Eli Lilly Promoted Zyprexa for Patients Who Were Badly Dressed

When Eli Lilly launched Zyprexa, its drug sales reps campaigned for doctors to prescribe the antipsychotic off-label to patients who appeared to be depressed because their clothes were “drab” or “disheveled,” according to a study in Social Science & Medicine.

The study, by Glen Spielmans of Metropolitan State University in St. Paul, Minn., is a broad look at Zyprexa marketing documents turned up in litigation and in the media (download a copy here). It concludes:

A key strategy in this campaign was the use of hypothetical patient profiles in detailing visits, most of which clearly failed to meet diagnostic criteria for any recognized mental disorder.

The marketing strategy was designed to “fit within the brand vision of broad spectrum efficacy” summarized by the phrase “complicated mood,” even though Zyprexa was FDA-approved only for the treatment of bipolar manic and mixed episodes, and schizophrenia.

Spielmans also found documents that seem designed to encourage doctors to make diagnoses based on patients’ fashion sense. The campaign, dubbed “Viva Zyprexa,” began in March 2000. Reps were given fictional profiles of patients for whom they were hoping to persuade doctors to write Zyprexa prescriptions. Among them were “Donna” and “Mark”:

Donna

… “a single mom in her mid-30s, appearing in your office in drab clothing and appearing somewhat ill at ease. Her chief complaint is, ‘I feel so anxious and irritable lately.’ Today, she says she’s been sleeping more than usual and has trouble concentrating at work and at home. However, several appointments earlier, she was talkative, elated, and reported little need for sleep.”

Reps were advised to tell doctors: “I would like you to get a patient like Donna started today. I will be back in a week to follow up.”

Mark

… “is a middle-aged male brought in by his wife. He appears agitated and disheveled. His wife says that he is irritable and causing problems at home but he believes he is fine.” It is further mentioned that he has had “periods” where he needed little sleep and had “significantly increased energy.” Further, his “anger and mood swings are causing trouble at work”…

In another document, his symptoms were said to be indicative of a manic episode…

Lilly employees will also be interested to learn that much of Spielmans’ material draws on the memos and emails of Zyprexa brand manager Mike Bandick:

Bandick further stated that the intention of Viva Zyprexa was to “redefine the way PCPs treat mood, thought, and behavioral disturbances” … In a similar vein, olanzapine was rebranded as a “broad spectrum psychotropic” in the primary care campaign.

Reps ultimately received this sales instruction:

Make sure the PCP recognizes the type of patient we are talking about today, not the psychotic or severely ill patient, but the complicated mood patient who has symptoms of irritability, anxiety, poor sleep and mood swings.

• BNET’s previous coverage of Lilly and Zyprexa:
• Lilly Q1: Price Rises, End of Zyprexa Woes Boost the Numbers
• Lilly Apologizes for Wrongful Zyprexa Promotion; Still Shovelling Cash Into Settlement Furnace
• More Zyprexa Trouble for Lilly as Insurers Want Money Too
• In Zyprexa Settlement, Lilly Fritters Away 7.2 Percent of Revenues
• How Eli Lilly Waved Goodbye to $3.1 Billion
• FDA to Allow “Off-Label” Unapproved Drug Promotion
• FDA: J&J’s Risperdal and Lilly’s Zyprexa Are Over-Used in Kids

Image by Flickr user Jem, CC