Last spring, hundreds of people in Florida opened their mailboxes and found, in and among the junk mail and bills, padded envelopes full of powerful prescription drugs.
Each package contained a one-month starter supply of Prozac Weekly, a new anti-depressant made by pharmaceutical giant Eli Lilly.
None of the people had asked for the drugs or knew they were coming. How could that happen? It was a marketing scheme for pitching Prozac - spearheaded by Eli Lilly sales reps - but also involving doctors, pharmacies and the medical records of unsuspecting patients. Correspondent Vicki Mabrey reports.
Michael Grinsted was 16 when he found the package of Prozac Weekly addressed to him one day after school.
The prescription was sent with a letter from the head doctor in the family practice Michael and his mother Susan go to in West Palm Beach, Florida.
In order to switch to Prozac Weekly stop your current daily antidepressant today and start Prozac Weekly tomorrow.
But Grinsted was not taking an antidepressant and never had. He says he has "no clue" where the sender would get the idea that he wanted or needed Prozac.
30 miles away in Ft. Lauderdale, 59-year-old Ann Parsons received a similar package from her doctor.
"At first I was startled and confused," she says. "Why would they suggest I take Prozac Weekly?" What Parsons didn't know was that she was targeted because she takes Zoloft - a drug manufactured by one of Lilly's competitors. Parsons says she was taking it for panic attacks she suffered after September 11th - a closely guarded secret she thought only her doctor knew.
She says she threw the pills in the garbage disposal and shredded the package. "I didn't want to be involved with it," she says.
"I don't think there are many things about our lives that we hold so personal as the medication that we're taking in the privacy of our own home," says attorney Gary Farmer, who represents Ann Parsons and Michael Grinsted in a lawsuit against their doctors, the Walgreens Pharmacy chain, and Eli Lilly. He says his clients' medical privacy was violated after Prozac's patent ran out and patients turned to the cheaper generic version.
"Their sales, it's well documented, have dropped 80 percent since they went off patent. This is one of the most profitable drugs in the history of the United States drug manufacturing industry. And they're desperate to regain some of that market share," he says.
To do that Lilly instructed its sales reps to push its new product, Prozac Weekly, the first and only anti-depressant that can be taken just once a week.
The new drug meant a new patent and new profits - if Lilly could just get people to take it instead of the generic.
60 Minutes wanted to ask Eli Lilly how patients were targeted for the Prozac Weekly mailing, but the company wouldn't talk to us.
But Frank LaCorte did. A 23-year veteran of Eli Lilly, he was one of the sales reps at the heart of the mailing.
He agreed to explain how it worked.
What kind of patients were supposed to be targeted for Prozac Weekly?
"Prozac daily patients. And patients on other anti-depressants," he says.
In other words, patients who were taking the competitors' medication were also targeted.
As a sales rep, LaCorte didn't have access to patient records, so he went someplace that did: the Holy Cross Medical Group in Ft. Lauderdale, where he'd been pitching Lilly drugs for almost a decade. He asked the doctors to come up with a list of patients suffering from depression. For that they searched their computer files.
He says there was a code in the database that said this is a person treated for depression. LaCorte took that computer generated patient list to a Walgreen's, along with a "Dear Patient" letter signed by all the doctors in the group. Lilly covered the cost of the prescriptions and Walgreens sent the drugs out.
Says LaCorte: "It was called a win, win, win situation. The patient got a free course of therapy. The doctor looked like a hero to his patient because he was updating them on the most new and improved medication. And Eli Lilly got a win because they've got a sale, at least one sale on Prozac."
"Win win win strategy sounds very much like corporate speak," Mabrey says.
"It is corporate speak. There's no doubt about it. It was a way to convince everybody involved that this was a good thing," LaCorte says.
Says Farmer: "The drug company has no business making itself a doctor. That's what they're trying to do. They're trying to force their will on physicians: 'Just give us the names doctor, we'll take care of the rest.'"
Ann Parsons' doctors in the Holy Cross Medical Group and Michael Grinsted's doctor wouldn't talk about their participation in the Prozac Weekly mailing.
But Dana Richard, a physician in West Palm Beach, Florida and his wife Linda, his office manager, did agree to talk. They also were approached by an Eli Lilly sales rep pitching Prozac Weekly.
He says an Eli Lilly sales rep asked him for patient names. "I didn't think it was a good idea. So I told him, 'No,' without any hesitation."
But the Lilly rep didn't take no for an answer. He asked someone else in the office for help. As one email from a manager in southern Florida shows, reps were taught to "involve the staff member with greatest computer skills…" and find out their ability to "generate a list of patients."
The Richards say that in their office, a medical assistant, who has since been fired, gave the Lilly rep access not only to an unauthorized list of patients, but also some office letterhead, on which the rep printed this letter to patients under the heading "change of prescription."
Richard says he did not write the letter.
"It has your name at the bottom," says Mabrey.
"Correct. I never let anything go out without my signature," says Dana Richard.
In fact the letter has no signature. It advises patients to stop their "current daily anti-depressant today and start taking Prozac Weekly tomorrow." We compared this letter to the one used by Frank LaCorte in his mailing and found that the language is almost identical. LaCorte says that's because the template for the letters was written by Lilly reps, not by the doctors.
It was important that it go out to the patient on their doctor's stationery, he says: "It was the only credibility that would work."
But in the Richards' case, the mailings never went out: A pharmacy claims manager became suspicious and called Eli Lilly when it appeared that more than 20 of Dr. Richards' patients had prescriptions for Prozac Weekly filled on the same day.
Dr. Richard says it's a good thing the drugs never went out because antidepressants can cause serious problems when switched abruptly. In fact, one patient on the list was a man dr. Richard says had suffered a violent psychotic reaction to Prozac in the past.
"I think it would have been a catastrophe," he says.
"God forbid if someone has gotten these and taken it and died or ended up in the hospital. I mean it was horrible," says Linda Richard.
Farmer lays the blame with the people at Eli Lilly: "They're just as bad as the guy selling illegal drugs down on the corner. They're pushing their product. They don't care what happens to the patient who takes that when they walk away with that drug."
"Isn't it reasonable for a pharmaceutical company to want to inform people about something new on the market, something that may be better for them?" Mabrey asks.
Says Farmer: "The drug companies have commercials running every half-hour. You cannot turn the television on at night without seeing drugs for any number of very personal and private conditions being marketed over the television. That's acceptable. Sending drugs in the mail is not acceptable."
In a public statement, Eli Lilly seems to agree, calling the mailings "limited incidents… inconsistent with corporate policy." It says the company does not "support programs in which medicine is mailed to patients without the patients' request." In fact, we've seen no conclusive evidence that knowledge of the program reached corporate headquarters.
But what is clear according to LaCorte is that the people heading his regional sales team knew all about it.
"We're always told how to market. Salespeople in the field are not developing programs. Salespeople in the field are implementers of programs. We've given a program and we're told, 'Ggo, do it.'" he says.
LaCorte says that's what he did - informing his supervisors every step of the way. In this email to two different managers, he describes the "sample packet of what the patient receives…" including a "filled prescription."
After Prozac Weekly went out to 145 patients, LaCorte received kudos in this email from a manager: "You guys rule!.. I can't wait to see "spike in the [prescription] data." That manager also sent instructions for duplicating the program to managers in five other states.
LaCorte says he received "accolades."
"I was on top of the world," he says.
But not for long. After some of the people who received the Prozac Weekly filed a lawsuit against Lilly, the company issued its statement saying it takes the matter "extremely seriously" and that "three sales managers and five sales representatives have been disciplined." LaCorte was fired. He is suing Eli Lilly for character defamation.
In the end, about 300 people in southern Florida received the Prozac Weekly in the mail. But short of mailing drugs, pharmaceutical companies target patients all the time. The main difference is, instead of asking doctors to compile lists of patients, more often the drug companies go straight to big pharmacy chains. They pay them up to two dollars a head for each patient they send letters to, touting the company's drugs. These multi-million dollar agreements are legal under new federal privacy guidelines.
Legal or not, Ann Parsons says it's wrong. In her case, being targeted for Prozac Weekly carried unforeseen consequences. She found that out when her pharmacist refused to refill her Zoloft prescription.
"He said, 'Oh, Miss Parsons, you can't have your Zoloft.' And I said, 'Why?' 'Well, I see here on our records you're taking Prozac." I said, 'I'm not taking Prozac. My prescription has not been changed.' I said, 'Why you people sent it to me is beyond my comprehension.'" She says.
She finally got her Zoloft - but she's also got Prozac Weekly on her permanent records - and so does Michael Grinsted - even though he's never been diagnosed with depression and says he has never taken anything stronger than an antibiotic.
The pharmaceutical companies and drugstore chains insist they protect patient confidentiality - but Susan Grinsted isn't convinced.
Before her son was sent Prozac Weekly, she thought only the doctors' office had access to her and her son's records.
Now, who does she think has access? "Anybody who's willing to pay for it."
Produced by Denise Cetta and Michael Bronner