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.

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!