Indianapolis Star Reports on CVS Caremark-Eli Lilly Marketing Scam

For most of us, blogging is a labor of love, and our payment is the possibility of having a positive impact in the world. So it was gratifying to see that the Indianapolis Star published this story prompted by my prior post about how Eli Lilly is paying CVS Caremark to sell doctors on Cymbalta for fibromyalgia.

Reporter John Russell did an excellent investigation, finding that the practice is more widespread than I realized. For example, he interviewed Dr. Matthew Mintz, an internist in Washington, D.C., who said he too had received a deceptive pharmacy drug ad, this one funded by Merck and encouraging Dr. Mintz to switch one of his diabetes patients from a different company's drug to Merck's Januvia.

The Star's Russell also revealed that Lilly had used the pharmacy-whore technique to sell Zyprexa in 2002, when it apparently paid another drug benefit manager, AdvancePCS, to send out 120,000 letters promoting Zyprexa to doctors nationwide. AdvancePCS hawked its services for $5/letter, meaning that they stood to make $600,000 from the scam. In documents forced public in the context of a trial, AdvancePCS officials wrote that this direct-mail campaign was "designed to influence key prescribers" as part of a "tactical plan for Zyprexa."

Lilly declined to say whether it took AdvancePCS up on the offer. Translated from PR speak, this means, "Yes, we did pay them the $600,000 but it was such an obviously slimy marketing technique that we will not admit it."

An Eli Lilly spokeswoman told the reporter that the latest CVS Caremark letter was simply meant to "share medically accurate and relevant information with health-care professionals," and denied that it was deceptive at all. I guess we'll have to wait for another trial to find out that this, like the earlier Zyprexa letters, was designed as a "tactical plan," this time for Cymbalta.

At any rate, the debacle may have a silver lining for us all, since Lilly told the Star that they are "re-evaluating the entire practice" of using pharmacies to market their drugs to doctors.

That's great. Lilly is quite proud of its good corporate citizenship. Last year, John Lechleiter, Lilly's CEO, crooned in this press release that "With each of our industry firsts, from launching our clinical trials registry to the public reporting of educational grants, Lilly is striving to be a leader in improving transparency across our industry. As Lilly continues to look for more ways to be open and transparent about our business, we've learned that letting people see for themselves what we're doing is the best way to build trust."

Dr. Lechleiter failed to mention that Lilly's decision to become a leader in transparency was done with a gun to its head--it was part of a corporate integrity agreement that was bundled with $1.4 billion fine for illegal off-label marketing of Zyprexa.

Details, details.

From Embarrassment to Scandal: Lilly + APA + The Psychiatrist's Program + Lots and Lots of Money

What began as an embarrassment of Eli Lilly, PV Updates, and PRMS is gradually becoming a full-fledged scandal. The Indianapolis Star picked up the story last weekend (read it here), and psychiatrist David Port, M.D. wrote me a letter alerting me to an expanding crisis of trust in psychiatry. Here is an excerpt:

"Whatever Lilly's justification for sponsoring a course ostensibly to help the psychiatrist to better deal with professional liability risks, I am outraged that PRMS has accepted money from Lilly and has chosen to offer its authority and reputation toward this Lilly effort. PRMS is the American Psychiatric Association-endorsed entity which directs APA members to a selected malpractice insurance agency. PRMS is thus the agency many or most of us psychiatrists turn to for guidance and direction as to liability exposure and malpractice coverage. For PRMS to work for Eli Lilly is a glaring conflict of interest between their psychiatrist clients and a pharmaceutical corporation whose interests do not necessarily coincide with those of the psychiatrists with whom they have a professional relationship. This is analogous to the same law firm representing two individuals opposing one another in a law suit; in that situation we assume that there cannot be fair representation of either client, and we may imagine that the client with an attorney who has more clout in the law firm may well prevail in the action. How can we trust PRMS, or the APA for that matter, to provide us with the best liability support? David Port, M.D."

Yes, it's true. PRMS runs The Psychiatrist's Program, a malpractice carrier that is officially endorsed by the APA.

I know, it can get very confusing. Let's follow the money. Eli Lilly gives the APA at least $1.3 million in 2007 (so far) for industry-supported symposia and fellowships. Lilly then gives PRMS a bunch of money (Lilly refused to tell John Russell at the Indy Star how much) to produce a web-based slide show teaching psychiatrists how to prescribe potentially toxic medications like Zyprexa without being sued. The APA officially endorses PRMS' psychiatry malpractice insurance for its members. Does APA receive any type of kickback for this endorsement? I assume that would be illegal, but who knows?

Look, I get as annoyed by conspiracy theorists as the next guy. But the web of money and influence here is so murky and repugnant that it leaves me wondering what's going on. I officially invite both the APA and PRMS to respond. And I'd love another diplomatic letter from Eli Lilly!