“Simon Nitinol IVC Filters” Now Included In BARD IVC FILTER MDL 2641 Claims

“Simon Nitinol IVC Filters” Included In BARD IVC FILTER MDL 2641 Claims

By Mark A. York (January 29, 2019)

SIMON NITINOL IVC FILTER

 

 

 

 

 

 

 

 

 

 

 

 

(MASS TORT NEXUS MEDIA) Recent pleadings in the Bard IVC Filter MDL 2641 reflect Bard’s Simon Nitinol IVC Filters now being included in the types of IVC filters permitted in claims. The Simon IVC filters being allowed in the litigation is based on motions by Bard that were deemed moot and had also included a Bard request for a separate MDL for Simon Nitinol Filters, which was denied. See Bard IVC MDL 2641 Joint Report Re Bard Simon Nitinol Filters part of MDL (Jan 28, 2019) also referenced in the January 2, 2019 JPML order JPML Order Re: Simon Nitinol IVC Filters Included in MDL 2641.

Bard-Davol is attempting to consolidate MDL 2641 IVC Filter litigation cases now that settlement discussions seem to be starting in earnest and having all their filters in this MDL makes good business sense.

Bard’s history includes being known as the company that manufactured IVC filters associated with at least 27 deaths and hundreds of related problems when they replaced the initial IVC device with a modified version, that it knew had similar and potentially fatal flaws soon after it was put on the market.

Company records have shown that New Jersey based C.R. Bard was concerned about reports of failures for its G2 series filters, designed to replace the company’s Recovery filter, within four months of being cleared to sell the G2 by the Food and Drug Administration.

Bard is currently involved in MDL 2641 Bard IVC Filter Litigation in US District Court -Phoenix, Arizona. For further information, see Mass Tort Nexus Briefcase BARD-IVC-Filters-MDL-2641-Product-Liability-Litigation Briefcase.

Bard IVC filter models include:
  • Simon Nitinol IVC Filter
  • Recovery Filter System
  • G2 Vena Cava Filter
  • G2 Express Vena Cava Filter
  • Eclipse Vena Cava Filter
  • Meridian Vena Cava Filter
  • Denali Vena Cava Filter

But instead of recalling the G2 filter, and the virtually identical G2 Express, the medical device manufacturer decided to keep them on the market for five years until 2010, selling more than 160,000 of them.

At least 12 deaths and hundreds of problems are now linked to the G2 series filters, according to Bard and FDA records.

“All of the data that we’ve seen in our own studies, as well as other clinician researchers’, is that this device consistently fractures, consistently causes major complications,” said Dr. William Kuo, a interventional radiologist who runs Stanford Health Care’s IVC Filter Clinic, which specializes in removing failed blood clot filters. “The number of complications, the frequency of severe failures makes it obvious that it was never safe to be implanted.”

The spider-shaped Bard filters, implanted in the largest vein in the body (the inferior vena cava) were designed to stop blood clots from moving to the heart and lungs, where they could be fatal.

                  Two of Bard IVC Filter Products

Blood clot filters are implanted in an estimated 250,000 people in the U.S. each year, most without incident. In the last decade, millions of filters have been implanted in Americans. Bard is one of 11 manufacturers that make these devices.

Bard had hoped to gain a new foothold in the lucrative filter market when it introduced the Recovery filter. But after it received FDA clearance to market the device in 2002, reports of deaths and injuries associated with it moving and breaking steadily climbed.

confidential study commissioned by Bard showed that the Recovery filter had higher rates of relative risk for death, filter fracture and movement than all of its competitors. An outside doctor hired to conduct the study wrote that “further investigation…is urgently warranted.”

But Bard decided not to recall the Recovery from the market. In 2005, after the device had been sold for three years, the company replaced it with the similar G2 series of filters. Internal Bard records and hundreds of reports to the FDA show that the G2 series did not solve the filter’s problems.

confidential memo written in December 2005 by a Bard vice president soon after the G2 was cleared by the FDA shows his concern about “problems with…migration,” “tilting” and “perforation.” He also noted that Bard had another filter on the market that had virtually no complaints. “Why shouldn’t doctors be using that one rather than the G2?” he asked.

Another document written later that includes data through 2010 showed the G2 series filters had more fractures, migrations and reported problems than any of its competitors.

Clinical Research Shows IVC Filter Dangers Were Known

 “Caval Penetration by Inferior Vena Cava Filters”

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.115.016468

Zhongzhi Jia, Alex Wu, Mathew Tam, James Spain, J. Mark McKinney, Weiping Wang    Originally published13 Jul 2015

https://doi.org/10.1161/CIRCULATIONAHA.115.016468Circulation. 2015;132:944–952

 Abstract:

Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters.

Methods and Results—

The MEDLINE database was searched for all studies (1970–2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications.

Conclusions—

Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement. Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.

Introduction

The inferior vena cava (IVC) filter is a device that is implanted in the IVC to prevent lower-extremity deep venous thrombosis from causing life-threatening pulmonary embolism. The IVC filter achieves this by catching the embolizing thrombus between metal struts. Therefore, it is critical that the IVC filter maintains its position once implanted to fulfill this filtration function. Limited penetration of the filter into the caval wall is needed to secure the filter to the caval wall, so penetration is considered pathological only when the limb protrudes >3 mm beyond the caval wall.1 Over the last decade, as more patients with optional filters have returned for filter retrieval, penetration has been increasingly recognized as a frequent finding, particularly with conically shaped filters.2 Although most cases of penetration are asymptomatic and regarded as incidental findings on imaging studies, penetrations may be clinically significant when they involve the adjacent organs or structures. In such cases, filter penetration may require intervention.3

Clinical Perspective

The purposes of this study were to conduct a literature review on the frequency and severity of caval penetration for commercially available IVC filters and to discuss the potential mechanisms, risk factors, treatment, and prevention strategies for filter penetration.

 Search Strategy

Institutional Review Board approval was not required for this literature review. The MEDLINE database was searched (search parameters: PubMed from 1970–2014, English language) for terms describing IVC filters (key words: inferior vena cava, filter, and perforation or penetration). Prospective clinical trials, retrospective studies, case reports, and series with IVC filter placement and subsequent radiographic imaging or surgical follow-up were included in this review for analysis. We excluded studies of IVC filter placements without either imaging or surgical follow-up, review articles, animal studies, laboratory investigations, duplicated case reports or clinical studies, and other unrelated articles such as editorials, guidelines, response letters, commentaries, or special communications.

Data Extraction

Articles that met the inclusion criteria were reviewed. A standardized data extraction database was created by tabulating the following information: first author; year of publication; title; journal; study design (prospective, retrospective, or case report); number and model of IVC filters; number of patients with imaging or surgical follow-up; cases of penetration; imaging findings; clinical symptoms; interventions; and clinical outcomes. Two investigators conducted the literature search independently to verify data accuracy and completeness, with a third reviewer resolving any uncertainties. The formal definition of penetration provided by Society of Interventional Radiology guidelines (the extension of a limb >3 mm beyond the cava wall) was used in this study.1 Major complications of IVC penetration were defined as admission to a hospital for therapy (for outpatient procedures), an unplanned increase in the level of care, prolonged hospitalization, permanent adverse sequelae, or death after filter placement.1 The quality of clinical studies and case reports was assessed with the Grading of Recommendation, Assessment, Development and Evaluation (GRADE), with study and report quality categorized as high, moderate, low, or very low.4

Results

The initial search for “IVC” and “filter” yielded 1511 English reports from January 1, 1970, to December 31, 2014. Of the 1511 reports, a total of 1311 studies were excluded, which included 146 review articles, 1158 studies unrelated to penetration, 1 duplicated clinical study, and 6 duplicated case reports (Figure 1). Ultimately, a total of 88 studies (14 prospective clinical trials and 74 retrospective studies) and 112 case reports were included in this study. The quality of evidence was as follows: high, n=9; moderate, n=44; low, n=34; and very low, n=113. The total number of filter placements qualified for analysis was 9002 (8833 from clinical studies and 169 from case reports; Figure 1). Fifteen types of filters exhibited caval penetration (Table 1); the basic shape of each involved filter is illustrated in Figure 2. Penetration segregated by filter type according to longitudinal studies is shown in Table 2. The incidence of caval penetration was 21% (973 of 4694) for conical filters and 4% (34 of 799) for nonconical filters (P<0.01). The incidence of caval penetration in prospective trials was 9.8% (105 of 1076) and for retrospective studies was 20% (902 of 4417). [end]

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WHAT DID BARD KNOW AND WHEN?

Bard kept the G2 series filters on the market until 2010, the same year that Chris Svedise had a Bard G2 Express implanted in him because he was prone to blood clots. Svedise, 69, a manager at a wholesale fish company in San Francisco, asked his doctor last October to check on the filter. He was alarmed to learn it had moved.

“He said, ‘It is dangerously close to your heart,’” Svedise said.

After two surgeons declined to remove the filter because of its precarious position, Svedise turned to Dr. William Kuo, whose team has developed an advanced technique to remove failed filters and filter pieces.

Dr. William Kuo of Stanford Health Care’s IVC Filter Clinic.

During emergency surgery, Kuo discovered three legs had already broken off of Svedise’s filter and traveled to his lungs. Kuo also said that two partially broken legs completely broke away during the operation. One, he said, could have killed Svedise.

“It floated off right in front of our eyes,” Kuo said. “First into the right atrium and then into the right ventricle. He’s very lucky.”

Kuo estimates that in the last 10 years he has removed 1,000 failed filters. Many of the cases were referred to him by other surgeons who deemed the procedure too complex and dangerous. Kuo said he has removed more Bard filters than any other single type.

The Recovery and G2 series filters should have been pulled from the market, “Whether it’s an ethical reason, a moral obligation, in the interest of public safety and patient safety, absolutely these devices should have been recalled,” he added.

Kuo said that along with device companies, the FDA also needs to take stronger action to protect patients.

“What we’ve learned the hard way is that we can no longer rely on medical device companies to do what’s in the best interest of the patient. And we can no longer rely on the FDA to properly regulate these devices,” he said.

Sen. Charles Grassley (R-Iowa), chairman of the Senate Judiciary Committee, sent a letter to the FDA inquiring about the agency’s oversight of the filter. One of his questions was about the actions the agency takes when new information about the performance of an already cleared medical device becomes known.

“FDA’s only got one responsibility. It’s not the company, it’s John Q. Public — to protect the American public from two standpoints: safety and effectiveness,” Grassley said.

Grassley then issued a statement that the FDA’s response was incomplete and he has more questions as he decides what steps to take next.

Asked about Grassley’s concerns and why Bard’s Recovery and G2 filters were not recalled, the FDA declined to answer. The agency said in a statement that it has “investigated the risks of all of these devices,” not just Bard’s, and “issued safety communications” about “risks associated with IVC filters.”

In 2010 and 2014, the agency recommended in those safety alerts that doctors should consider removing the filters from patients as soon as protection from blood clots is no longer needed.

The Society of Interventional Radiologists, Society for Vascular Surgery, and blood clot filter manufacturers, including Bard, have started a large clinical trial called PRESERVE to examine how safe and effective filters now on the market are. The study, which the FDA helped organize, is expected to enroll 2,100 patients over the course of five years, the most ambitious filter study ever in the U.S.

In the meantime, Kuo worries about the steady stream of patients coming into his clinic whose filters have failed and risk injury or death. ”It’s upsetting to see the patients who have actually suffered from a system that appears to be broken,” he said.

As of January 2, 2019 when the JPML issued the Simon Nitinol related order, there were 85 Simon IVC filter related cases directly filed in to MDL 2641, and how many more of these claims will be filed is unknown, as many Simon Nitinol cases have been historically declined by firms due to not being part of Bard MDL 2641.

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Purdue Pharma’s Historical Bad Conduct Started 50 Years Ago: “Crafted By The Sackler Brothers”

 DOCUMENTS SHOW LONG-TERM DRUG INDUSTRY MANIPULATION BY THE SACKLERS

By Mark A. York (January 16, 2019

 

 

 

 

 

 

 

(MASS TORT NEXUS MEDIA) In 2007, Purdue Frederick Co. (not Purdue Pharma) and three company executives pled guilty to misbranding OxyContin and agreed to pay $634.5 million to resolve a U.S. Department of Justice investigation, in the US District Court of Virginia, see Purdue Criminal Plea Agreement US Department of Justice May 10, 2007. This plea deal “a get-out-of-jail free card” was engineered by none other than former New York City Mayor and political/corporate fixer, Rudy Guiliani, by directly leveraging high level US DOJ contacts and other DC insiders to derail the prosecution of Purdue Pharma, and instead offer up Purdue Fredrick Co. as the guilty party and thereby permitting the multi-billion dollar per year Oxycontin assembly line to continue operations.

The Sackler family has always been protected by the company shield, even though their most profitable selling opioid drug Oxycontin, and its boardroom coordinated marketing campaign was the brainchild and a direct result of the Purdue Pharma company founders, the Sackler brothers and their tried and true business model.

That is now changing, as the State of Massachusetts has filed a lawsuit against Purdue Pharma and the Sackler family as well as various Purdue executives over the prescription painkiller OxyContin. Oxycontin is now recognized as the opioid fuse that ignited America’s opioid crisis, and in a positive move forward, the leading executives and members of the multibillionaire Sackler family, now known to be feuding over the opioid crisis have been named in civil litigation.

The Sacklers named in the lawsuits include Theresa and Beverly, widows of Purdue founders, brothers Mortimer and Raymond Sackler and Ilene, Kathe and Mortimer David Alfons Sackler, three of Mortimer’s children; Jonathan and Richard Sackler, Raymond’s two sons; and David Sackler, Raymond’s grandson. The Sackler family is worth conservatively, an estimated$13 billion according to Forbes, which has been generated from sales of OxyContin.  As is normal procedure by the Sackler family and the company itself, the Sackler family feuding members always decline requests for comment on the catastrophic opioid crisis and avoid discussing any Purdue Pharma links to how the crisis came about.

As Purdue Pharma comes to grips with the fact that they are being designated as the primary litigation targets of states, counties and cities across the country for being the Opiate Big Pharma leader in creating the current opioid crisis in the United States, they may need to determine how they will pay the billions of dollars in jury verdicts and affiliated legal settlements resulting from the lawsuits that now number over 1,200 cases in state and federal courts.

The entire Sackler brothers’ Oxycontin marketing plan followed their previously proven drug marketing test drive of “Valium” – when Hoffman-LaRoche hired the Sacklers to market their new drug “diazepam” commonly known as Valium and its sister drug Librium.

While running the drug advertising company, Arthur Sackler became a publisher, starting a biweekly newspaper, the Medical Tribune, which eventually reached 600,000 physicians. He scoffed at suggestions that there was a conflict of interest between his roles as the head of a pharmaceutical-advertising company and the publisher of a periodical for doctors. Later it emerged that a company he owned, MD Publications, had paid the chief of the antibiotics division of the FDA, Henry Welch, nearly $300,000 in exchange for Welch’s help in promoting certain drugs. Sometimes, when Welch was giving a speech, he inserted a drug’s advertising slogan into his remarks. After the payments were discovered, Welch was forced to resign from the FDA.

When Purdue Pharma started selling its prescription opioid painkiller OxyContin in 1996, Dr. Richard Sackler asked people gathered for the launch party to envision natural disasters like an earthquake, a hurricane, or a blizzard. The debut of OxyContin, said Sackler — a member of the family that started and controls the company and then a company executive — “will be followed by a blizzard of prescriptions that will bury the competition.”

Five years later, as questions were raised about the risk of addiction and overdoses that came with taking OxyContin and opioid medications, Sackler outlined a strategy that critics have long accused the company of unleashing: divert the blame onto others, particularly the people who became addicted to opioids themselves.

“We have to hammer on the abusers in every way possible,” Sackler wrote in an email in February 2001. “They are the culprits and the problem. They are reckless criminals.”

Sackler’s comments at the party and his email are contained in newly public portions of a lawsuit filed by the state of Massachusetts against Purdue that alleges that the company, the Sackler family, and company executives misled prescribers and patients as they aimed to blanket the country with prescriptions for their addictive medications.

“By their misconduct, the Sacklers have hammered Massachusetts families in every way possible,” the state’s complaint says, noting that since 2007, Purdue has sold more than 70 million doses of opioids in Massachusetts for more than $500 million. “And the stigma they used as a weapon made the crisis worse.”

The new filing also reveals how Purdue aggressively pursued tight relationships with Tufts University’s Health Sciences Campus and Massachusetts General Hospital — two of the state’s premier academic medical centers — to expand prescribing by physicians, generate goodwill toward opioid painkillers among medical students and doctors in training, and combat negative reports about opioid addiction.

Since the beginning of May, the attorneys general of Florida, Nevada, Massachusetts, North Carolina, North Dakota, Tennessee, Texas, Utah and Virginia have also filed lawsuits against the company.

New York City previously filed a $500 million suit, against pharmaceutical companies that make or distribute prescription opioids, the complaint was filed in New York state court, the Superior Court of Manhattan, which is a break from other Opioid lawsuits filed by cities, who filed into federal court, see Mass Tort Nexus Briefcase,  OPIOID-CRISIS: MDL-2804-OPIATE-PRESCRIPTION-LITIGATION. The primary claims state that the opiate drug companies fueled the deadly epidemic now afflicting the most populous U.S. city, joining Chicago, Seattle, Milwaukee and other major cities across the country in holding Big Pharma drug makers accountable for the opioid crisis. The case docket information is: City of New York v Purdue Pharma LP et al, New York State Supreme Court, New York County, No. 450133/2018.

Major US Cities Filing Suit Against Opioid Big Pharma-New York, Seattle, Chicago Join MDL 2804

Gov. Andrew Cuomo said in a statement “The opioid epidemic was manufactured by unscrupulous manufacturers and distributors who developed a $400 billion industry pumping human misery into our communities”.

The suit comes three months after Underwood first announced her intention to sue the pharma giant, joining several other states that have already targeted Purdue for its alleged role in the epidemic that saw more than 3,000 New Yorkers die of opioid overdoses in 2016. Daniel Raymond, deputy director of the Harm Reduction Coalition, said that the cities and states are forced to file suits now, after realizing initially that the opioid overdose rates “were primarily driven by prescription painkillers — they weren’t concentrated in urban areas.”

“But the recent rises in prescription overdoses, which in turn has accelerated a major increase in heroin overdoses, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets,” said Raymond, whose organization is based in New York City. “That’s certainly true in places like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths. That doesn’t mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers.”

The only bright spot — and it’s a dim one at that — was that the CDC found decreases in opioid overdoses in states like West Virginia, New Hampshire and Kentucky that have been leading the nation in the category.

“We hope this is a positive sign,” said Schuchat, who credited leadership, particularly in West Virginia, with taking bold steps to combat the crisis. “But we have to be cautious in the areas that have reported decreases.”

Dr. Rahul Gupta, then Director of Public Health for West Virginia has been at the forefront of addressing the opioid crisis in not only West Virginia but across the country, he stated “Sometimes places that have had such high rates have no place to go” but down, he added, with West Virginia being one of the states to address the issues pro-actively in all areas.

The same drug abuse related issues that are in New York and other major metropolitan areas are now at healthcare crisis levels, with the causation now being seen as based on the ongoing marketing abuses by Purdue Pharma and other opiate industry drug makers and distributors.

The new CDC “Vital Signs” report was released a week after Attorney General Jeff Sessions issued a “statement of interest” in support of local governments that are suing the big pharmaceutical makers and distributors, accusing them of swamping many states with prescription painkillers and turning millions of Americans into junkies.

The new CDC numbers come from analysis of emergency room data from 16 states, including some hardest hit by the plague — Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maine, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin.

Dozens of states, counties and local governments have independently sued opioid drugmakers in both state and federal courts across the country, (see OPIOID-CRISIS-BRIEFCASE-MDL-2804-OPIATE-PRESCRIPTION-LITIGATION by Mass Tort Nexus) with claims alleging all opiate drug makers, distributors and now the pharmacies engaged in fraudulent marketing to sell the powerful painkillers. They also failed to monitor and report the massive increases in opioid prescriptions flooding the US marketplace. Which has now resulted in fueling the nationwide epidemic, that’s reported to have killed over a quarter million people. The now organized approach steps up those efforts as officials sift evidence and are holding not only the companies, but the executives and owners culpable in the designing the opioid crisis.

Purdue Pharma is facing a legal assault on many fronts, as cities, counties and states have either filed suit or are probing the company for an alleged role in the United States’ opioid and addiction epidemic. The lawsuit filed by Massachusetts’ Attorney General Maura Healey, is the first to bring the company’s current and former execs into the mix, including the billionaire family with sole ownership of Purdue.

The Sackler family name graces some of the nation’s most prestigious bastions of culture and learning — the Sackler Center for Arts Education at the Guggenheim Museum, the Sackler Lefcourt Center for Child Development in Manhattan and the Sackler Institute for Developmental Psychobiology at Columbia University, to name a few.

Now for the first time since the opioid crisis came to the attention of America, the Sackler name is front and center in a lawsuit accusing the family and the company they own and run, Purdue Pharma, of helping to fuel the deadly opioid crisis that has killed thousands of Americans.

Lawsuit filed by the state of Massachusetts against Purdue Pharma

Under an agreement with Mass. General, Purdue has paid the hospital $3 million since 2009 and was allowed to propose “areas where education in the field of pain is needed” and “curriculum which might meet such needs,” the court document shows. Tufts made a Purdue employee an adjunct associate professor in 2011, Purdue-written materials were approved for teaching to Tufts students in 2014, and the company sent staff to Tufts as recently as 2017, the complaint says. Purdue’s New England staff was congratulated for “penetrating this account.”

A Tufts spokesman declined to comment, citing the ongoing legal process. Mass. General did not immediately comment.

In a statement Purdue criticized the Massachusetts Attorney General Maura Healey’s office, which is spearheading the lawsuit, and said the complaint was “a rush to vilify” Purdue. It noted that its medications were approved by the Food and Drug Administration and regulated by the government, and that the company promoted the medications “to licensed physicians who have the training and responsibility to ensure that medications are properly prescribed.”

“Massachusetts’ amended complaint irresponsibly and counterproductively casts every prescription of OxyContin as dangerous and illegitimate, substituting its lawyers’ sensational allegations for the expert scientific determinations of the [FDA] and completely ignoring the millions of patients who are prescribed Purdue Pharma’s medicines for the management of their severe chronic pain,” the company said.

It also said the state attorney general’s office omitted information about the steps Purdue has taken in the past decade to promote safe and appropriate use of opioid medicines.

“To distract from these omissions of fact and the other numerous deficiencies of its claims, the Attorney General has cherry-picked from among tens of millions of emails and other business documents produced by Purdue,” the company said. “The complaint is littered with biased and inaccurate characterizations of these documents and individual defendants, often highlighting potential courses of action that were ultimately rejected by the company.”

Healey’s office sued Purdue, current and former executives, and members of the Sackler family in June. In December, it filed an amended complaint that was nearly 200 pages longer than the June filing, with more allegations spelled out against the individual defendants. Many of the details were redacted; a portion of them were made public in an updated document filed Tuesday in state court, though much of the complaint is still blacked out.

The state’s suit focuses on Purdue’s actions since 2007, when the company and three current and former executives pled guilty in federal court to fraudulently marketing OxyContin and the company agreed to pay $600 million in fines. The case is separate from litigation being waged by STAT to obtain sealed Purdue documents in Kentucky, including the only known deposition of Richard Sackler, about the company’s marketing practices in earlier years, which have been blamed for igniting the current opioid addiction crisis.

The Massachusetts complaint sketches an image of the Sacklers, as board members, exercising tight control over the company, overseeing the deployment of a phalanx of sales representatives who were pushed to get Purdue medications into more hands, at higher doses, and for longer periods of time. The Sacklers, the complaint states, reaped “billion of dollars,” even as the company blurred the risks of addiction and overdose that came with the drugs.

Richard Sackler, who was named president of the company in 1999 before becoming co-chairman in 2003, is singled out in the complaint as particularly domineering as he demanded greater sales. In 2011, he decided to shadow sales reps for a week “to make sure his orders were followed,” the complaint states.

Russell Gasdia, then the company’s vice president of sales and marketing, who is also a defendant in the Massachusetts lawsuit, went to Purdue’s chief compliance officer to warn that if Sackler directly promoted opioids, it was “a potential compliance risk.”

“LOL,” the compliance officer replied, according to the complaint. Other staff raised concerns, but they ultimately said that “Richard needs to be mum and anonymous” when he went into the field.

After the visits to doctors, Richard Sackler claimed that Purdue’s drugs shouldn’t need a legally mandated warning. He wrote in an email cited in the complaint that the warning “implies a danger of untoward reactions and hazards that simply aren’t there.”

Secret trove reveals bold ‘crusade’ to make OxyContin a blockbuster

The following year, Sackler’s pressure on the staff grew so intense that Gasdia asked the CEO to intervene: “Anything you can do to reduce the direct contacts of Richard into the organization is appreciated,” Gasdia wrote in an email cited by the complaint.

It apparently didn’t work. The next week, Richard Sackler emailed sales managers to say that U.S. sales were “among the worst” in the world.

Sales managers were badgered on nights, weekends, and holidays, according to the filing. The marketing campaigns focused on high-volume doctors, who were visited repeatedly by salespeople, and pushed doctors to prescribe high doses. The demands on sales managers created such a stressful environment that in 2012, they threatened to fire all sales representatives in the Boston area because of lackluster numbers.

The complaint also accuses Purdue of rarely reporting alleged illegal activity, such as improper prescribing and massive Oxycontin order increases to government officials when it learned about it. In one 2009 case, a Purdue sales manager wrote to a company official that Purdue was promoting opioids to an illegal pill mill.

“I feel very certain this is an organized drug ring,” the employee wrote, adding “Shouldn’t the DEA be contacted about this?” Purdue did nothing for two years, according to the complaint.

In addition to relying on its sales force, Purdue cultivated ties with academic hospitals, which both treat patients and train the next generation of prescribers.

In 2002, the company started the Massachusetts General Hospital Purdue Pharma Pain Program after a Purdue employee reported that access to the hospital’s doctors “is great … they come to us with any questions, and allow us to see them when we need to.” The hospital, the staffer added, “has significant influence through most of New England, simply because they are MGH.”

As part of the program, Purdue gained influence over training programs and organized a symposium in the hospital’s famed “Ether Dome” — the site of the first public surgery with anesthetic.

The Sacklers renewed the deal with Mass. General in 2009 and agreed to contribute $3 million to fund the program, the lawsuit says.

Purdue’s funding, however, didn’t stop researchers at Mass. General from raising concerns about its products. The complaint cites a July 2011 email from Purdue’s then-chief medical officer Craig Landau — who is now the CEO and is a defendant in the lawsuit — flagging a study questioning the use of opioid painkillers for chronic pain that was conducted by Mass. General researchers with Purdue funding. Landau wanted to make sure that any Purdue-funded study supported the use of its medicines.

Purdue’s ties to Tufts date back even further, according to the lawsuit. In 1980, three Sacklers donated funding to launch the Sackler School of Graduate Biomedical Sciences. In 1999, the Sacklers gave money to help start the Tufts Masters of Science in Pain Research, Education, and Policy. Through the program, “Purdue got to control research on the treatment of pain coming out of a prominent and respected institution of learning,” the filing states. Purdue employees even taught a Tufts seminar about opioids, and Tufts and its teaching hospital collaborated with Purdue on a publication for patients called, “Taking Control of Your Pain.”

Purdue also allegedly used Tufts’s ties in Maine as reports about addiction emerged in the state. Tufts ran a residency program in the state, the complaint says, and in 2000 “agreed to help Purdue find doctors to attend an event where Purdue could defend its reputation.”

The bulk of the documents cited in the Massachusetts complaint were filed by Purdue in federal court in Ohio as part of a consolidated case involving hundreds of lawsuits filed by states, cities, counties, and tribes against Purdue, other opioid manufacturers, and others in the pharmaceutical industry.

Purdue says it produced 45 million pages of documents for the federal court case — known as a multidistrict litigation. In a motion filed last month and in an emergency hearing before the federal judge in Ohio overseeing the MDL, Purdue argued that the details in Massachusetts’ amended complaint were largely drawn from about 500 Purdue documents it had filed on a confidential basis in the federal court. The company’s lawyers argued the rules of confidentiality established in the federal court should apply to Massachusetts’ filing in state court, while state officials say the issue of what should be made public should be decided in state court.

Among the records Purdue said last month should remain confidential are those involving the company’s board of directors. Making them public, the company argued, would have a “chilling effect” on corporate governance.

The effort to protect the disclosure of board-related documents serves another purpose not cited by the company: It protects the Sackler family, whose members have long constituted the majority of board members.

In its filing last month, Purdue also said one company official, whom it did not name, was concerned for his safety because his home address was listed in the complaint along with “numerous irrelevant, incendiary, and misleading comments about his career at Purdue.”

Purdue’s attorneys contend the Massachusetts amended complaint is a “concerted effort by the Commonwealth to use confidential documents in an attempt to publicly embarrass Purdue and its officers, directors and employees.” They claim the information selected was “cherry-picked” to “bolster a series of inflammatory and misleading allegations against Purdue.”

In September 2017, Landau, by that time Purdue’s CEO, jotted down a note summarizing some of the roots of the opioid crisis. It reads:

“There are:
Too many Rxs being written
Too high a dose
For too long
For conditions that often don’t require them
By doctors who lack the requisite training in how
to use them appropriately.”

The state’s lawsuit concludes: “The opioid epidemic is not a mystery to the people who started it. The defendants knew what they were doing.”

The Sackler family is the 19th richest in the nation, with an estimated fortune of $13 billion, according to Forbes.

The Sacklers involved with Purdue Pharma are the descendants of brothers Mortimer and Raymond Sackler. Their eldest brother, Arthur, died in 1987, well before Purdue began making and selling OxyContin. Arthur also worked in pharmaceuticals and developed a reputation for cleverly marketing new drugs directly to doctors, convincing them to prescribe medications including tranquilizers to their patients.

Arthur was inducted into the Medical Advertising Hall of Fame after his death, but he has also been criticized for originating “most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today,” as Allen Frances, the former chair of psychiatry at Duke University School of Medicine, told the New Yorker last year.

Arthur’s family has made a point of noting that he was not involved in the sale of OxyContin and would prefer him to be remembered for his philanthropy, including funding the Arthur M. Sackler Gallery of Chinese Stone Sculpture at The Metropolitan Museum in Manhattan and the Arthur M. Sackler Museum at Harvard University.

“None of the charitable donations made by Arthur prior to his death, nor that I made on his behalf after his death, were funded by the production, distribution or sale of OxyContin or other revenue from Purdue Pharma,” his widow, Jillian Sackler, said in a February statement. “Period.”

Seven of the Sacklers named in the suit have been on the Purdue board since the 1990s, according to the suit, while David Sackler, the grandson, has served since 2012.

The board met on a weekly — sometimes daily — basis while the company was being investigated by 26 states and the Justice Department from 2001 to 2007, according to the lawsuit. In 2007, the board settled and agreed to pay a $700 million fine after the company’s CEO at the time, Michael Friedman, and two other high-ranking company officials pleaded guilty to misleading doctors and patients about opioids.

KENTUCKY LEGAL FIGHT TO KEEP SACKLER TESTIMONY SEALED

In an example of the past coming back to haunt the present, in 2015 Purdue Pharma agreed to pay $24 million to settle a lawsuit filed by Kentucky, December 22, 2015 Purdue Pharma Settlement With State of Kentucky,  which Purdue thought would end that problem by paying a fine and moving on, which isn’t the case it seems. See Purdue Pharma settles with Kentucky over Oxycontin claim(statnews.com/pharmalot) for information on the claims in Kentucky.

That state court litigation is now subject to an ongoing legal battle in the Kentucky courts where Purdue is fighting to keep the original court records from that settlement sealed, due to the only deposition testimony of one of the Sackler brothers is known to be located. The Purdue court records were unsealed by Pike County Judge Stephen Combs in May 2016, and Purdue immediately appealed with oral arguments taking place June 26, 2017 in front of a three judge panel of the Kentucky Court of Appeals, which as of June 20, 2018 has not issued a ruling on releasing the records. The original Kentucky vs. Purdue docket information is case no. 07-CI-01303, Judge Stephen Combs, Pike County Circuit Court of Kentucky.

OxyContin was hailed as a medical marvel when it debuted in 1995. Pitched as balm for people suffering from moderate to severe pain, it reportedly generated more than $35 billion in revenue for Purdue Pharma.

Oxycontin’s chief ingredient is oxycodone, a cousin of heroin, and prosecutors say Purdue played down the dangers of addiction while getting hundreds of thousands of Americans hooked on opioids.

Purdue has argued that OxyContin is approved by the Food and Drug Administration and accounts for just 2 percent of the opioid prescriptions nationwide.

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How Johnson & Johnson Hid Asbestos In J&J Baby Powder Products For Over 40 Years

“Why Did Johnson & Johnson Hide Asbestos In Baby Powder Products?” 

By Mark A. York  (January 2, 2019)

 

 

 

 

 

 

  (Mass Tort Nexus Media) Johnson & Johnson has hidden the fact that they’ve known its raw talc and finished powders tested positive for quantities of asbestos, with the company’s doctors and lawyers being fully aware of the findings but failed to alert regulators or consumers.  This may currently be due to the Talc based litigation docket that’s quickly becoming a major mass tort, but in looking back over 40 years, it seems that J&J simply chose to ignore the science and hide the data from the public.

Among the recent documents unsealed in court indicates that in May 1974, an official at Johnson & Johnson’s Windsor mine in Vermont recommended “the use of citric acid in the depression of chrysotile asbestos” from talc extracted from the site.

“The use of these systems is strongly urged by this writer to provide protection against what are currently considered to be materials presenting a severe health hazard and are potentially present in all talc ores in use at this time,” the mine’s director of research and development wrote then.

See also “New Evidence of Johnson & Johnson Bad Conduct Moved LA Jury to Award $417 Million Talc Verdict”.

Johnson & Johnson stock — up 6 percent for the year — plunged 11 percent on news of the report, based on memos, internal documents and confidential memos that the maker of Johnson’s Baby Powder had been compelled to share with attorneys for some 11,700 plaintiffs who claim the company’s powder products caused their cancers. The cases include thousands of women with ovarian cancer.

Johnson & Johnson is facing thousands of lawsuits across the country including in a federal multi-district litigation in New Jersey, see Johnson & Johnson Talcum Powder MDL 2738 (USDC New Jersey). This litigation is related primarily to the ovarian cancer claims brought by women, who claim that J&J talcum powder products cause ovarian cancer, which combined with the emerging talc mesothelioma lawsuits, would open an entire new area of mass tort litigation for J&J and its affiliates to defend.

Any exposure to asbestos is a health risk, according to the World Health Organization and other medical groups.  ompany documents, along with deposition and trial testimony, show that from at least 1971 to the early 2000s, tests showed small amounts of asbestos could sometimes be found in the company’s raw talc and finished powders, Reuters reported.

At the same time, company executives, mine managers, scientists, doctors and lawyers worried about the problem and how to address it but did not disclose the issue to regulators or the public.

https://www.cbsnews.com/video/johnson-johnson-vows-to-appeal-4-7-billion-talcum-products-verdict/

An examination of the documents also revealed how J&J succeeded in curbing regulators’ plans to curtail asbestos in cosmetic talc products as well as scientist research on talc’s health effects, Reuters stated.

Johnson & Johnson denied reports in a statement to the Associated Press. J&J said “thousands of independent tests by regulators and the world’s leading labs prove our baby powder has never contained asbestos.”

The New Brunswick, New Jersey, company  also has publicly maintained in recent years there is no science to back alleged links between its powder and cancer. J&J has won several recent court cases alleging liability and damages, and is appealing other judgments, including $4.6 billion awarded in July to 22 women who claimed its product caused their ovarian cancer.

J&J dominated the talc powder market for more than a century, with its talc products adding $420 million to the company’s $76.5 billion in sales in 2017. While contributing a relatively small portion to overall revenue, Johnson’s Baby Powder is seen as a major component of J&J’s image as a caring company — a “sacred cow,” as one 2003 internal email cited by Reuters put it.

SCIENCE SAYS TALC IS DANGEROUS

The debate over talc began decades ago. In the early 1970s, scientists discovered talc particles in ovarian tumors. In 1982, Harvard researcher Daniel Cramer reported a link between talcum powder and ovarian cancer. His study was followed by several more finding an increased risk of ovarian cancer among regular users of talcum powder. Cramer, who at one point advised J&J to put a warning on its products, has become a frequent expert witness for women suing the company. J&J ignored and suppressed Mr. Cramer’s attempts to show them the study data then publicly declared this research as flawed, which J&J still continues to this day.

DOES J&J TALCUM POWDER CAUSE CANCER?

Johnson & Johnson has been ordered to pay nearly $1 billion in total damages after just 5 trials, alleging its baby powder is causing ovarian cancer, all jury verdicts have been in state courts in Missouri and California, see J&J Talc Trials St. Louis Missouri.

Talc, a mineral composed of magnesium, silicon, oxygen and hydrogen, is used extensively in cosmetics and personal care products. Women sometimes use talcum powder on their genital areas, sanitary napkins or diaphragms to absorb moisture and odor – contrary to the guidance of most physicians. (Asbestos, linked to lung cancer, was once an impurity in talc, but it has been banned for several decades.)  J&J is notorious for using any means possible to influence scientific data and opinion as well as manipulating research reports and public media commentary by industry experts. The recent California trial showed payments made to previously perceived impartial Science Council members, who were declaring publicly that J&J talcum powder does not pose a cancer risk, the Los Angeles jury did not agree with J&J and other pro-talc defense team members, as over $300 million of the total $417 million judgment was for punitive damages, usually awarded for intentional misconduct, see “New Evidence of Johnson & Johnson Bad Conduct Moved LA Jury to Award $417 Million Talc Verdict”.

His studies and the many others that have found a relationship used a case-control approach. A group of women diagnosed with ovarian cancer and a group without it were asked to recall their past diet and activities, and the results were then compared.

Critics say these kinds of studies have serious drawbacks, particularly “recall bias.” Women may forget what they did or, if diagnosed with cancer, might inadvertently overestimate their use of a suspect substance. People without a serious disease may be less motivated to remember details.

Three other studies – considered cohort studies – did not find any overall link. Unlike the case-control studies, these efforts began with a large group of women who did not have cancer and followed the progress of their health, with participants recording what they were doing in real time. The results of this approach, most scientists say, are stronger because they aren’t subject to the vagaries of memory.

One such study included more than 61,000 women followed for 12 years as part of the National Institutes of Health’s well-respected Women’s Health Initiative.

WILL “MESOTHELIOMA TALC” BE THE NEW MASS TORT?

Two recent verdicts for asbestos contamination demonstrate the risk to cosmetic talc defendants, when a Los Angeles County jury awarded $18M to Philip Depolian against Whittaker, Clark & Daniels finding it 30% responsible for his mesothelioma due to his alleged exposure to various cosmetic talc products used at his father’s barbershops that contained asbestos. The jury apportioned liability against various cosmetic talc defendants that had settled and several other cosmetic talc product defendants that sold products including Old Spice, Clubman, Kings Men and Mennen Shave Talc.

In 2015, another Los Angeles jury awarded Judith Winkel $13M against Colgate-Palmolive for mesothelioma allegedly caused by exposure to talc in its baby powder. The jury rejected Colgate and its experts’ claims that the cosmetic talc at issue was not contaminated by asbestos and that the talc in question were non-fibrous “cleavage fragments” unlikely to be inhaled or embedded in the lungs. Although details of the trial are not readily verified, at least one report indicated that evidence presented at trial showed that the talc contained 20% asbestos fibers.

These cases are particularly important because the defendants were held responsible for cosmetic talc containing asbestos and for having caused mesothelioma and not ovarian cancer as in the earlier J&J talc cases. Further, both juries found that the defendants acted with malice. However, the cases were confidentially settled before the respective punitive damage phases.

Will “Talc Mesothelioma” be the next mass tort against Johnson & Johnson and its affiliates? Mass Tort Nexus will continue to report on this as additional information becomes available.

 

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