Doctors Prescribe Zyprexa on Bets With Lilly Sales Reps

by Heidi Stevenson

12 September 2009

How would you like knowing that your doctor prescribed a drug to you because he lost a bet with a pharmaceutical representative? That's exactly what happened with Zyprexa, one of the most toxic drugs around. A doctor playing golf with an Eli Lilly and Co. drug representative made bets to start a new patient on Zyprexa for each time the rep hit par or got the ball in within a certain number of strokes.

Zyprexa is an extremely toxic drug, with effects that include diabetes and diabetic coma, tardive dyskinesia—an incurable disorder causing involuntary, often disfiguring, movements and sometimes pain—mental impairment, and a host of other serious disorders. Can you imagine your doctor prescribing it to pay off a bet?

This is our healthcare system gone mad. Recently, Pfizer settled a similar case by paying $2.3 billion in fines. That was its fourth fine within a decade. It's simply a cost of doing business—and you know who ultimately pays that cost, both in money and suffering.

Other Eli Lilly Settlements

Federal

In January of this year, Eli Lilly pleaded guilty to a misdemeanor charge brought by the United States Attorney for the Eastern District of Pennsylvania (EDPA) and the Department of Justice's Office of Consumer Litigation for illegal marketing and promotional practices. Lilly's chairman, CEO, and president said:

We deeply regret the past actions covered by the misdemeanor plea. At Lilly we take seriously our responsibilities to abide by all the laws governing our business practices, and we realize that we have a tremendous responsibility to the patients and healthcare professionals we serve. Every day and with every interaction we strive to operate in a responsible and compliant manner. Doing the right thing is nonnegotiable at Lilly, and I remain personally committed to all of us at Lilly maintaining the highest standards of conduct."

The fact that Eli Lilly's marketing practices have included selling Zyprexa for senile dementia, a condition for which it's unapproved, and deaths occurred as a result, makes it rather difficult to comprehend what sort of "highest standards of conduct" are considered "nonnegotiable" by the company. Apparently, making bets with doctors on golf games with patient prescriptions as the prize doesn't conflict with those nonnegotiable standards.

Eli Lilly agreed to pay $800 million to settle the charges. They also agreed to a corporate integrity agreement with the Office of Inspector General of the U.S. Department of Health and Human Services, in which the company agreed to abide by a set of integrity obligations. The worth of this is questionable, since the company's existing policies and procedures are already in compliance. Obviously, the written policies and the real-life ones have little to do with each other.

Alaska

Alaska sued Eli Lilly for failing to adequately inform about Zyprexa's risk of causing diabetes. The state sought $5,000 each for 200,000 prescriptions, one billion dollars. Three weeks into the trial, a settlement for $15 million was reached. Part of the agreement was to pay Alaska more if other states get better deals.

As always in these cases, the issue is about money. The harm done and the people hurt don't get anything. The money goes to the state.

Other Settlements and Cases

Many private cases have been brought against Eli Lilly on Zyprexa. At the time of the Alaska settlement, 31,000 plaintiffs had received a total of $1.2 billion. Nine other states and 1,600 individual plaintiffs had cases pending.

Back to South Carolina's Case

The information about betting has come out because South Carolina is suing Eli Lilly for $200 million dollars, an amount the state claims to have paid for prescriptions because of Eli Lilly's attempts to get doctors to prescribe for conditions other than those approved by the FDA.

Vince Sullivan, the Eli Lilly salesman who made the golf bet, wrote in his diary, "I got four pars out of nine holes. I said I wanted my four new patients." Lilly spokeswoman, Marni Lemons, said, "Call notes are jottings written by sales reps and most reps make hundreds of notes monthly. They are not literal recitations of interactions with physicians." She also said that the notes were taken "out of context". One must wonder, though, why a salesman would make a point of jotting down such a thing, if not to use it. I'm still trying to imagine a context for that note that would magically make it innocent.

An attorney representing South Carolina, John Simmons, stated that the sales notes also documented that many Zyprexa prescriptions were for off-label (unapproved) uses. He also claims that a Lilly stated they were "betting the farm on Zyprexa" to replace the previous blockbuster drug, Prozac. They even had a code word for off-label marketing, diamond.

According to Simmons, Zyprexa was pushed for use in children, including for those difficult "kids whose parents have to shove the pills down their throat every day." One mother was noted as putting Zyprexa in her child's tea.

Who Benefits?

All these suits demonstrate something quite distressing. In modern medicine, the only issue that seems to matter is money. South Carolina isn't suing because its citizens may have been harmed by Eli Lilly's shenanigans. It's suing only to recover money. People whose lives have been devastated are, largely, left to struggle on their own.

The bottom line, as ever in modern medicine, is the bottom line. The thousands and millions of people harmed by pharmaceuticals usually slip through the cracks. Like most ill people, they struggle to survive. Most do not have the energy to fight. For them, there is no justice. This isn't just a matter of a single drug and a single pharmaceutical company. It's Zyprexa and all the other antipsychotics, such as Risperdal, Clozaril, Seroquel, and Abilify, among others. All have horrific effects and never cure. It's Vioxx and all the other similar drugs, such as Bextra and Celebrex. It's the massive overuse of steroids and antibiotics. These and so many others produce enormous profits for both their manufacturers and the doctors who prescribe them.

The mantra of the bottom line is also taken up by the agencies of the people, the services that should be protecting them—like the FDA and USDA. Rather than serving the people, they serve mammon.

The agencies that come in to clean up after, like attorneys general and United States Department of Justice, focus only on money. They recover money for the government as a whole, but do nothing to defend the people who have been harmed. They don't go after the individuals who make the corporate decisions that cause such suffering. They don't punish the scientists and doctors who produce and publish fraudulent studies. All they do is collect money for the state.

The people who've been harmed are on their own.