DEAR DOCTOR LETTERS
making his decision to prescribe Paxil to Father Tucker.”169 Notably, in
2006, SmithKline issued a Dear Doctor letter advising of such an
association: a “statistically significant” increase in suicidal behavior in
adults with major depressive disorder who were on Paxil (as opposed to a
SmithKline moved for summary judgment based on lack of causation
because Dr. Bright knew that patients on Paxil were at risk for suicide
before prescribing it to Father Tucker.171 The court found there was triable
issue of fact on causation based on Dr. Bright’s comment that he “would
have considered” information in a more “explicit warning.”172 The court
was not bothered that there was no evidence that an additional suicide
warning—whether via a revised package insert or a Dear Doctor letter (the
court didn’t specify)—would have changed his decision to prescribe
Paxil.173 Because “Dr. Bright’s statement [was] not definitive either way,”
the court reasoned, “it must be construed in favor of the plaintiff.”174 Thus,
like Winter, Tucker provides a very loose standard to survive a causation
summary judgment motion in a failure-to-warn case.
Tucker provides additional considerations for drug manufacturers to keep
in mind before issuing Dear Doctor letters, as such letters very well may be
used against manufacturers.175 The court used the 2006 Dear Doctor letter
in rejecting SmithKline’s Daubert motions to exclude plaintiff’s experts.176
Not surprisingly, the court found admissible the plaintiff’s expert’s
controversial opinion that there was an increased risk of suicidality in adult
patients taking Paxil, when SmithKline’s Dear Doctor letter essentially
stated as much.177 Similarly, the court found that another plaintiff’s
expert’s opinion regarding general causation was reliable, as it
“appropriately relied on [SmithKline’s] voluntary issuance of a ‘Dear
Doctor’ letter.”178 Thus, manufacturers should be certain they are
comfortable with each word of a Dear Doctor letter, as plaintiff’s counsel
may readily use each word as a defense concession or admission.
Plaintiff also used SmithKline’s 2006 Dear Doctor letter to oppose the
169. Id. at 1045.
170. Id. at 1046.
171. Id. at 1067.
172. Id. at 1068.
173. Id. at 1068 (“He did not opine as to what his ultimate decision would have been.”).
175. See also Section III( C) regarding whether Dear Doctor letters may be excluded
under Federal Rule of Civil Procedure 407 as subsequent remedial measures.
176. Tucker, 701 F. Supp. 2d at 1061-63.
177. Id. at 1062.