Big Pharma Out of Bounds Again

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

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."


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At a glance,zyprexa was promoted 'off label' to uses that weren't FDA approved.This opens up a can of worms for patients like myself took it for PTSD for which it was ineffective and moreover gave me diabetes.

True,leaked documents don't convey the 'whole picture' but what is compelling is that zyprexa is the 7th some say 5th largest drug sell in the world and Eli Lilly's #1 drug sale by their own admission.
This is for a drug that won't get you "high" cost $2.50 a pill and only indicated for less than 1% of the population.
Hello! Somebody in Lilly land is pushing zyprexa hard-Daniel Haszard

Why is anyone surprised that a company in a capitalist society would be trying to make more money? It is up to the doctors to maintain the ethics here and put what is best for their patients ahead of what is best for them.

Organic Chemistry asks, "Why is anyone surprised that a company in a capitalist society would be trying to make more money? It is up to the doctors to maintain the ethics here and put what is best for their patients ahead of what is best for them."

The problem is not the seeking of profit per se but the willingness to maximize profit by hiding dangers and exaggerating benefits of the drugs sold. It's perfectly reasonable for society to expect more of a drug company than of a maker of, say, DVD players, for drugs directly affect public health. Companies that build highway bridges aren't allowed to overstate the bridges' carrying capacities; someone who sells me a climbing rope isn't allowed to tell me it'll hold 300 pounds when it'll only hold 50. We'd be crazy not to demand the same accountability of pharmaceutical companies.

Up to the doctors? Please. Doctors can't make sound decisions if they've been given unsound information.

"Buyer beware" has its applications, I suppose. But it makes a lousy principle for regulating (or not regulating) the drug industry.