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Prozac-in-the mail incident highlights drug companies' aggressive tactics

Tuesday, August 06, 2002

By Theresa Agovino, The Associated Press

It was marketing gone amok.

A few weeks ago, up to 150 people in southern Florida received Prozac in the mail. They didn't ask for it, and there are conflicting stories whether there were prescriptions for it.

Outraged consumer advocates said the promotion was just another example of drug companies caring more about profits than patients. Privacy proponents feared patients' medical records were being mined for direct advertising campaigns without their consent.

"There is a real hysteria out there about privacy, so that Prozac situation touched a nerve," said Douglas Wood, a partner at Hall, Dickler, Kent, Goodstein & Wood, a law firm specializing in advertising. "Pharmaceutical companies are using every angle to advertise."

The incident comes as doctors and politicians try to muffle messages from pharmaceutical companies in the hope of protecting patient privacy and lowering skyrocketing prescription drug costs. The Centers for Medicare and Medicaid Services estimates that overall spending on prescription drugs last year rose 16.4 percent to $142 billion.

Some tie ballooning prescription drug costs to surging pharmaceutical promotion spending. Such expenses, including consumer ads, more than doubled from 1995-2001 to $19 billion, according to the research firm IMS Health.

Drug companies are under enormous pressure lately because many of their blockbuster products' patents have expired and they don't have new medicines to replace sales lost to generic drugs. Prozac sales have virtually evaporated since it lost its patent last August. The promotion was for a weekly version of the drug with limited sales that is still under patent.

In June, Vermont passed a law requiring pharmaceutical sales reps to register every gift, fee or payment worth more than $25 to doctors and other health providers. The records will be made public. A bill based on that law was recently introduced in Congress, and another bill would end pharmaceutical companies' tax deduction for advertising. Finally, some doctors are now charging sales representatives for the opportunity to pitch their products in hopes of curtailing unnecessary visits.

Drug companies insist promotions provide valuable information to doctors and patients.

Jeff Trewitt, spokesman for the Pharmaceutical Research and Manufacturers of America, said consumer ads are closely monitored by the Food and Drug Administration, and doctors can set the tone for meeting with sales reps. He noted that new industry regulations on marketing to doctors strictly forbid many practices considered objectionable, such as taking doctors to dinner or to sporting events.

Vermont Gov. Howard Dean points out the rules adopted by the pharmaceutical industry are voluntary, so there is nothing compelling the companies to comply.

"We think marketing affects prescribing patterns so we just want it all reported," said Dean, a doctor. "I don't think doctors are going to take anything if they know it will wind up in the paper."

Efforts to restrain pharmaceutical companies transcend doctors' offices. Last December, the Florida attorney general's office launched the Eckerd investigation because it didn't believe the form customers signed when picking up a prescription adequately informed them that their signature authorized commercial use of their personal medical information.

Many of the major drug store chains are paid by pharmaceutical companies to contact patients and encourage them to either refill prescriptions, upgrade to a newer version of a medicine or change to a different drug. The practice has spawned numerous invasion of privacy suits.

Soon, the Bush administration is to release regulations that will set national privacy standards for patient medical records. The Health Insurance Portability and Accountability Act will go into effect in April and will determine if pharmacies need to alter their promotional agreements with drug companies.

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