Pfizer's $2.3 billion fine is only the tip of the iceberg

When I was writing Side Effects, I learned that the New York State Attorney General's office had sued Pfizer for the illegal off-label marketing of Bextra, its Cox-2 painkiller. (If you'll recall, Bextra, like Vioxx, was withdrawn from the market because of evidence that it increased the risk of heart failure in patients). Sources at the AG's office told me that other prosecutors were also going after Pfizer for its deceptive marketing tactics and asked me to keep this information under my hat for the time being.

If you read today's New York Times or Washington Post, you'll see that these legal actions have culminated in a record $2.3 billion fine against Pfizer for the illegal marketing not only of Bextra but of three other drugs as well. As The Washington Post reports:

The Pfizer unit Pharmacia & Upjohn pleaded guilty to a single felony charge that accused the company of marketing its anti-inflammatory drug Bextra for broader uses and higher dosages than those approved by the Food and Drug Administration.

The company allegedly enticed doctors to prescribe the drug for pain relief by taking them on lavish trips, created sham requests for medical information as an excuse to send unsolicited advertising materials to physicians, and drafted articles promoting the pills without disclosing its role in preparing the stories.

In connection with the settlement, Pharmacia & Upjohn consented to pay $1.3 billion in fines and forfeiture, the biggest criminal penalty ever imposed in the United States, prosecutors said. Pfizer paid an additional $1 billion to state and federal authorities to resolve civil allegations of improper marketing over Bextra and three more drugs: Geodon, an antipsychotic medicine; Zyvox, an antibiotic; and Lyrica, an epilepsy medicine.

This is Pfizer's fourth settlement for illegal marketing activities since 2002 and prosecutors said they factored that "recidivism" into the steep penalty announced yesterday. Yet, as Gardiner Harris in The New York Times notes, the $2.3 billion penalty amounts to less than three weeks of Pfizer's sales.

Deja vu, anyone? A few days ago, Forest Labs was in the news for spending lots of money on doctors in medical conferences, consulting fees, junkets and free meals to convince them that the antidepressant Lexapro was much better than its off-patient antidepressant Celexa (even though the chemical make-up of the two drugs are nearly identical). And now we have Pfizer dunned for doing much the same thing with several of its blockbuster drugs.

It's good to see the Obama administration and various states getting serious about such health care fraud. But it's not enough to fine drug companies for deceptive and illegal marketing tactics. There has to be real reform in the medical research establishment. Until universities and doctors stop taking money that taints their scientific judgment and refrain from putting their names on papers they didn't write, how can the American public trust any health professional when it comes to the safety and effectiveness of prescribed drugs?