis added). Upon information and belief, Michael is a reference to Michael Novinsky, Organon’s Head of Marketing.

17. Dr. Feldstein also discovered that the reference in the e-mail to the Dallas meeting was related to a meeting of the investigators involved in Raplon’s US Phase III Pivotal trial at which Organon disbursed topline data. . . . The investigators understood that these SAEs were caused by Raplon, even though they had used a double blinded trial, because the investigators never experienced this type of SAE during the many years they had worked with the comparator drug succinylcholine. . . .

19. After reviewing other internal, non-public documents and Organon’s various submissions to the FDA, Dr. Feldstein concluded that Organon had failed to disclose to the FDA instances and the severity of the SAEs associated with Raplon both before and after obtaining FDA approval. Upon information and belief, Organon’s submissions to the FDA contained numerous quantitative and qualitative misrepresentations concerning Raplon’s propensity to cause SAEs, which were purposely labeled only as expected and non-life threatening adverse events (“AEs”), such as coughing or wheezing, bronchospasm and other airway symptoms, contrary to the FDA and CFR definitions.

20. Moreover, after receiving FDA approval, Organon never advised doctors or patients of the potential for SAEs in any labeling or package insert and never had a treatment protocol in place prior to or even after launch. . . .

21. The extent of the danger posed by Raplon came to light following its approval by the FDA. In or about August 1999, physicians began reporting instances of SAEs related to Raplon to Organon’s safety department. Organon disingenuously suggested that the cause of these SAEs might have been related to the incorrect insertion of endotracheal tubes by physicians when it knew that Raplon was the true cause.

22. Many individuals died from Raplon. Additionally, reports from physicians indicate that Raplon also caused a significant number of non-fatal cases of SAEs in patients which, in turn, led to innumerable surgical delays, cancellations and/or other unnecessary medical expenses associated with treating same.

23. Organon’s actions have caused false claims to be submitted to and paid by Medicare and Medicaid, which are agencies of the United States government. Raplon’s approval by the FDA was invalid because it was obtained by Organon as a result of a willful failure to disclose and/or through the use of fraudulent and/or deceptive information. Organon, therefore, caused many hospitals, physicians and/or patients to submit false reimbursement claims to Medicare and Medicaid associated with Raplon they otherwise would not have been able to submit. Moreover, Medicare and Medicaid would not have reimbursed hospitals, physicians and/or patients for the use of Raplon had those agencies known that the FDA approved Raplon without the benefit of adequate disclosures regarding the potential for SAEs. Organon’s actions also have caused Medicare and Medicaid to pay for medical costs associated with treating SAEs that never would have been incurred had adequate disclosures been made. . . .

As ever, there will be is now more to come, on this.

Categories: Feldstein Organon Raplon 2001 1999 2005 Schering crimin

In answer to a reader, over at CafePharma. . . .

April 16, 2008 · Leave a Comment

These questions deserve more-complete answers — and so, I’ll return later today, to provide ‘em, but this is the thumbnail version I gave, just now, on CafePharma’s boards:

From: Anonymous — Today, 08:39 AM

“….thank you for your fine work…I’m a big fan of yours from the Yahoo! board.

What I can’t figure is how you know so much about SP…did you work there? Or are you a journalist?

What do you make of Bots’ report dated Jan 2007 which said that the data were ‘fine’? Why did it take 10 months to convene the infamous end-point changing advisory board after that? Does that sound like a delay to you? But what is the problem, since delaying the data isn’t illegal?

Thanks”

My answers, for now, are below, in green — other duties call me, at the moment — but, I will return to more fully flesh these answers out, with links (and some editorial asides):

Smile — I’ve NEVER worked for Schering-Plough; I am NO journalist. Did you ever see “Three Days of the Condor“?

I am a. . . . reader, I guess. I just read. . . everything. I’ve spent some time really “reading up” on SGP, over the past three months.

Now, your questions do deserve answers, and I do have my opinions(!), but I want to be careful not to libel/defame any private person. I do think Dr. Bots was right. I think the data were “fine.” I think it likely that Schering and Merck just didn’t “like” what the data pretty-plainly implied. Note that I’ve echoed, and amplified, Sen. Grassley’s publicly-aired concerns that the very-likely outcomes from even the “blinded” data, were discernible to a medically-trained eye, long-before the data were actually, formally, unblinded.

So, I think — emphasis on “think“, here — Schering and Merck asked to have the data “refined” — to try and tease some statistically-significant outcome, from it. But even the expert panelists then later agreed, on November 16, 2007, that it was likely that any variance in the “blinded data” could be the result of pure chance, not treatment/control arm outcomes. In a word — the study had utterly failed to show any benefit — in my humble opinion, of course(!).

I’vell likely posted answers to your specific questions on my blog, where I can links to each piece of authority, for each statement, above.

Now, I will say that — as a matter of law — even innocently delaying such data, and then selling stock to the public at $27.50 (near the high-price for the year!), is generally-frowned upon, over at the SEC.

Note that Schering sold $3.8 billion of equity, and another ~$4 billion of debtright in the middle of this “entirely innocent delay” on a project that impacted (or should I say sustained) 60-plus percent of Schering’s 2007 profitability. That much is entirely undisputed — and fascinating, no?. . . .

Hopefully, I’ll be back soon, to add to this.

Categories: CafePharma Bots ENHANCE delay $3.8 billion offering Vyt

Raplon — Not Discoverable on Diligence, by Schering-Plough(?). . . .

April 16, 2008 · Leave a Comment

One note, though — because the Organon Qui Tam/False Claims Act matter was so tightly-sealed, it is not likely that Schering, or its bankers — even with pointed inquiries — could have uncovered that this mess had become civil litigation, and a criminal inquiry, prior to acquiring the Organon businesses. Remember, now, the case was not ordered unsealed until February 2008.

Just for what it’s worth. . . .

However. . . . it remains an entirely open question as to whether the 1999 to 2002 Raplon documents — the FDA submissions, and the related back-up files, for example — still remained in the permanent file archives at Organon. It would have been customary to have a junior associate (for Schering) walk through each material FDA approval file-jacket, inside Organon’s HQ, prior to paying $14.4 billion for it.

The interesting question will be “How much of what Dr. Feldstein alleges was there. . . is still there?”

We will learn, in the coming months, I suspect.

Categories: Raplon Schering Organon criminal inquiry due diligence

It seems the Pre-Acquisition Organon matter WAS Criminal. . . .

April 16, 2008 · Leave a Comment

From a review of the Boston case file, it is clear that a criminal investigation of the predicate facts was underway at various points between 2002 and 2005, at least.

Once the case was transferred to New Jersey, and eventually unsealed, what was a Qui Tam Act suit, was amended to simply assert False Claims Act violations. Here are some of the salient details from the as amended, and unsealed, complaint. [I am still working up a narrative that explores the balancing of interests previously at-play in this case -- on the one hand, the fundamental right of each litigant to be present -- and at least witness -- proceedings on his case, versus the preventing of a leak, or other form of compromise, of a then-pending criminal investigation, on the other -- back later with that.]

. . . .4. Dr. Feldstein, individually and on behalf of the United States of America, seeks relief pursuant to 31 U.S.C. § 3729, et seq., commonly known as the False Claims Act. Pursuant to 28 U.S.C. § 1331, this Court possesses subject matter jurisdiction over this claim because it presents a question of federal law. . . .

6. For many years, Organon expended enormous time, money and resources developing and ultimately obtaining regulatory approval for a neuromuscular blocking agent known as Raplon. Raplon was designed to paralyze a patient’s throat area to allow the painless insertion of an endotracheal tube into a patient’s trachea. An endotracheal tube is designed to facilitate the administration of oxygen and anesthetic agents to patients during surgical or obstetric procedures.

7. On August 18, 1999, Raplon received regulatory approval from the United States Food and Drug Administration (the “FDA”). Organon subsequently engaged in extensive efforts to market Raplon to physicians in the United States and abroad.

8. Organon hoped that Raplon would be superior to its competitor drugs because it induced paralysis so rapidly. For example, Raplon would paralyze a patient’s throat area more quickly than the drug most often used, succinylcholine, an older generic drug that competed with Raplon.

9. Raplon, however, sometimes produced an unexpected serious, and sometimes fatal, side effect which met the definition of a serious adverse event (“SAE”) as set forth in the FDA regulations. Certain individuals would suffer severe respiratory problems and, at times, even, “chest rigidity” after receiving Raplon, nothing like a brief bronchospasm (a condition that occurs when a patient’s bronchial tubes close and prevent breathing.)

10. The SAEs generated by Raplon were unique in their severity when compared with similar drugs of its class. The seriousness of these episodes was described as “like having a clamp over the airway” or “the chest felt like concrete”. These SAEs would cause a patient’s entire thoracic region to contract so completely that it became extremely difficult or impossible for physicians to ventilate patients. In certain instances, physicians were unable to reverse the condition before the patient succumbed from a lack of oxygen.

11. On May 31, 2000, Organon hired Dr. Feldstein to serve as Associate Director of Medical Services for Antithrombotics. During his employment, Dr. Feldstein acquired nonpublic information concerning the clinical problems associated with Raplon. This included evidence that Organon had knowingly concealed information and made misrepresentations to the FDA during and after the regulatory approval process concerning SAEs caused by Raplon. . . .

12. In early 2001, Organon’s Associate Director of Anesthesiology, Dr. Daniel Sack, informed Dr. Feldstein that Raplon had caused numerous SAEs and multiple deaths since its approval. Dr. Sack also disclosed to Dr. Feldstein that he was in possession of a private e-mail suggesting that personnel at Organon knew prior to Raplon’s approval by the FDA that Raplon caused SAEs.

13. The e-mail was prepared by Organon’s Director of Hospital Products, Dr. Jonathan Deutsch, and sent to Organon’s Vice President of Medical Services, Dr. Deborah Shapse, prior to the FDA’s approval of Raplon. Dr. Sack discovered the e-mail on Dr. Shapse’s laptop computer after Organon had reassigned the laptop to Dr. Sack for his use. . . .

16. The e-mail also indicates that “Michael may be correct in not wanting to draw attention to bronchospasm.” (emphasis added). Upon information and belief, Michael is a reference to Michael Novinsky, Organon’s Head of Marketing.

17. Dr. Feldstein also discovered that the reference in the e-mail to the Dallas meeting was related to a meeting of the investigators involved in Raplon’s US Phase III Pivotal trial at which Organon disbursed topline data. . . . The investigators understood that these SAEs were caused by Raplon, even though they had used a double blinded trial, because the investigators never experienced this type of SAE during the many years they had worked with the comparator drug succinylcholine. . . .

19. After reviewing other internal, non-public documents and Organon’s various submissions to the FDA, Dr. Feldstein concluded that Organon had failed to disclose to the FDA instances and the severity of the SAEs associated with Raplon both before and after obtaining FDA approval. Upon information and belief, Organon’s submissions to the FDA contained numerous quantitative and qualitative misrepresentations concerning Raplon’s propensity to cause SAEs, which were purposely labeled only as expected and non-life threatening adverse events (“AEs”), such as coughing or wheezing, bronchospasm and other airway symptoms, contrary to the FDA and CFR definitions.

20. Moreover, after receiving FDA approval, Organon never advised doctors or patients of the potential for SAEs in any labeling or package insert and never had a treatment protocol in place prior to or even after launch. . . .

21. The extent of the danger posed by Raplon came to light following its approval by the FDA. In or about August 1999, physicians began reporting instances of SAEs related to Raplon to Organon’s safety department. Organon disingenuously suggested that the cause of these SAEs might have been related to the incorrect insertion of endotracheal tubes by physicians when it knew that Raplon was the true cause.

22. Many individuals died from Raplon. Additionally, reports from physicians indicate that Raplon also caused a significant number of non-fatal cases of SAEs in patients which, in turn, led to innumerable surgical delays, cancellations and/or other unnecessary medical expenses associated with treating same.

23. Organon’s actions have caused false claims to be submitted to and paid by Medicare and Medicaid, which are agencies of the United States government. Raplon’s approval by the FDA was invalid because it was obtained by Organon as a result of a willful failure to disclose and/or through the use of fraudulent and/or deceptive information. Organon, therefore, caused many hospitals, physicians and/or patients to submit false reimbursement claims to Medicare and Medicaid associated with Raplon they otherwise would not have been able to submit. Moreover, Medicare and Medicaid would not have reimbursed hospitals, physicians and/or patients for the use of Raplon had those agencies known that the FDA approved Raplon without the benefit of adequate disclosures regarding the potential for SAEs. Organon’s actions also have caused Medicare and Medicaid to pay for medical costs associated with treating SAEs that never would have been incurred had adequate disclosures been made. . . .

As ever, there will be is now more to come, on this.

Categories: Feldstein Organon Raplon 2001 1999 2005 Schering crimin

A Pre-Acquisition Organon Mess has been Unsealed by Judge Cavanaugh. . . .

April 16, 2008 · Leave a Comment

As many other capable bloggers have indicated, it appears that Organon was involved in some highly irregular efforts to keep one of its drugs, used in the operating suite, on the market, long before Organon was acquired by Schering (1999 through 2002). Ultimately, these marketing efforts failed, and Organon withdrew the product — allegedly, in part, due to increased incidence of mortality — while the drug was employed in the OR.

What interested me about this particular lawsuit — as I read through the docket — was (1) that the same predicate events did result in a criminal investigation, out of the Boston US Attorney’s office (which has since apparently been closed), and (2) that it was, for the vast length of its prior existence, held under a very strict — nay, all-but-air-tight — seal. Click it to enlarge, here:

This sealing — and the February 2008 unsealing — seem unusual, and are thus what I’ll focus on, here, tonight. At one point, there were in camera proceedings held, and orders entered, by the federal District Court in Boston — that the nominal claimant/plaintiff was entirely prevented from learning about — even after the fact.

That is rather extraordinary, even in the otherwise cloak-and-dagger world of federal Qui Tam Act (QTA) suits, brought by individuals (but in the name of the United States of America). Some times, when a criminal indictment is contemplated, but not yet unsealed, the civil QTA matter will be stayed (or “put on hold“) until the indictment issues, or the investigation otherwise closes, without any indictment issuing.

But to hold hearings, and to enter orders, on a claimant’s case — without letting his lawyer be present — or even notifying his own lawyer, after the fact, is in my experience, all but jaw-slacking. That this case stayed sealed for almost seven years, is likewise astonishing. It was transferred down to New Jersey (when the claimant moved there), and into the federal district courts there, about a year and a half ago. More on that in a second.

I am still reviewing all the formerly-sealed documents I downloaded last night, out of Boston, and New Jersey, to try to ultimately sort out what happened — and why, procedurally, this remained in a “Star Chamber” for so long. I’ll update prominently, here, if anything really interesting turns up, in that regard.

But, now — and my punchline, here — the case was unsealed in February 2008 by none other than Judge Cavanaugh’s own Magistrate Falk — the very same Judge Cavanaugh who will now oversee all 33-plus of the consolidated Schering consumer fraud suits in MDL 1938. At first blush, that makes a lot of sense, as he will no doubt, become an expert in the intricacies of Schering’s inner workings — as part of his review of the consumer fraud multi-district litigation.

I have set, in running-text, the entire the order, below, though, to point out that Judge Cavanaugh’s court unsealed the case “sua sponte” — which means “on his own intiative” — or, without anyone moving to ask him unseal it. The Court felt it important to unseal this case. Why? I hope to sort the answer to that question out in the next few days. Until then, take a look at this truly extraordinary order:

~~~~~~~~~~~~~~~
UNITED STATES DISTRICT COURT
DISTRICT OF NEW JERSEY

~~~~~~~~~~~~~~

UNITED STATES OF AMERICA,
Plaintiff,

v.

ORGANON, INC., et al.,
Defendants.

Hon. Dennis M. Cavanaugh
Civil Action No. 07-2690 (DMC)

~~~~~~~~~
ORDER
~~~~~~~~~

THIS MATTER having come before the Court sua sponte; and it appearing that this case has been proceeding under seal pursuant to 31 U.S.C. § 3730(b)(2); and it further appearing that the Government has filed a notice of election not to intervene in this matter; and for good cause shown;

IT IS on this 11th day of February, 2008 ORDERED that the complaint in this matter be and hereby is unsealed; and it is further ORDERED that plaintiff serve the complaint in accordance with Rule 4 of the Federal Rules of Civil Procedure.

/s/Mark Falk

MARK FALK

United States Magistrate Judge

Orig.: Clerk of the Court
cc: Hon. Dennis M. Cavanaugh, U.S.D.J.

All Parties

File

Wild. What was up with all of that, I wonder. But, fret not, gentle readers — I’ll go find out. Heh.

Categories: Raplon Dennis Cavanaugh Mark Falk Schering Organon Feld