Wednesday, February 3, 2010

Lilly: "Execute the *%#&*! out of them"

A new paper, written by Glen Spielmans and Peter Parry and published in the journal Bioethical Inquiry, shows how various drug companies, particularly Eli Lilly and AstraZeneca, manipulated science and lied to doctors in order to sell their drugs. While this is not exactly news, the intriguing aspect of this article is that the authors reproduce e-mails and slides that are the smoking guns of deceptive sales practices. And let me tell you, these gun barrels are hot and you can still smell the gun powder.

"The data don't look good."

That's what John Tumas, an AstraZeneca publications manager, wrote in an email to a brand manager and a scientist. He was referring to an AstraZeneca-funded study showing that Haldol was superior to Seroquel (oops!). The fact that AZ officials knew about this data didn't prevent them from sending one of their hired guns to an APA meeting two months later to claim that Seroquel was "significantly superior" to Haldol.

When AZ didn't have the stomach to lie about unfavorable study results, they did the next best thing--they buried them. "Thus far," wrote Mr. Tumas in a different email, "we have buried Trials 15, 31, 56 and are now considering COSTAR."

Zyprexa and Weight Gain: "Don't introduce the issue!"

Eli Lilly knew that Zyprexa caused enormous weight gain as far back as 1995, and knew that it was worse than competing atypical antipsychotics as of, at the latest, 1999--we know this because Alan Breier (now Lilly's Chief Medical Officer) admitted to senior executives in an email that "Fact: the order of weight gain among antipsychotics is: Clozapine>olanzapine [Zyprexa]>seroquel>risperidone>traditional neuroleptics."

But in 2001 Lilly sales reps were being trained to "neutralize" physicians' concerns about weight gain by pushing what managers were calling a "comparable rates message." Most of all, reps were instructed to follow the "don't ask, don't tell" policy favored by the U.S. Army regarding a different inconvenient issue.

There are many other zingers in this comprehensive description of what the authors call "Marketing-based Medicine" as opposed to "Evidence-based Medicine." The entire paper is required reading for those interested in the realities of pharmaceutical marketing in the modern age.


Anonymous said...

Er... um... this is not a trick question. But how on earth do you psychiatrists decide to prescribe medications based on all of this Pharma nonsense? I mean really there a secret you guys and gals harbor that allows you to "see" the "truth" lurking behind the misinformation? Or do you rely on Divine revelation? Just asking.

Dark Jay said...

Thank you for posting this. Yep, it's not news, per se, but the kind of evidence that we need to see how marketing has driven health care over the cliff. I always loved drug rep lunches at our agency. The Panera sandwiches kicked ass and I enjoyed challenging them on the weight gain issue. Risperdal causes an average weight gain of two pounds? Er, um, two kilos? At least the Lilly rep artfully dodged the questions and never tried to tell outright lies. But we all saw the weight gain problems immediately and did our best to educate our clients about the risks and how to contain it.

Anonymous said...

Dr. Carlat: Given all that is known about lack of conclusive evidence of efficacy of all these drugs, strong evidence of significant side effects and difficulties with withdrawal, ghostwriting, suppression of clinical trial data, corruption in academia, WHY are we continuing to prescribe all these drugs at such alarming rates?

Joel Hassman, MD said...

Excellent post, loved the title as the lead in.

It is nothing less than both incredulous and disgusting how non-psychiatrists are prescribing antipsychotics with greater frequency of late, and then dumping these patients on our laps to fix their screw ups in using specialty meds as general providers.

And, while I hope I am wrong in claiming this, our field as a sizeable majority is so far out of touch with the standards of care in treating people with genuine illnesses that have biopsychosocial components, I wonder what options I have to find a career choice I can appreciate and somewhat enjoy day to day.

God, these patients who lost a job, going through grief, having marital issues, raised in families from hell, all want g-d pills to "fix my problem"!

Did Sears or WalMart have a residency program I missed that trained people in psychiatry?

That is where the majority of Americans need to go until they listen to what is the standard of care, by responsible, invested providers.

So until then, they can all be sedated, gain weight, develop hyperglycemia and hypercholesterolemia, be so fogged it is misinterpreted as depressive features, and then develop addictive behaviors, at least with Seroquel. Now there is a treatment plan!!!

Anonymous said...

I believe you have never seen a patient in your whole life... Families who have a beloved one with a mental ilness would not discard a medication like this, because they know how important it is.
What is the problem if the pharmaceutical companies enphasize the good aspect of their product? Do you think doctors are so naive that they don't know about side effects of medication they are prescribing? Everyhing has its defects. The great issue is that science has to develop new and better medications. Until that, this is what we've got and it's better than what past generations had.

Gallucci-Neto said...

Anonymous (up):
Well...I´m not so sure about your afirmatives like "this is what we've got and it's better than what past generations had" and I think you've missed the point.

Anonymous said...

Educators provide information for the sole benefit of the student while salespeople provide information for the sole benefit to themselves. So, I live my life with one axiom in mind: "The credibility of the information is solely dependent on the intent of the provider." Determine the provider's intent before even looking at the information. This is more specific than the often cited saying "Buyer beware."

Anonymous said...

34 years as a rep so far...Bravo, hold us accountable, we owe it to physicians and patients to tell the truth, the whole, truth and nothing but the truth!!!!