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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
Related Articles:
Forest charged with kickbacks, off-label antics
Lexapro, Namenda boost Forest
Comments
By Tom Brownlie | Posted 11:11am | September 2, 2009
Note that Forest is not a member of PhRMA; therefore, they do not follow the Code of Conduct. Sadly, this is the consequence.
By Anonymous | Posted 11:05am | September 3, 2009
The comment by Mr. Brownlie is not entirely true. Correct, Forest is not a member of PhRMA. However, Forest does adhere to the PhRMA Code. Because the PhRMA Code is closely related to the OIG guidelines, it is followed by most pharma companies, whether they pay for a PhRMA membership or not.
By Anonymous | Posted 12:31pm | September 3, 2009
Forest is not a part of pharma. However, the pharma code is to be followed and is signed by every rep for Forest. Forest promotes that they are not part of pharma and therefore can do things outside the rules. Forest knows how to make things look legit.
By health guy | Posted 11:50am | September 2, 2009
Look at this and also device manufacturers like ortho implants if we want to start controlling healthcare costs. When will we ban this ????
By Anonymous | Posted 2:50pm | September 2, 2009
Although Forest is not a member of PhRMA how can it be said that they do not follow the code of conduct? (Read sections 2 and 7 of the PhRMA code via the link below.)
http://www.phrma.org/files/PhRMA%20Marketing%20Code%202008.pdf
Both meals and reasonable compensation to physicians to provide educational programs is within PhRMA code. Would you rather have a doctor (who has been provided full information on the drug in question) speaking to other doctors about drugs and their interaction? Or would you prefer doctors get ALL of their information from articles and sales reps? With all of the drugs on the market I hardly think your physician has enough time to read all of the information at hand.
It is interesting that only Forest's BUDGETED figures are given in both this and the NYTimes articles. What about all other PhRMA companies as well as all health related industries? What is the ACTUAL spend? Considering we're talking about multibillion dollar companies...
What about oil companies? Is there any unnecessary spending that should be cut to lower prices for consumers?
Honestly, there are not enough facts given in these articles to come to an educated conclusion.
By Anonymous | Posted 4:50pm | September 2, 2009
Forest has this reputation for outspending its competition on meals and honoraria. Also, they have had several FDA warning letters for Celexa and Bystolic for unsubstantiated claims. In my opinion (which is shared by many industry veterans including those who have worked for them or co-promoted) Forest is the dirtiest pharma company out there. Ethics not a core of their value system the way it is elsewhere. Unfortunately, with stories like this, every other pharma sales organization gets painted with the same brush.
By Anonymous | Posted 12:48pm | September 3, 2009
I disagree vehemently with the anonymous poster at 4:50 pm on September 2. I have worked in medical marketing for over 25 years, and at one time or another with most of the major pharmaceutical companies, including Forest.
In my experience, Forest is among the most ethical companies. It is one of the few to shun DTC advertising, in the belief that most lay people do not have the requisite educational background or knowledge of the scientific literature to adequately evaluate advertising claims.
My guess is that the total marketing budget for Lexapro is less than the cost of TV advertising for Viagra, Cialis, or Levitra.
By Anonymous | Posted 5:53pm | September 2, 2009
Does anyone know...are there any specific limits that PhRMA has set for this type of spending?
By Anonymous | Posted 7:33pm | September 4, 2009
OK September 3 poster. You shun DTC advertising and use those cost savings to outspend on honoraria. You don't do DTC out of ethics? How about you shun DTC out of staying out of the spotlight because you are already in the crosshairs of the FDA about efficacy claims of your products. Why is it that Forest gets such a bad rap? Everybody, I mean everybody points to Forest as the bad apple when it comes to marketing tactics. Consistently ranked at the bottom by doctors in surveys despite the heavy presence of their sales people. Am I to believe that everyone else is wrong and you are right? I wasn't born yesterday.
By Anonymous | Posted 8:31am | September 10, 2009
Actually the NYT article states that Eli Lilly, Pfizer, Novartis and Merck all outspend Forest on honoraria. If it is true that Forest is worried about "staying out of the spotlight because you are already in the crosshairs of the FDA..." Why have never attempted DTC advertising even before they were in the proverbial "crosshairs"? And what exactly do you mean "heavy" presence of sales reps? Forest has a sales for of approximately 3000 that cover both the entire US and Puerto Rico. I'm sure companies the likes of Pfizer have far greater numbers in their sales team.
By Anonymous | Posted 8:46am | September 8, 2009
It's not Forest, it's our current medical system. No company should be allowed to market psychotropic drugs to any doctors except psychiatrists. They do not have the expertise to dispense these drugs or do any follow up. I was given lexapro & campral by my PCP on my first time visit and then proceded to get 3 drunk in publics, 2 dui's, & 1 hospitalization for trying to commit suicide and was given Buspar when I told a psychiatrist at a rehab I wanted taken off Lexapro. My blood pressure went from 120/80 to 145/110 by the time I had taken Lexapro for 7 months. In addition, this doctor started kissing me and grabbing my breasts at one of my visits. This is like receiving medical treatment from the 3 stooges. When I finally stopped taking it, my drinking problem and anxiety magically dissapeared. Unfortunately, there is no legal remedy for me to recoup my financial losses. Jail is full of people on these same medications. CSB therapists and counselors have no business referring people to their PCP's to get these drugs. Depression is an event, not a life long chronic disorder. PCP's don't go around reading the DSM IV so they don't know what they're doing. I am so glad that the stockholders got a $65 MIL settlement from Forest. I feel really sorry for those rich people who lost money investing in it. Too bad there's no recourse for the people who went crazy from it and are now sitting in jail or pushing up daisies.
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