Pfizer Inc., the largest pharmaceutical company in the world, paid an American physician $4,000 a day to promote the anti-psychotic drug Geodon, and expensed his use of a private helicopter to get him to speaking events that the company booked for him, according to a whistleblower lawsuit. The suit was one of several that led to a recent record-breaking $2.3 billion judgement against Pfizer to settle allegations made in multiple whistleblower lawsuits that the pharmaceutical giant defrauded Medicare, Medicaid and other government-funded health care programs in connection with its market practices for four of its drugs.

The settlement is the largest whistleblower, or qui tam, settlement in U.S. history.  Pfizer agreed to plead guilty to criminal conduct and to pay $2.3 billion in criminal and civil fines.

Mark Westlock of Missouri was a sales rep for Pfizer from 1991 to 2007. He alleges that Pfizer paid psychiatrist Dr. Neil Kaye $4,000 daily speaker fees to talk to other doctors about “the off-label use of Geodon in adolescents,” among other issues.

Now, if I were Dr. Kaye, I’d now be some mad, as Newfoundlanders like to say here, because he no doubt was unaware that competing drug giant Eli Lilly was generously paying its own stable of hired docs up to $50,000 per speech, according to reports about 60 doctors on Lilly’s payroll, revealed last month in the Boston Globe. Westlock claimed in court:

“Pfizer conspired with defendant Dr. Kaye as early as 2001 to begin a nationwide Geodon promotional campaign at locations across the United States.

“In exchange for promoting Geodon off-label, Dr. Kaye was paid up to $4,000 per day plus all his expenses.  Dr. Kaye became such a frequent speaker that he used his own private helicopter to fly to various locations throughout the U.S. all at Pfizer’s expense.”

Dr. Kaye was not the only shrink on the take from the drug giant. Pfizer needed to target pediatrics and adolescents to expand off-label use of Geodon, and maintained on its payroll an army of more than 250 child psychiatrists across the country.

Pfizer paid generous speaking fees to these child psychiatrists to give what were basically promotional lectures about the benefits of Geodon to their peers, who were also child psychiatrists, despite the fact the drug was not FDA-approved or medically indicated to treat children at all.

The purpose and intent of paying so many child psychiatrists is clear –  to gain a foothold within the fastest growing market for antipsychotics: children.

The practice of expansive off-label use is dangerous, particularly in children because this drug has not been evaluated for its safety for the unique physiological make up of children. And because it is clearly illegal for pharmaceutical companies to promote any drug for uses or dosages that have not been approved, that army of psychiatrists like Dr. Kaye really paid off.

Geodon sales topped $1 billion in 2008.

Some of Dr. Kaye’s material, for example, was e-mailed to Pfizer pharmaceutical sales representatives under the heading “Take-home selling points.”  The material within that package was also labelled “Do not detail” – ostensibly because it covered off-label material, which is illegal. (‘Detailing” is what sales reps call office visits to physicians on their daily routes).

But Mark Westlock claims that all Pfizer sales reps knew they were to use it in their sales pitches to physicians because the e-mail would not have been titled “Take-home selling points” if they were not.

According to the public relations news service PR Newswire, it was a decision by another Pfizer sales representative in Florida to file a whistleblower lawsuit over off-label marketing of the arthritis drug Bextra back in 2003 that kicked off investigations that led to Pfizer’s record-breaking $2.3 billion settlement last month.

“In the Army, I was expected to protect people at all costs,” said the whistleblower, former sales rep John Kopchinski. “At Pfizer, I was expected to increase profits at all costs, even when sales meant endangering lives. I couldn’t do that.”

” The largest piece of the settlement — $1.8 billion — is solely due to Pfizer’s improper “off-label” marketing of Bextra that Kopchinski exposed through his lawsuit. Pfizer is paying $502 million to settle civil charges and an historic $1.3 billion criminal fine, both relating to Bextra marketing.

“The FDA approved Bextra to treat arthritis as well as menstrual pain in very limited doses. Kopchinski alleged in his lawsuit — which the government joined — that Pfizer promoted Bextra for uses and in doses that far exceeded what the FDA had approved. This put patients at risk for serious health problems such as heart attack, stroke and pulmonary embolism (blood clot in the lung). The lawsuit also said that Pfizer paid doctors kickbacks in various ways to influence them to prescribe and endorse Bextra for off-label uses.”

Find out more about this case.

See also:

• Harvard Cozies Up with Big Pharma
• Harvard’s Ethical Ultimatum to Doc: Give Up Big Pharma Moonlighting Jobs, or Lose Harvard Teaching Post
• Is Your Doctor a “Thought Leader”?
• Bad Doctors Earning Good Money from Big Pharma
• Doctor’s Kiss & Tell Tale: My One-Year Career As a Drug Rep