Smooth Pebbles

I try to keep on top of controversies about drug companies, but lately it's hard to keep up with all the latest revelations and laundry spills -- and to wrap your head around the variations. Today the New York Times reports that Eli Lilly mounted an organized effort to convince doctors to prescribe its powerful schizophrenia and bipolar-disorder drug Zyprexa for elderly patients with symptoms of dementia -- despite that dementia in the elderly rises from causes quite different than those of schizophrenia or bipolar disorder, is far less serious problem than schizophrenia, and that Zyprexa seems cause sometimes serious weight gain and susceptibility to diabetes (for which it is facing several lawsuits).

Zyprexa Lilly 4117
digital ink print on canvas, 2005
by Hans Bernhard

It's a troubling thing to see, but by now unsurprising. As more academic clinicians and researchers are seeing, marketing rather than medicine or science has been driving Big Pharma's practices for some time now. Yet the baldness still shocks -- to say nothing of the greed. As the Times noted,

Zyprexa is by far Lilly's best-selling product, with $4.2 billion in sales in 2005, 30 percent of its overall revenues. About two million people worldwide received it last year.... 20 million patients worldwide have received the drug.

Yet apparently this isn't enough.

Like many expand-the-market drug-company campaigns, this one was aimed at primary-care physicians. In an age of managed care, primary care physicians are increasingly overwhelmed; are "encouraged" and pressed by managed-care guidelines to limit referrals to specialists, which in turn encourages treatment by drugs rather than physician visits; and are besieged by drug company sales reps eager to "educate" them about new drugs or new drug uses that allegedly solve medical problems quickly and easily. Patients, meanwhile, are constantly encouraged by drug company ads to "ask their doctors" whether Drug A or B might help them "feel better." It was precisely these forces that have led so many primary care physicians to prescribe antidepressants for not just severe but moderate or even mild depression, creating the boom in their sales. This widespread use, along with frequent failure to follow up with the patients frequently in the first few weeks of use, helped create the settings for the suicides that started created more scrutiny of antidepressant use in 2004.

Was good business, though -- and the attempt to expand the prescription parameters of drugs like Zyprexa follows a similar but even more aggressive template.

The Times story is quite stunning, and well worth a full read. Perhaps the most notable quote, from an internal Lilly document about the campaign leaked to the Times:

"Dementia should be the first message."