HE drug industry has created vast markets for products like
Viagra, Celebrex and Vioxx by spending billions of dollars on
consumer advertising.
But to sell medicines that treat schizophrenia, the companies
focus on a much smaller group of customers: state officials who
oversee treatment for many people with serious mental illness. Those
patients - in mental hospitals, at mental health clinics and on
Medicaid - make states among the largest buyers of antipsychotic
drugs.
For Big Pharma, success in the halls of government has required a
different set of marketing tactics. Since the mid-1990's, a group of
drug companies, led by Johnson & Johnson, has campaigned to
convince state officials that a new generation of drugs - with names
like Risperdal, Zyprexa and Seroquel - is superior to older and much
cheaper antipsychotics like Haldol. The campaign has led a dozen
states to adopt guidelines for treating schizophrenia that make it
hard for doctors to prescribe anything but the new drugs. That, in
turn, has helped transform the new medicines into blockbusters.
Ten drug companies chipped in to help underwrite the initial
effort by Texas state officials to develop the guidelines. Then, to
spread the word, Johnson & Johnson, Pfizer
and possibly other companies paid for meetings around the country at
which officials from various states were urged to follow the lead of
Texas, according to documents and interviews that are part of a
lawsuit and an investigation in Pennsylvania.
How did this play out? In May 2001, as Pennsylvania was weighing
whether to adopt the Texas guidelines, Janssen Pharmaceutica, a
Johnson & Johnson subsidiary that sells Risperdal, paid $4,000
to fly two state mental health officials to New Orleans, where they
dined at an elegant Creole restaurant in the French Quarter, visited
the aquarium and met with company executives and Texas officials,
according to documents. Janssen also paid two Pennsylvania officials
$2,000 each for giving speeches at company-sponsored educational
seminars for doctors and nurses working in the state's prisons.
The payments were discovered a little more than a year ago by
Allen L. Jones, an investigator in the inspector general's office in
Pennsylvania, who stumbled upon them when he was looking into why
state officials had set up a bank account to collect grants from
pharmaceutical companies.
With the help of his congressman in Pennsylvania, Mr. Jones, who
is 49 and a former parole officer, brought the information to the
attention of federal health officials - after, he says, his
superiors removed him from the investigation, citing the political
influence of the drug industry. The Department of Health and Human
Services has asked the health care fraud unit of the Federal Bureau
of Investigation to determine whether any laws were broken,
according to letters Mr. Jones has received from federal officials.
DETAILS of the drug companies' efforts, recorded in Mr. Jones's
investigative files and confirmed in part by drug companies and
state officials, offer a glimpse inside the drug industry's
behind-the-scenes efforts to promote the new-generation
antipsychotics, called atypicals because their action in the body is
unlike that of earlier drugs.
There is no proof that drug-industry money changed any state
official's opinion about the drugs. And compared with the billions
of dollars spent marketing to doctors from their first days as
medical students - or the billions spent to underwrite and publish
research - the dollar amounts are small.
But questions have multiplied about the many ways that the drug
industry tries to influence the medical information that determines
its products' success or failure. Last month, for example, some
senators sharply criticized the National Institutes of Health for
allowing its scientists to accept consulting fees and stock options
from drug and biotechnology companies. Officials of the agency said
that its top-level scientists were no longer accepting such
compensation.
Sales of the new antipsychotics totaled $6.5 billion last year,
according to an estimate by Richard T. Evans, an analyst at Sanford
C. Bernstein & Company. About a third of those sales were to
state Medicaid programs, whose costs have ballooned with their
adoption of the new medications. Texas, for example, says it spends
about $3,000 a year, on average, for each patient on the new drugs,
versus the $250 it spent on older medications. The escalating costs
have prompted a few states to try to limit access to the new
antipsychotics - efforts that drug makers have opposed
vigorously.
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