The Zyprexa Chronicles: A Doctor Bites Back

Well, well, well. An internist in New York steps up to the plate and writes openly about how an Eli Lilly sales rep tried to coax him into prescribing Zyprexa:

"Sitting across from my desk on the small blue couch, the Eli Lilly rep tried to convince me that there was a good reason those boxes should be piled next to my coveted cholesterol drugs. She said that I was likely seeing bipolar patients, as well as demented patients who were agitated....

But I told the rep that I hadn't prescribed the drug, that I had sent Anne to a psychiatrist who had prescribed it. Bipolar disorder and agitated dementia (for which Zyprexa is sometimes used off-label) are in a psychiatrist or a neurologist's domain.

I mentioned that most of the psychiatrists I knew used milder and better-tolerated mood-stabilizing drugs such as Depakote for bipolar disorder, that they didn't rely on the more powerful and side-effect-plagued Zyprexa as a mainstay of treatment. And neurologists had told me that antipsychotics such as Zyprexa are often over-prescribed for dementia and are not indicated if the patient is relatively calm.

When the drug rep persisted in trying to persuade me to prescribe the drug, I grew angry. Raising my voice, I accused her of trying to jeopardize patient care.

At that point, she said the company had given her a directive to reach out to as many internists as possible. The company felt that we internists as a group were underutilizing the drug, she said.

That's dangerous thinking, I replied. I told her that such persistence would no doubt lead to the drug being wrongly prescribed — that it would hurt patients. She seemed insulted by my charge, and left, and I gave all her sample boxes to Anne, the one patient I had who was clearly benefiting from the drug."

I keep threatening to tell about my days as a sales rep for a pharma company. I worked for Abbott Laboratories. One of these days, I'll get into it a bit more. For now read, Marc Siegel's piece, which is great. I congratulate him for his forthrightness. I wish a few psychiatrists would join him in such behavior, which I have heard is efficacious for patients, not to mention the free market of ideas in the health care world.

Gee, are these the same pharma companies who are somehow able to monitor how much a doc prescribes of each drug and sic their sales reps on ones who don't use the product to the degree or to the dosages that said pharma company would like? (BTW, many embarrassing typos in the post I just linked to. Sigh.)