Files reveal plans to sway doctors

Lawsuit targets tactics in pharmaceutical sales

Newly unsealed court files provide an inside view into how one of the largest pharmaceutical companies sought to influence doctors - many of them prominent Massachusetts physicians - into prescribing a key drug, a strategy that included ghost-writing journal articles and rewarding the largest potential prescribers with seaside trips.

The files, hundreds of pages of internal company memos, voice mail messages and records on individual physicians, are part of a civil lawsuit brought by a former company sales representative turned whistle-blower against Pfizer Inc. and Parke-Davis, which merged two years ago. The civil lawsuit and a parallel criminal investigation by the U.S. attorney in Boston seek to prove that Parke-Davis and its parent company, Warner-Lambert, illegally influenced and paid kickbacks to doctors to prescribe the anti-seizure drug Neurontin for a range of medical problems for which the drug was never approved.

One company memo in March 1996 directs sales representatives to "target neurologists with the greatest potential" for an all-expenses-paid weekend at the Jupiter Beach Resort in Florida that included a $250 honorarium for each physician. To do so, the company generated a list of the top prescribers of anti-epileptic drugs for sales representatives and said that "it is essential that the invitees are from this list."

In a memo after the April conference, the Neurontin marketing team wrote that doctors who attended "were delivered a hard-hitting message" about the drug. The company included charts for each physician and told sales representatives to tally their prescriptions before and after the trip.

Many drug companies have used such strategies for years to increase sales of their drugs. But federal and state prosecutors, angry over the soaring costs of prescription drugs to state Medicaid programs, are increasingly investigating and bringing charges against companies that market drugs illegally.

A key issue is whether pharmaceutical companies are promoting their drugs for conditions not approved by the U.S. Food and Drug Administration - an illegal practice. It is not illegal for doctors to prescribe drugs for "off-label" uses. Neurontin is approved only as combination therapy for seizures. But in one undated transcript of a voice mail message, the whistle-blower, Dr. David Franklin, said he recorded a manager telling company medical liaisons: "When we get out there, we want to kick some ass. We want to sell Neurontin on pain. All right?"