Tuesday, May 29, 2007

The Pfizer Mirapex Whistleblower's amazing story . . .

A new Pfizer whistleblower claims Pfizer illegally marketed Mirapex for off-label indications, such as restless leg syndrome, before Mirapex got this approval. Mirapex was at the time only indicated for idiopathic Parkinson's disease.

She had an amazing story to tell me, however, I couldn’t simply believe her off the bat, even though her tale was filled with details.

So I asked her to prove that she really worked as a sales rep for Pfizer.

And she sent the attached pay stub. Pretty good proof, I thought.

This is the Mirapex Whistleblower’s story:

I left Pfizer a few months ago and I am new to your website and only found it after being tipped off from one of my former Pfizer teammates.

It’s so interesting to see your recent Pfizer stories, as it reminds me of my time working as a Neurology Specialty Representative selling Mirapex.

Mirapex, I felt, was a low-grade Neurontin in that we were quietly pushed to sell it off-label for the treatment of Restless Leg Syndrome. Like Neurontin, most of the off-label use was being driven by the physicians themselves but we were encouraged to encourage them.

I did very well selling Mirapex and, at the time, I was one of the top reps in the country. I did so well, so consistently, that I was placed on the Mirapex Advisory Panel – you know, one of those BS rewards for top reps in a drug category.

During a conference call a few years ago with the DMT I mentioned Restless Leg Syndrome and how, at least, 75% of my business came from RLS scripts as opposed to Parkinson's Disease (PD). The moderator of the call feigned shock and surprise at this which, I knew, was completely insincere. They sure as hell knew what was going on and where their business was coming from.

As in Watergate, the key was to “follow the money”. In this case – quotas. They had our quotas and growth targets so high that to meet them, practically every PD patient in the country would have to be put on Mirapex. Obviously, this was not ever going to happen. Not that Mirapex was a bad PD drug, it was quite effective. But no drug ever gets 100% of the business.

Obviously, they expected the growth to come from other areas. Areas outside the approved indication. There is no other way that we could have hit our quotas otherwise. And one didn’t need to be a forensic accountant to see that. It was blatantly obvious.

The push was especially strong a few years back when our main competitor, Requip, filed for a Restless Leg Syndrome indication that was expected to be approved.

So it was critical that we build up as much share and physician loyalty as possible before an “indication approved” competitor hit the market. Later, in 2005, Requip got their approval for Restless Legs Syndrome, and Mirapex was approved for RLS in 2006.

This was quite a story, so of course Question Authority had a few questions for the Mirapex Whistleblower. Like why did she leave Pfizer?

“I left Pfizer for two reasons: One, the job was becoming ridiculous. Despite all the rhetoric about ‘being entrepreneurs’ and ‘owning our own territories’ the reality was that Pfizer wanted and expected us to be drones. Ironically, they only wanted us to be entrepreneurial when they needed us to go off-label to increase sales. Which was more and more of the time by the time I left. Of course, they would deny everything and hang the rep out to dry if anyone got caught. But the direction came from the top.

Secondly, I wanted to make more money. And, unlike many in the pharma world, I was willing to accept the risks that entailed. I love my new job. There hasn't been one single day when I've regretted my decision. It hasn't been easy but at the end of the day I usually feel like I've accomplished something.

And finally, it's nice to be treated like an adult again.”

“Why did you decide to share you story at this time?”

“I guess it was just the memories brought about by seeing your stories about the marketing of maraviroc and recognizing some of the names. Nothing about the story surprised me. Not in the least. It seemed to me to be just Standard Pfizer Operating Procedure. I sold many different Pfizer drugs throughout my decade with the company and the ones that we WEREN'T pushed to sell off-label were in the minority.”

“As a rep I guess you talked to the other sales reps, which drugs did you hear your colleagues talk about promoting off-label?”

“Zithromax - Sinusitis, acne, dermatitis, those are the ones I can recall at the moment.”

“Neurontin - Christ! Pick a disease. Any disease! Although, much of this off-label use was physician-driven. I recall one of my Neurologists describing Neurontin as the ‘Swiss Army Knife’ of pharmaceuticals. Hot flashes associated with menopause was one of my personal favorites.”

“Lipitor - Not so much off-label as making claims supported by clinical data before it was officially in the label.”

“Viagra - Post-turp or radical prostatectomy surgery prophylactically. ‘100mg helps preserve function before it is lost forever.’ No real data to support that but, boy, it sure sounded good. Oddly enough, we were never really pushed to go for female use. At least I wasn't. But then, Pfizer never really knew how to sell that drug. Still don't, in my opinion.”

“Aricept - Vascular dementia, Severe Alzheimers (we didn't have the indication at the time).”

“Mirapex - Well, I covered that already, didn't I? And the list goes on . . .”

“Are you upset with Pfizer?”

“I really have no particular axe to grind against Pfizer. Off-label promotion of drugs is not a Pfizer invention. In fact, in the world of off-label and illegal promotion they aren't even one of the top-tier players (see Forest Pharmaceuticals). The only strong feelings I have towards them right now are related to the horrible way they treated the sales force during this recent round of layoffs. I saw good, talented people let go because of hired gun consultants. It was a shameful period in Pfizer history.”

“But you worked for them for many years, don’t you feel bad talking about all this?”

“Bottom line, the Pfizer that I once loved is dead and gone. I was once proud to bleed Pfizer blue, no longer.

"Why did you send your pay stub to me with your name redacted? You have left Pfizer, what are you so worried about?

Obviously, I do not wish to be identified by you or anyone else, so I've taken steps to ensure that nothing can be traced back to me. For starters, it would just be damned inconvenient. Then I have to be concerned with the effect this could have on my current and future career prospects. Frankly, the benefit does not exceed the cost.

And, Pfizer is in the midst of defending itself against a myriad of lawsuits relating to the off-label use of Mirapex. In fact, the month before I left Pfizer one of my own physicians was served with a lawsuit from a patient he had put on Mirapex for RLS and months later, even though I was no longer with Pfizer and had not yet begun selling Mirapex when this physician prescribed the drug, I found myself on a multi-hour conference call with Pfizer attorneys.

"Are you telling me you don't live in California?"

"I could be from anywhere. My story is the same as hundreds of others."

"OK, finally, I must ask this, since I've never met you and many Question Authority readers have this idea that all drug reps are very attractive. Is that true?"

"I'm gorgeous and so were some of my colleagues. And life is good!”


Anonymous said...

As miss gorgeous says, Ppizer did not invent the off label promotion and other miscnduct. The fact is they all did. The way it works, when one big pharma comes up with something legal or illegal that works the others jump on it almost immediately. They all watch the industry, have their "spys", the personell is moving around so the "news" travels fast and far. Before you know it all are doing the same. Some get caught some never. "Poor" Pfizer seem to get it from all sides but what is gratfying that our good doc here and other places are exposing lot of "dirt" and US goverment has the laws and is willing to follow through. Other countries should get on with this kind of tough approach and do the right thing.
Thak you gorgeous for doing this and I can testify that I saw the very same thing with my x big pharma co. They are amongst those that did not get caught where it counts in USA, at least not yet.
If I insert their name where Pfizer name is and their drugs where Pfizer's dugs names are, it would be as if I wrote it myself. No difference and that goes for all of them.
Such is the life in the Bigpharmaland.

Anonymous said...

I like the photo. And, do I detect a pattern here? Marketing of RLS indication before approval, marketing of maraviroc drug before approval.

Anonymous said...

Where's the beef? Documents please......