Files reveal plans to sway doctors

Lawsuit targets tactics in pharmaceutical sales

May 19, 2002|By Liz Kowalczyk | Liz Kowalczyk,THE BOSTON GLOBE

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?"

The American Medical Association responded to the government investigations by launching an ethics-education campaign with the pharmaceutical industry for doctors and sales representatives last year. The organization's ethical guidelines - which generally prohibit physicians from accepting trips unless they are conference speakers - have been in place since 1992. But the AMA contends that many doctors remain unfamiliar with them. Doctors who violate AMA guidelines can get expelled from the organization, but the guidelines don't carry the force of law.

Pfizer defends itself against Franklin's allegations in the court filings. Company spokeswoman Mariann Caprino said she could not comment on pending litigation specifically. But she said that the allegations against Parke-Davis were made up to six years ago, before the merger with Pfizer.

"It's firm and established policy at Pfizer that our representatives do not promote off-label use of our medicines under any circumstances," she said.

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