For a measly $200,000 (truly a drop in the drug bucket when  you consider that Big Pharma is a $235 billion industry) the pharmaceutical company Forest Laboratories, Inc. decided to add some medical muscle to its Paid Media Outreach for the  anti-depressant drug Lexapro. Forest Labs’ plan was to write  ‘bylined articles’ with the collaboration of ‘thought leaders‘ to push sales. The New York Times has released a copy of this marketing plan, including these gems:

“Bylined articles will allow us to fold Lexapro messages into articles on depression, anxiety, and co-morbidity developed by (or ghostwritten for) thought leaders.  We will identify a Lexapro thought leader to place 1-3 bylined articles in trade journals, consumer publications and on the Internet.  Estimated costs include article development, revisions and honoraria for the authors. Examples of topics include co-morbidity of depression and anxiety and selectivity.

“In addition to the traditional editorial media outreach, there are also opportunities in which we can increase control over the final product by paying for the placement.  These opportunities, which will supplement our core activities, may include Lexapro message placement in radio programs (e.g. American Health Radio) or other “advertorial” venues.  Expenses may include spokesperson honoraria, production costs, logistics, and script writing.”

Lexapro, or escitalopram oxalate has been in hot water earlier as well. In March 2009, the drug was named along with the drug Celexa in a lawsuit by U.S. Department of Justice prosecutors around off-label promotion of the drugs for prescription to children (allegedly involving payments to physicians).

Forest Labs has also faced critics who say Lexapro’s success came thanks to gifts and payments for psychiatrists and primary care physicians. After all, it’s an expensive branded anti-depressant with plenty of identical and cheaper generic competition. So why  would physicians prescribe it?

Some docs claim that it’s simply a better drug. But according to the marketing plan, Forest intended to spend $34.7 million to pay 2,000 physicians for giving lectures to other doctors. The lectures alone averaged $17,350 per doctor. Forest also budgeted $36 million for lunches in doctors’ offices.

And it mounted a concerted Continuing Medical Education (CME) effort for one year to promote Lexapro.

And let’s not forget the Wall Street Journal revelation earlier this year when Catherine DeAngelis, Editor-in-Chief of the Journal of the American Medical Association, called whistle-blowing neuroanatomy professor Dr. Jonathon Leo “a nothing and a nobody” after he, correctly, pointed out that the author of a Lexapro clinical trial published in her journal had failed to disclose his financial relationsip with Forest Labs.

But five months after Dr. Leo blew the whistle, JAMA published an ever-so-slight correction admitting these financial ties, along with this stunner: the clinical trial in question actually showed that there was essentially no difference between taking Lexapro or just talk therapy alone for effectively treating depression.

We need more “nothings and nobodies”.

Read the full New York Times report.

See also:

• How other doctors (but not you, of course) are influenced by Big Pharma
• Big Pharma’s remarkable powers of persuasion
• A philosopher’s take on Big Pharma marketing
• The New Therapeutics: 10 Commandments
• Bad doctors earning good money from Big Pharma

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