Did Lexapro's success depend on doc payments?

For a behind-the-curtain look at Forest Laboratories' efforts to promote the antidepressant Lexapro, look no further than a marketing plan obtained by a Congressional committee. The 88 pages, obtained by the New York Times, show that Forest touted Lexapro--a tweaked version of the SSRI drug Celexa--via a multimillion-dollar campaign of doc payments and meals.

Already under fire from federal prosecutors for alleged off-label marketing of both antidepressants--and an alleged doctor-kickback scheme--Forest now faces critics who say Lexapro's success came thanks to gifts and payments for psychiatrists and primary-care physicians. After all, it's an expensive branded med with plenty of generic competition. So why do physicians choose it?

Some docs say it's simply a better drug. But others say there's more to the story. According to the marketing plan, Forest planned to spend $34.7 million to pay 2,000 physicians for lectures to other doctors. Plus, Forest budgeted $36 million for lunches in doctors' offices. And it mounted a concerted CME effort in support of the drug. That's just for one year of promoting Lexapro. (According to Vermont figures, Forest outspends many Big Pharmas when it comes to paying doctors for time or services.) Just the lectures amount to $17,350 per doc, on average.

Sen. Herb Kohl, who chairs the Senate Special Committee on Aging, held hearings in July about CME funding and industry influence. After looking at the Lexapro marketing plan, he told the Times that the hearing asked the question, "Is the line between medical education and marketing blurred?" Then he said, "These documents show that for these companies, there is no line." Fair? Or not?

- see the NYT story [1]