Markets

Pfizer's Illegal Drug Promotion Had a "Kick Ass" Effect on Sales, Charts Show

By Jim Edwards

Updated on: December 14, 2010 / 11:25 AM EST / MoneyWatch

A federal court ruling that dismisses all but two plaintiffs from a massive consolidated lawsuit against Pfizer (PFE) contains a galling lesson: Illegal sales promotions in the drug business are very, very effective. It only takes a couple of visits from a sales rep willing to "kick some ass" -- as Pfizer's managers put it -- to increase the dollar value of prescriptions written by a physician by 1,100 percent, recent rulings in the case say.

The Neurontin case has been dragging on for years. It stems from a $430 million settlement that Pfizer paid the Department of Justice to settle allegations that its Parke-Davis unit illegally promoted the anti-seizure drug for a witch's brew of unapproved, "off-label" uses such as depression and chronic pain.

Pfizer was then sued by a crowd of insurers claiming they paid for a drug that Pfizer promoted without evidence or FDA approval that it worked for the conditions it was used for; and by various patients alleging the drug either did them no good or harmed their mental health. Today's ruling goes against a Blue Cross unit and some other healthcare plan operators because they failed to demonstrate that they relied on Pfizer's false claims about Neurontin when reimbursing prescription costs. (It's the sixth recent federal court ruling that says a drug company is not liable for fraudulent marketing if the reimburser did not directly rely on the false claims being made.)

While the ruling is good for Pfizer as a matter of law, it's embarrassing for the company and the medical profession as a matter of ethics. Judge Patti Saris has sprinkled her opinion with four charts showing how visits from pharmaceutical sales reps affected doctors' prescription-writing habits. All four docs wrote virtually no scrips for Neurontin until the snake-oil pitchmen from Parke-Davis showed up. After that, the docs couldn't write enough of the drug, Saris states:

Prior to receiving this letter [from Pfizer's medical marketing arm], Dr. Arness's Neurontin prescriptions averaged a cost of $289 per month. In the two years after he received this letter, the average cost of his prescriptions increased to $3,486 per month, an 1100% increase.

Saris provides these charts, showing the effect of the mere arrival of a drug sales rep carrying a "dear doctor" promotional letter on prescription writing habits (click to enlarge):

It's not as if these doctors were persuaded by the science. The "dear doctor" letters -- which were about off-label uses of Neurontin -- were misleading, the ruling says:

The Dear Doctor letter also omitted information about the negative results of three double-blind, randomized controlled trials ("DBRCTs") studying the use of Neurontin to treat bipolar
disorder.

The sad but true conclusion is that off-label promotion works. According to a November ruling in the same case (which awarded the Kaiser Foundation Health Plan $95 million in damages), a Parke-Davis medical liaison staffer told his sales colleagues in a 1996 voicemail to "kick some ass" on Neurontin by promoting it off-label for pain:

The ass-kicking was entirely effective, it seems.

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