Wednesday, March 17, 2010

Pfizer Fraudulent Marketing Techniques from the Bextra/Geodon Settlement

Many doctors scoff when they are told that they have been unduly influenced by pharmacuetical companies into prescribing certain drugs. They feel insulted that anyone might suggest that they could be bought off by just "a pen and a pizza" - a free meal and a trinket with a drug company logo plastered all over it.

They think the drug companies influence them only through the detail persons or drug reps that come by their office, or because, as a Dilbert cartoon showed a doctor saying to a patient, "I need you to take these pills because the pharmaceutical rep is smoking hot."

Well, the pen and the pizza have recently been banned, and the drug companies did not put up much of a fuss about it. Why? Because promotional trinkets and meals were the least important of their marketing techniques with physicians.

In September of 2009, Pfizer agreed to a settlement with the US Department of Justice of $2.3 billion for off-label marketing of several drugs, most prominently Bextra, but also including the atypical anti-psychotic Geodon.

The judgment was posted on the internet (, with a list of their shady marketing practices, many of which appear to be common practice within the pharmaceutical industry. Among the most egrecious:

1. Doing market research to identify influential specialists to provide an “Advocate Concierge” for other physicians in terms of their ability to influence key medical societies, guideline committees, and specialty journals.

2. Convening so-called advisory boards, consultant meetings, and other forums for purposes of a “cascade of influence" in order to target high prescribing physicians.

3. Paying targeted physician airfare and hotel costs at lavish resorts and also paying them honoraria of $1,000 to $2,000.

4. They distributed treatment protocols to hospitals and physicians that advocated non FDA-approved uses for the drugs.

5. False and misleading claims of superior safety and efficacy were made by sales reps, with contests and other rewards to those that did this most successfully.

6. They also created sham physician requests for information about non-FDA approved usages. (They are not allowed by FDA rules to volunteer such information, but they are allowed to answer questions about unapproved uses if specifically asked about them by a physician). Promotional material was then sent to these physicians, who were usually high prescribers of the drug already.

7. Free samples were sent to physicians who had no need for any FDA-approved use of the drug.

8. They hired advertising agencies to prepare standard promotional slides at continuing Medical Education (CME) meetings. They had the slides certified by other vendors as CME.

9. They promoted the drugs for unapproved uses through a “publication strategy” whereby they initiated, funded, sponsored, and sometimes drafted or hired medical writer vendors to draft articles promoting unapproved usages, often without disclosing their role in this process.

10. They implemented a manuscript development process whereby a core marketing team at the company would plan potential publications and recruit “authors” for them. On some of these papers, the author was listed as “to be determined.”

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