Manipulation of physicians and journals: Neurontin discussed in the NEJM
A Perspective in the New England Journal of Medicine on 8 January (not freely available, unfortunately) discusses the insights that have come from the documents made available as part of the litigation surrounding the off-label marketing of Neurontin (gabapentin). This is a very long-running story. However, the evidence still has the power to shock — for example, this quote in 1996 of an executive from the company selling gabapentin talking to a new recruit:
“We can’t wait for [physicians] to ask, we need [to] get out there and tell them up front. Dinner programs, CME programs, consultantships all work great but don’t forget the one-on-one. That’s where we need to be, holding their hand and whispering in their ear, Neurontin for pain, Neurontin for monotherapy, Neurontin for bipolar, Neurontin for everything… I don’t want to hear that safety crap either, have you tried Neurontin, every one of you should take one just to see there is nothing, it’s a great drug.”
The authors conclude “that pharmaceutical marketing can be comprehensive, strategic, well financed, disguised as 'education' and 'research,' influential, and very effective” and that this “comprehensive marketing” involved many people and institutions that apparently failed to recognise the serious ethical and legal problems with their actions. And finally they note “these cases substantiate the emerging conviction,” as Cathy de Angelis and Phil Fontanarosa have previously said that “drastic action is essential” “to preserve the integrity of medical science and practice and to justify public trust.”
Kay Dickersin's in-depth report on gabapentin, which the NEJM authors cite, is also available at http://www.pharmalot.com/wp-content/uploads/2008/10/neurontin-dickersin-1.pdf and at http://www.pharmalot.com/wp-content/uploads/2008/10/neurontin-dickersin-2.pdf (NB: these are very large documents).