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Context of 'November 28, 2005: Drug Companies Allegedly Using Sex to Sell Drugs'

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During this period, pharmaceutical companies begin hiring fewer and fewer universities to perform the clinical research studies for their drugs, contracting instead private research firms or conducting the studies themselves. In the early 1990s, roughly 75 percent of drug companies’ clinical research budgets went to universities. By 2000, this figure drops to only 34 percent. [New York Times, 11/22/2002]

Timeline Tags: US Health Care

Warner-Lambert launches a new campaign to aggressively promote its epilepsy drug Neurontin. To boost the drug’s sales, the company begins marketing the drug for uses that have not been approved by the FDA. (While it is legal for doctors to write prescriptions for “off-label” uses, drug companies are prohibited from promoting such uses.) The company’s discreet campaign claims the drug can be used to treat pain, headaches, Lou Gehrig’s disease, attention deficit disorder, restless leg syndrome, drug and alcohol withdrawal seizures, bi-polar disorder, and other psychiatric illnesses. [New York Times, 5/15/2002; Associated Press, 8/8/2003] One marketing executive is recorded on tape telling a sales representative, “If we are going to market Neurontin effectively, we have to do it for monotherapy, for epilepsy, also for pain and bipolar and other psychiatric uses.” (Neurontin is only approved for use in conjunction with other drugs—it is not supposed to be used monotherapeutically.) Independent studies later suggest that the drug is not an effective treatment for some of those unapproved uses, and in some cases, Neurontin may even make a patient’s condition worse. Furthermore, patients may suffer if a doctor takes them off an effective medication so they can take Neurontin instead. [New York Times, 5/15/2002] The company’s marketing campaign is so effective that by 2003, 90 percent of the drug’s $2.7 billion in sales is for uses not approved by the FDA. [New York Times, 5/14/2004] In addition to the promotion of off-label use, the Warner-Lambert sale representatives are instructed to press doctors to prescribe the drug at levels higher than the FDA-approved dosage. [New York Times, 5/15/2002]
Marketing tactics -
bullet Paying doctors to write favorably about the drug. In one case the company reportedly pays $303,764 to publish a textbook on epilepsy written by Ilo Leppik, a professor at the University of Minnesota. Leppik later denies that the book was a marketing tool and says the book discussed other drugs beside Neurontin. [New York Times, 3/30/2003; Associated Press, 8/8/2003]
bullet Hiring marketing firms to help write articles favorable of Neurontin. Doctors are paid to claim authorship for the articles, which are vetted by Warner-Lambert before being submitted to a journal for publication. In one case, Warner-Lambert agrees to pay a company $12,000 per article and $1,000 to any doctor agreeing to accept authorship. [New York Times, 5/15/2002]
bullet Rewarding dozens of doctors who write a high-volume of Neurontin prescriptions with consulting or speaking contracts worth tens of thousands of dollars. By 1997, Dr. B. J. Wilder, a former professor of neurology at the University of Florida, receives almost $308,000 for speeches he gives. Six other doctors get paid more than $100,000 each. And Dr. Steven C. Schachter, a neurologist at Beth Israel Deaconess Medical Center, earns $71,477 for speaking on the drug’s off-label uses. [New York Times, 3/30/2003]
bullet Paying doctors $350 a day or more to admit sales representatives into examining rooms to meet with patients, review their medical charts, and recommend treatment. This tactic, known as “shadowing,” involves approximately 75 to 100 doctors in several Northeast states. [New York Times, 5/15/2002]
bullet Instructing sales representatives to pressure doctors to write Neurontin prescriptions for unapproved uses (see April 1996-July 1996).

Entity Tags: Parke-Davis

Timeline Tags: US Health Care

An expert panel convened by the US Food and Drug Administration unanimously agrees that Celebrex, Bextra, and Vioxx “significantly increase the risk of cardiovascular events” such as heart attacks. However the panel does not believe that the risk is so great that these drugs should be banned from the market. (Vioxx was withdrawn from the market voluntarily by its manufacturer in September (see September 30, 2004).) The sales of these drugs should be permitted to continue, but only under strict conditions, the panel says. It also recommends a prohibition on direct marketing to consumers, a patient’s guide for the drug, and a black box warning—the most severe possible—detailing the drug’s cardiovascular side effects. [CNN, 2/18/2005; Washington Times, 2/19/2005] After the vote, the New York Times reveals that 10 of the panel’s 32 members had at one time been paid-consultants to the makers of the drugs in question. In analyzing the votes, the Times discovers that neither Bextra nor Vioxx would have survived the vote if the scientists with connections to the company had not voted. For both Bextra and Vioxx, the industry-connected panelists voted 9 to 1 in favor, while the experts with no ties voted 14 to 8 and 17 to 15 to ban Bextra and Vioxx, respectively. The Times notes in its article that “these votes were deeply important” for the makers of those drugs. After the votes, the shares of Merck and Pfizer increase substantially. In e-mails to the Times, eight of the panelists, responding to questions from the newspaper, say their votes were not influenced by their ties to the companies. Two of the panelists do not respond. One of the panel members, Dr. John Farrar, who has received research support from Pfizer, says, “I think FDA would have a hard time finding people who are good at what they do who never spoke to a pharmaceutical company.” But another panel member, Dr. Curt Furberg, who has no ties, says he was “uncomfortable with the Pfizer-friendly undertone” at the meeting and he felt the industry ties might have contributed to that tone. Furberg adds that it has never been proven that Celebrex, Bextra, or Vioxx offer better pain relief than ibuprofen or more than a dozen other over-the-counter drugs. Daniel E. Troy, the FDA’s former chief counsel and a longtime advocate of drug-maker interests, plays down the importance of the ties, saying that any suggestion that experts’ votes were influenced by industry connections “buys into an overly conspiratorial view of the world.” [New York Times, 2/25/2005]

Entity Tags: Daniel E. Troy, John Farrar, Curt Furberg, US Food and Drug Administration

Timeline Tags: US Health Care

A survey of 483 physicians by GfK Market Measures finds that one-third feel drug company sales representatives are “too aggressive or pushy.” Roughly an equal percentage says that many reps are “not knowledgeable.” One general practitioner tells GfK, “It’s silly that a highly trained sales force does not know what their product is used for and they have to ask me.” According to the survey, drug companies Pfizer and Merck are considered by doctors to have the most effective marketing teams. Abbott Laboratories’ sales force is rated as the least effective. [CNN, 9/14/2005]

Entity Tags: GfK Market Measures, Merck, Abbott Laboratories, Pfizer

Timeline Tags: US Health Care

The New York Times publishes an article suggesting that pharmaceutical companies are using sex to sell their drugs. Physicians interviewed in the article indicate that the sexual marketing of drugs is widespread. “There’s a saying that you’ll never meet an ugly drug rep,” says Dr. Thomas Carli of the University of Michigan. T. Lynn Williamson, a cheering advisor at the University of Kentucky, tells the Times that recruiters from pharmaceutical companies routinely call him looking for prospective sales representatives. “They watch to see who’s graduating,” he explains. “They don’t ask what the major is. Exaggerated motions, exaggerated smiles, exaggerated enthusiasm—they learn those things, and they can get people to do what they want.” He says approximately two dozen cheerleaders from the university, mostly women but also some men, have gone on to work for the drug industry. The newspaper also interviews Gregory C. Webb, the owner of Spirited Sales Leaders, a company that helps former cheerleaders find work in the sales industry. “I’ve had people who are going right out, maybe they’ve been out of school for a year, and get a car and make up to $50,000, $60,000 with bonuses, if they do well,” he explains. His company’s website boasts that a “large number of former Varsity employees have secured sales positions and built successful careers in various fields, such as pharmaceutical and medical sales.” The website’s header combines a large photo of a hospital room with a photo of a cheerleader. [New York Times, 11/28/2005; Spirited Sales Leaders, 7/23/2006]

Entity Tags: T. Lynn Williamson, Gregory C. Webb, Spirited Sales, Thomas Carli

Timeline Tags: US Health Care

Concerned about Democratic plans (see After November 7, 2006) to push for lower drug prices and tighter regulation of the pharmaceutical industry, drug companies begin communicating with Democrats and recruiting lobbyists with Democratic connections. [New York Times, 11/24/2006]
bullet Billy Tauzin, president of the drug lobbying organization Pharmaceutical Research and Manufacturers of America (PRMA), meets with Senator Byron L. Dorgan, a North Dakota Democrat who has spent six years pushing for legislation that would allow drug imports from Canada. [New York Times, 11/24/2006]
bullet Amgen, a biotechnology firm, retains George C. Crawford, a former chief of staff for Representative Nancy Pelosi (D-Ca), as a lobbyist. [New York Times, 11/24/2006]
bullet Merck hires Peter Rubin, a former aide to Representative Jim McDermott of Washington. [New York Times, 11/24/2006]
bullet Cephalon contracts Kim Zimmerman, a health policy aide to Senator Ben Nelson (D-Ne). [New York Times, 11/24/2006]
bullet The Biotechnology Industry Organization retains Paul T. Kim, a former aide to Senator Edward M. Kennedy (D-Ma) and Representative Henry A. Waxman (D-Ca). [New York Times, 11/24/2006]
bullet One unnamed medicare expert who works for House Democrats tells the New York Times in late November that he received three separate job offers in one day from the drug industry. [New York Times, 11/24/2006]

Entity Tags: Kim Zimmerman, Paul T. Kim, W.J. (“Billy”) Tauzin, Peter Rubin, Merck, Biotechnology Industry Organization, Amgen, Byron L. Dorgan, George C. Crawford, Cephalon

Timeline Tags: US Health Care

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