Did Pfizer pull a fast one to convince doctors to prescribe more Lipitor?

Bending the Rules

How do you make your drug the best selling drug of all time? Well, it doesn’t hurt to get creative.

Unless you get caught…

That’s the dilemma facing Pfizer executives right now. Seems they may have gotten a little TOO creative in their sales tactics for their cholesterol-lowering juggernaut Lipitor. They’re charged with misleading millions of doctors and patients, which just might include defrauding of the government.

Now, I can’t say whether they did or they didn’t. But either way, they apparently benefited from a miscalculation of heart attack risks. It’s like they drew a variation of that Community Chest card in Monopoly: “Bank error in your favor. Collect millions of extra dollars.”

Hard to figure

To get the full scope of what Pfizer may have been up to, we need to think back on a time when computers and multi- function cell phones didn’t dominate the way we went about our daily routines. (I know, it’s hard for me, too. But there was a time…).

Back in those days, doctors used a complex equation to judge a patient’s 10-year risk of heart attack. They had to sharpen a pencil, get out a calculator, and cross reference your blood test results with sets of tables. It was actually kind of difficult to figure out if your risk made you a candidate for drug therapy.

A few years ago this equation was reworked into a much simpler point system by the National Cholesterol Education Program (NCEP). Then it became easy for your doctor to figure your drug needs.

But now, with new computer programs, that original equation is easily calculated.

So some researchers at Weill Cornell Medical College wondered what would happen if they compared the old equation with the newer point system. Which kind of makes you wonder why someone didn’t think of making the comparison a long time ago!

You can see where this is going. Using data for more than 2,500 people, the Weill Cornell team calculated once with the old equation and once with the point system. And they found significant differences in the outcomes.

Most importantly, they discovered that millions of patients at low risk have been wrongly classified in a higher risk group–a group that is routinely recommended drug therapy.

That’s a pretty sweet gift for any company that happens to make cholesterol drugs!

Stretching the points

One of the Weill Cornell study authors is Jesse Polansky, who also happens to be a former Pfizer executive. He claims that this point system gift still was not quite sweet enough to satisfy the all-out marketing blitz behind Lipitor.

In a lawsuit filed earlier this year, Polansky says that the company exploited the point system by intentionally distorting the guidelines. The distortions were then highlighted when making “educational” presentations– whether for individual doctors or hundreds of doctors attending health conferences.

Polansky notes that these efforts boosted the reclassification of many moderate risk patients into a high risk group. Of course, this made them perfect candidates for a lifetime membership in the Lipitor club.

And beyond the obvious health concerns, there’s yet another kicker: “Millions of those improper prescriptions were ultimately paid for by various government healthcare plans.”

Normally federal lawmakers don’t look too kindly on getting bilked out of millions of dollars. It will be interesting to see if they make an exception for a government-cozy drug giant like Pfizer.

I’ll keep an eye on this one to see how it goes. I can’t wait to find out if a judge or jury agrees that Pfizer execs were caught with their hand in a really large cookie jar.

To Your Good Health,

Jenny Thompson

“Coronary Risk Assessment by Point-Based vs. Equation-Based Framingham Models: Significant Implications for Clinical Care” Journal of General Internal Medicine, Published online ahead of print, 9/8/10, springerlink.com
“Former Pfizer Exec Sues Over Lipitor Marketing” Ed Silverman, Pharmalot, 2/11/10, pharmalot.com

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