Thread by @JackieFortier

Good morning! Day four of the #opioidtrial soon to get underway!

Lawyers for @jnjcares have filed a motion to dismiss their corporate representative who has been testifying for the last couple days. They say she doesn’t have knowledge of the docs the state is showing her.

Judge says we will continue with Deem-Eshleman today, and he’ll read the motion later. Each side gets 4 weeks to present their side.

It's getting argumentative today, the niceness of the last few days has worn out apparently.

State: Why not let our medical schools do their job? Why are you paying for speakers?
Deem-Eshleman: After a physician has graduated, things change, formulas change. They learn from multiple sources, including our sales reps.

Now a sales rep. document. The state is relying heavily on these.

Deem-Eschleman is being very careful with these documents. Lots of "I see that written here yes, I see that, etc."

Sales rep. document who worked in Oklahoma. We found out yesterday that J&J sales reps made about 140,000 calls to Okla. doctors over the years.
State: you trained them to move doctors [to Duragesic their fentanyl patch]
Deem-Eschleman: That's what she's written here, yes.

Sales rep calls in Oklahoma. We're going over visual aids that reps used to talk to Oklahoma physicians. State is showing notes that show reps made a comparison between J&J products and Purdue's
Deem-Eschleman: It's showing the functionality between Duragesic [fentanyl patch]

State: Label to label comparisons are not allowed under FDA regulations, right?
Deem-Eschleman: It says she [sales rep] did that, but I'm not sure she did

More sales rep. documents, now in Oklahoma City in 2009.

we are flying through these. Yesterday the judge made the state remove the 35 boxes of the sales rep documents, so they are trying to show the court how many calls were made in the state, and how reps influenced doctors to prescribe more J&J opioids.

No more 'sir' and 'ma'am' today, the gloves have come off.

I'm going to be talking about the trial live on @drivetimerte in a couple hours!

State: FDA approves your label, or packet insert, right?
Deem-Eschleman: Yes
State: but the FDA isn't in the room with the sales rep and the doctor right?
Deem-Eschleman: No, but we send all the materials to the FDA
State: But not what you say [to docs]

Still looking at sales rep. notes. One says an Okla. physician didn't want to give their fentanyl patch to a 40-year-old patient because the doctor didn't want the patient to be addicted "that young."

Sales rep. then showed the doctor a study, who still didn't want to prescribe to that patient.
State: Your sales reps just don't give up do they?
Deem-Eschleman: She [sales rep] showed him [doctor] the study, yes.

Lots of objections today by @JNJCares lawyers. "Asked and answered judge" Some are being sustained by Judge Balkman

And we're on break for a few minutes. Phew!

we're back. More drug representatives' sales notes with questions for J&J corporate representative Kimberly Deem-Eschleman.

State: How much money have you spent to abate the opioid crisis in Tulsa?
Deem-Eschleman: I don't know.
State: I asked you the same thing about the state yesterday, and you had time to sleep on it and do research, did you?
Deem-Eschleman: No.

We're still reading sales rep. notes in Oklahoma. The state is pounding home their point that @JNJCares were in direct competition with Purdue, and drug reps were blanketing the state with sales calls to Okla. doctors.

Per sales rep notes in Okla. :Doctor used to write Vicodin but didn't want to put people on short-acting opioids due to abuse potential. Sales rep told the physician that J&J's fentanyl patch had lower abuse potential.

The state is trying to show that J&J drug sales reps ignored industry warnings against using certain data during sales calls with Okla. doctors. The state is saying the company knew because these notes are sent back to corporate in New Jersey.

State: Do you know if anyone [in corporate] ever [read these drug rep. notes?]
Deem-Eschleman: No, I don't.

We're still on sales rep. notes taken in Oklahoma, mainly from the early 2000s. It's hard to keep up, we keep jumping between them, and the media can't see the evidence (the court is working on it)

State: You would recruit high prescribing speaker [physicians from Oklahoma] to talk in Oklahoma?
Deem-Eschleman: ...They were trained by us on our drugs.
State: to sell
Deem-Eschleman: No, to communicate the benefits and the risks of the drug.

State: the doctor is telling your sales rep that they have experience with abuse and nurses taking old patches. Should your rep. report it?
Deem-Eschleman: Yes, probably.
[We don't know if they did or not]
State: Did you train your reps to report [that situation] to corporate?

[answer] Deem-Eschleman: They are trained if there is a specific instance to report it...if it's a general statement, like 'I've heard' then no.

State: is it a myth that opioids are addictive?
Deem-Eschleman: No.
State: Did your company put unbranded marketing out that said it's a myth that opioids would cause addiction.
Deem-Eschleman: No, not in that context

State: Did your company put unbranded marketing out that said the fentanyl patch has a low risk of addiction?
Deem-Eschleman: Yes, that was in the medical literature of the time [I'm paraphrasing her answer]

Stopping for lunch. To rest my fingers! I'm going to go do a live interview now on Irish public radio! woot

And we're back from lunch. Jumping back in immediately with sales rep. documents.

Deem-Eschleman, the corporate representative for Johnson & Johnson is still being questioned by the state.

State: Your company had internal strategic documents [that said] if you don't treat acute pain, it will turn into chronic pain.
Deem-Eschleman: No, I don't believe we did that.

We've moved to 2004 sales rep reports here in Oklahoma. There were 35 boxes of these piled up in the courtroom yesterday. I'm wondering how many of them the judge will allow the state to go over like this. The state is now confused as to which ones they've already talked about.

Back on track.
State: you knew it would go off patent in 2004 [meaning generic versions could be released] so it became very important for doctors to write 'DAW' on the prescription right?
Deem-Eshleman: If a doctor writes DAW then they will continue to get the brand name drug.

DAW = Dispense As Written

Deem-Eshleman: These are not complete notes. So you'd expect more of a discussion to take place that isn't written down.... we don't know, we weren't there. We don't know what was said, what the context was. [These notes] were to remind them what to do the next [sales call]

State: Your [J&J] sales reps made over 125,000 calls in Okla. and you're telling me they didn't have time to write even this much down after 2009?
Deem-Eshleman: We streamlined the note system after that timeframe.

State: You knew that one of the ways to get doctors to prescribe your drugs, you should talk to the nurses and you could get them loyal to the brand, right?
Deem-Eshleman: We'd educate nurses the same way we'd educate doctors about the risks and benefits of the drug.

I think we've moved away from drug rep. sales calls in Okla. Now we're in on to an internal document regarding Nucynta.

Brad Balkman for the state of Oklahoma, questioning J&J corporate representative Kimberly Deem-Eshleman. Pool photo. It's getting fairly combative.

Back to sales calls made by pharma reps to doctors in Oklahoma. Now to spring break blitz marketing campaign called 'Sprains and Strains' per the state.

State: 'Dispense As Written' is a [marketing] hook right?
Deem-Eshleman: No, that's not a hook. If the physician wants the patient to get the brand drug, they write DAW...

Deem-Eshleman: They are moving the patient to Duragesic, but the 'DAW' again is the choice of the physician.
State: and influenced by your sales representatives
Deem-Eshleman: I would say again. it's the choice of the doctor [paraphrase]

DAW again is Dispense As Written. If the physician writes that on a prescription, the pharmacy will stick with the brand of drug that the doctor wrote.

It's been hours now of @JNJCares sales rep. notes in Oklahoma. The state is reading pieces of them out loud to Deem-Eshleman.
New water drinking game. Every time state says 'do you see that?' take a sip. You'll be very well hydrated.

Sales doc says that J&J reps brought Sonic food to doctors in Oklahoma. Sonic is headquartered here.

Deem-Eshleman: Sales rep is selling to the doctor. They are telling them about potential patients. But it's up to the doctor as to what level of analgesic that the doctor feels is appropriate. [paraphrased]

No objections by the defendant to the term 'y'all' being used today by state lawyers to refer to @JNJCares and Janssen. I guess they are letting that go.

I'd like to point out that almost every time a doctor is referenced in the abstract, they are referred to as 'him' by both sides.

We're on a break for 20 minutes.

Back from break, but we're in a sidebar right now.

Deem-Eshleman questioning continuing.

State is now using a physical copy of @MerriamWebster's definition of words.
Lawyers for @JNJcares says that a dictionary definition can be hearsay. By far the best moment of the day. Here's the definition of hearsay, just so you know.

We're done, after reading out the definitions of 'influence' among others.

Now we're looking at the state's 'influence map' of ambulatory services in Oklahoma.

State: You didn't just have to influence and target the doctor. You targeted pharmacists as well, right?
Deem-Eshleman: Through education, if they saw the value in our product, if you say that's influence then, okay.

State: You didn't market opioid to patients? Ever?
Deem-Eshleman: No, we didn't.

Deem-Eshleman: A direct to consumer is you bypass the physician to try to get the patient to ask the provider for that prescription. We did not do any direct to consumer advertising. We did direct to patients, who were already prescribed [the fentanyl patch] to educate them.

Sidebar time. @JNJCares lawyers initiated.

So close to 5...but we're back.

Now looking at Duragesic business plan. That's @JNJCares fentanyl patch.

We are adjourning! Tune in Monday at 9 a.m. for more from Oklahoma's #opioidtrial! I'm going to do more work for @NPR!