Thursday, July 31, 2008

Eli Lilly and Physician Malpractice Education: The Outrage Continues

Eli Lilly & Co. is continuing to pay a major insurance company to provide sham education to psychiatrists about the liability risks of prescribing potentially toxic medications like Zyprexa.

The courses, entitled "GET THE FACTS: Understanding Professional Liability Risk Associated with Prescribing Medications,”
are being heavily promoted to thousands of U.S. psychiatrists via mailings, and are offered both online and in the context of lavish free dinner programs. Although funded by Lilly, they are taught by PRMS, Inc. (Professional Risk Management Services), a risk management company that manages The Psychiatrists’ Program, a malpractice insurance policy tailored for psychiatrists.

The central message of these “educational” programs is that psychiatrists are unlikely to be sued for prescribing medications that may have toxic side effects. According to the course, “there are effective ways to decrease risk related to prescribing, and if a lawsuit is filed, the risk of a plaintiff prevailing is low.” While Zyprexa is never actually mentioned in the programs, it is clear that the intent of the courses is to convince psychiatrists that they are unlikely to be successfully sued by patients claiming that Zyprexa has caused obesity or diabetes.

There are numerous veiled allusions to Zyprexa in the course. In the introductory section, for example, they state that “Advancements in medicine usually add to the complexity of treatment and at the same time increase patients’ unrealistic expectations about treatment outcomes. Patients may be less likely to accept that unexpected and adverse outcomes are a part of treatment. Even in the absence of negligence, there are always risks of medical treatment that must be weighed against the benefits.” This mirrors the common theme of Eli Lilly promotional material for Zyprexa, namely, that it is more important to focus on the clinical benefits of the medication rather than the risks associated with it.

Lilly’s extraordinarily deceptive marketing tactic takes on new relevance with the unsealing two days ago of internal company documents in the State of Alaska’s suit against the drug-maker. According to Bloomberg News,
an instruction sheet given to Lilly sales reps in 2002 stated that: “We believe it is essential to weaken this link to neutralize the diabetes/hyperglycemia issue. Neutralizing any concern from our customers will be essential to the future growth of Zyprexa in the marketplace.” Meanwhile, the company’s own data showed that patients taking Zyprexa had 3.5 times the rate of high blood sugar as patients taking a placebo.

PRMS’s psychiatry insurance program is the only malpractice program receiving an official endorsement from the American Psychiatric Association.
While the APA neither endorses nor participates in this educational exercise, the fact that it endorses PRMS means it may have leverage in curtailing the company’s unethical activities. Psychiatrist and APA member Dr. David Port originally alerted me to these shenanigans, and we have jointly sent a letter to the APA requesting that the organization ask PRMS to cease this program immediately. I will keep you informed of any developments.


Anonymous said...

I think you are doing a great job with your blog. Just wanna say thanks!
I think it should be advertised more between the people in the field and the patients as well.


Anonymous said...

Zyprexa has generated a lot of bad press for Eli Lilly and they still have unresolved Zyprexa settlement claims.
Eli Lilly is 'reaping the whirlwind' for aggressive marketing of Zyprexa that has caused suffering and deaths.

Zyprexa is being avoided by doctors they aren't prescribing it for new patients at all anymore.
Daniel Haszard 4 year Zyprexa patient who got diabetes from it.

Anonymous said...

I agree that this relationship between PRMS and Lilly is "outrageous". I will call the APA and PRMS. Many thanks for highlighting this issue!

soulful sepulcher said...

This is outrageous! They still use it in psych wards, and my next door neighbor was just rx'd it Fall 07 and is now diabetic.

The Zyprexa documents (hosted at Furious Seasons) should say enough as to why Lilly needs to be smacked down with this.

Thanks for the info as usual.

Anonymous said...

Pharmacapital at its finest. You Go Dr. Dan!

Anonymous said...

Dr C:

You've reported on this before, if memory serves correct. Why Lilly want to push this med further shows a masochistic/sadistic side that is a bit unbelievable to a fairly well read and traveled doc.

Glad you're back. Hopefully the commentary will be a bit more rational and supportive than at other sites I have traveled these past few months. At least you do some "moderation", even though it has stopped me in the past.

Talk with ClinPsych regarding Iloperidone? Another pot hole in the road of antipsychotics, eh?

Anonymous said...

Someone should alert Senator Grassley.

Anonymous said...

I was just looking at old PDRs. Did you know that in the late '90s Lilly used to run diabetes education ads in the PDR at the end of the Zyprexa labeling.

Also have you noticed the similarity of cardiovascular side effects, especially in combination with Symbyax to Phen-Fen. Also the FDA's very quiet warning about phen-fen like side effects (PAH)with Symbyax and Zyprexa on the FDA website.


Anonymous said...

Don't know if my previous comment took.

Have you noticed that in the late 90's Lilly used to put ads for diabetes education at the end of the Zyprexa labeling in the PDR.

Also have you noticed that the cardiovascular side effects, especially the pulmonary arterial hypertension that especially noticable in combination with fluoxetine (i.e. Symbyax) look just like the CV toxicities with phen-fen. Plus isn't it interesting that FDA put out a warning about this quietly on their website but hasn't put anything in the labeling.


Anonymous said...

Refer to one of your earlier entries on a company getting grants from Lilly for CME. Looks like they plan these programs as well. More of the same huh?