Painkiller marketing secrets? Check Chicago's unredacted suit against Endo, Purdue, Cephalon, et al.

The city of Chicago made big news when it sued 5 drugmakers, alleging that their painkiller marketing broke the law. But much of the juicy detail in that lawsuit was hidden from view, redacted under a confidentiality agreement with the companies.

Now, it's open for viewing. As Bloomberg reports, a federal judge ruled that the information filed under seal could be made public, despite objections from two of the companies. The city then filed an amended complaint that's mostly redaction-free.

So, what did those drugmakers have to hide? The news service compared the documents to find out. The redacted portions mostly offer detail on marketing tactics that would be familiar to any pharma company. Speaking programs to support newly launched drugs. Journal articles drafted by ghost writers. Funding for pharma-friendly patient groups. And so on.

The kicker here is twofold: Content, secrecy and scale. The city alleges that the drugmakers--Endo ($ENDP), Purdue Pharma, Johnson & Johnson's ($JNJ) Janssen unit, Cephalon (now part of Teva) and Actavis ($ACT)--exaggerated the benefits of opioid painkillers and soft-pedaled their risks. Several of the companies used backing for "front groups" and their projects as a sly way to promote their products, the lawsuit alleges. And the amounts laid out for speaking programs are impressive, even in the context of Big Pharma.

For instance, there's the matter of a book-length guide for treating pain, which built on guidelines published by the Federation of State Medical Boards, a trade group the drugmakers allegedly sought to influence. According to the complaint, Endo shelled out $286,620 to support the guide's publication, and Purdue and Cephalon paid $150,000 each. Then, the FSMB used the companies' sales reps to distribute the book to doctors. The treatment guide? Opioid friendly, the lawsuit says, to the point of leaving out or understating the risks of the drugs, including the risk of addiction.

And then there's Cephalon's speaking program, rolled out to support the launch of Fentora. It cost a cool $6 million. The company wasn't shy about entertaining doctors, either; within a three-day period, Cephalon allegedly spent more than $7,500 on dinner parties for 36 Chicago-area prescribers. Endo spent $4 million on 1,000 speaker events in 2008, the suit claims.

The suit also details some marketing tactics, company by company. One redacted section: Actavis trained reps and physician-speakers to say that opioid doses could be raised during long-term use, without ever hitting a dose ceiling--and that long-term use of opioids was safer than long-term therapy with drugs like acetaminophen or NSAIDS, which include aspirin and ibuprofen. Signs of addiction really amount to "pseudoaddiction," sales trainers said, adding that any withdrawal symptoms would easily managed, the suit claims.

It's worth mentioning that this lawsuit isn't the only legal issue on these companies' radar. Two California counties filed a similar suit against the same companies in May, just before Chicago did. Earlier this year, Endo agreed to pay $193 million to settle three off-label marketing claims with the Department of Justice, involving its pain patch Lidoderm. Kentucky sued Purdue blaming the drugmaker for an addiction epidemic in the state, aiming for $1 billion in damages. And that's just a sampling.

For the full flavor of the secrets the companies wanted to keep, check out Bloomberg's page-by-page comparison of the two complaints. And in the meantime, consider this for some validation that pharma marketing techniques do work--and sales reps are worth their salt. When pushing the powerful painkiller Opana ER, Endo reps were detailing docs by the thousands--72,000 pitches in all. And those pitches worked, the lawsuit says, citing company records.The doctors reps visited wrote three times as many scripts for the drug as those who weren't on the call list. The most heavily targeted docs prescribed the drug an average of 30 times a month.

- read the Bloomberg story

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