Florida Prozac case raises issues of privacy, health — (Chicago Tribune)

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Chicago Tribune

July 11, 2002

By Bruce Japsen, Tribune Staff Reporter

Direct marketing dangers alleged

An investigation into whether a drug company illegally mailed samples of a powerful antidepressant to Florida residents shows how drug marketing practices place patients’ health and privacy at risk, critics say.

The Florida attorney general wants to know whether an unsolicited mailing of Prozac tablets to a woman violated the state’s deceptive and unfair trade practices act. Prosecutors say the woman received a once-a-week dosage of Prozac, an antidepressant she says she hadn’t been using and hadn’t asked her doctor to give her.

It’s believed to be the first time a powerful prescription drug was sent to patients who did not request it. That would be an unusual marketing tactic in an industry known for spending more than $16 billion a year to push pharmaceuticals in a variety of ways.

Questions about health and privacy aside, aggressive drug marketing is one reason why the nation’s tab for prescriptions is rising an average of 17 percent annually, critics say. Prosecutors and consumer groups are probing whether drug industry gift-giving to physicians influences prescribing habits while the Food and Drug Administration is evaluating whether television ads lead consumers to request drugs they may not need.

At the center of the Florida investigation is Prozac-maker Eli Lilly & Co. of Indianapolis, Deerfield-based drugstore chain Walgreen Co., and a group of Ft. Lauderdale physicians who say their letterhead was used by the drug maker to solicit patients. The letter, which included a free one-month supply of Prozac, was sent in a Walgreen envelope.

The woman has since filed an invasion of privacy suit against Lilly, Walgreen and her doctor.

“This is a privacy and public health issue,” said Joe Bizzaro, spokesman for Florida Atty. Gen. Bob Butterworth, who announced the investigation earlier this week. “Here you have a serious drug being sent unsolicited. It becomes a public health issue when mailing this type of medication.”

For their part, Walgreen and the medical group say they are investigating the mailing. Lilly has issued an apology and suspended several employees in Florida with ties to the mailing, saying what occurred was “inconsistent” with company marketing policy.

Consumer groups and Florida prosecutors say the case illustrates the potential dangers of paying pharmacies to market drugs directly to patients. Many pharmacy chains use computer databases loaded with lists of names, phone numbers and addresses of customers and their prescriptions. Customers often don’t even know their information is used for these marketing practices.

“This sounds like a real seamy drug marketing tactic,” said Larry Sasich, a pharmacist and drug researcher at consumer group Public Citizen. “The core business of the pharmaceutical industry these days is marketing and not research and development.”

Prozac sales hurt by generics

For Lilly, Prozac sales have fallen dramatically with the advent of generic competition. Sales of Prozac, which came off patent last August, were down 26 percent last year to $2 billion from $2.7 billion in 2000, according to health information firm IMS Health.

Because the daily Prozac dosage no longer has patent protection and there are cheaper generic copies, the company has intensified marketing of the weekly dosage because it is still protected by a patent, industry analysts say.

In the letter to the Florida patient, the correspondence touts Prozac Weekly as the same as the daily dosage, but with “convenient once-a-week dosing.”

“For your convenience, enclosed you will find a free one-month trial of Prozac Weekly,” the letter on Holy Cross Medical Group stationery says. “If you wish to try Prozac Weekly, stop your daily antidepressant one day before starting Prozac Weekly, then take only Prozac Weekly once a week thereafter. Congratulations on being one step to full recovery.”

Doctors’ group is mum

A spokeswoman for the medical group had no comment but said the doctors “approved something and something else was given,” but she wouldn’t elaborate.

Lilly and Walgreen say the drug sent to the woman in Florida was not part of company-approved “patient education” or “patient compliance” programs, common industry promotions on pharmacy letterheads that remind patients to refill their prescriptions.

“Based on our understanding of the facts, this case in southern Florida goes beyond what is acceptable under Lilly policy,” Lilly spokesman Blair Austin said.

Response from Walgreens

Walgreen spokeswoman Lori Meyer said the prescriptions were ordered by physicians, filled by a Walgreens store and mailed in a Walgreens envelope, but the drugstore chain didn’t sponsor or direct the mailing to the patient.

Lilly said one of its sales representatives provided reimbursement vouchers in order to send the recipients free samples. The doctors’ office provided Lilly reps with a list of their patients taking antidepressants.