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The recent examination into the marketing of Vioxx by pharmaceutical giant Merck has provided a rare glimpse into how drugs are presented to physicians. Papers released by a congressional House committee show that marketing instructions were as detailed as how long to shake a physician's hand -- three seconds -- and how to eat bread when dining with doctors -- "one small bitesize piece at a time." One memo, on Feb. 9, 2001, told sales reps, "Do not initiate discussions" on a study that raised heart concerns. Another document describes "obstacle handling" to overcome physician concerns.