Lexapro is an antidepressant medication that is pretty much the equivalent to the now-generic version, Celexa. It is primarily prescribed to treat depression by primary care physicians and psychiatrists. It is a popular antidepressant.
And it’s also a big money maker for its manufacturer, Forest Laboratories.
So you have to wonder, how do drug companies “educate” docs about the greatness of their products? How does one get an antidepressant to become “popular.”
Embarrassing documents released through an investigation by the Senate’s Special Committee on Aging into the drug manufacturer’s marketing practices describes the process in grueling detail:
Under “Lunch and Learns,” the company intended to spend $36 million providing lunch to doctors in their offices. “Providing lunch for a physician creates an extended amount of selling time for representatives,” the document states.
Who ever said there ain’t no such thing as a free lunch? If you were a doctor practicing for the past two or three decades, you know exactly how many free lunches there were. Many. Subtle, clever marketing? Not really, but effective nonetheless.
An entire section of the marketing plan, titled “Continuing Medical Education,” outlines how the company intended to use educational seminars for doctors to teach them about Lexapro. The Senate’s Special Committee on Aging held a hearing in July on whether industry funding of medical education classes leads to tainted talks.
Yes, there’s nothing better than attending a seminar designed so that all paths led to “understanding” that Lexapro was a great choice for your depressed patients.
The 88 pages released and circulating demonstrate how important it is for pharmaceutical companies to market directly to doctors to try and persuade them to prescribe the “latest and greatest” antidepressant. Despite the fact that Lexapro is basically no different than Celexa. Oh, there is one important difference — Lexapro is covered by a patent (and is therefore 5 to 8 times more expensive), and Celexa is not.
Dr. Carlat’s take on the document, from the continuing medical education perspective:
In other words, rather than waiting for doctors to decide to write their own articles singing the praises of Lexapro, Forest decided to hire reporters from journals to cover the CME symposia they already paid for. Based on the reporting, ghostwriters would then scribble the articles, and plant some psychiatrists’ names as authors. The articles would be packaged as “CME supplements” with the journals.
It’s so much more… efficient this way!
The scary part is to consider what pharmaceutical companies are going to do, now that their past marketing practices are seeing the light of day. As many states are banning doctor gifts (or severely limiting them) such as free lunches, and journals and universities are cracking down on their conflict of interest disclosures, and the continuing medical education needed to keep doctor’s licenses up-to-date are becoming disentangled from their past enmeshment with pharma funding, how will pharmaceutical companies continue to guarantee future profitable quarters? If the spotlight is shining brightly on these mostly-past practices, what new practices are they devising to keep their prescription rates high?
I suppose we’ll find out in another 5 years’ time. After all, that’s how old the current Forest Laboratories’ Lexapro marketing documents are.
Here’s a novel thought for pharmaceutical companies to consider — let doctors decide for themselves which drugs to prescribe to their patients. Without fake educational courses, free lunches, or ghost-written journal articles.
Read the New York Times Magazine article: A Peek at How Forest Laboratories Pushed Lexapro
Read Dr. Carlat’s take: Forest’s Promotional Objective: Use CME to Sell Lexapro
13 comments
Interesting post. Did you see the practices Pfitzer was using? The UK Guardian mentioned some of the ways they enticed doctors to prescribe their drugs. I posted about this today. In 2004 Pfitzer declared themselves ethical and here in 2009 they have the dubious reputation of wearing the highest fine in US history.
i am not entirely comfortable with this blog posting. you condemn lexapro because it is pushed by forest; just because they’re selling it doesn’t make it bad in itself.
as a long time lexapro user who switched from celexa, i tend to disagree with you in your indifference to discriminate between these two. of course these work on exactly the same receptors–so if you chose to be reductionist you are partly correct.
lexapro is an isomer of celexa. it is much more efficacious than celexa. arguably, increasing a celexa dosage should have the same effect as using lexapro and might be cheaper. but there are a lot of quality of life issues involved in using half as much meds with specificity to side effects. i can personally attest to having suffered from over two years of sexual impotency using anti-depressants. psychologist did not see this as an endocrinological problem that it was and i am being treated for it while i take lexapro and some other drugs. meanwhile this side effect nearly led to suicide because i did not understand the dynamics of what was happening to me and over the long term my affect eroded drastically in spite of psychopharmacology.
since anti-depressants cause weight gain as well– and large doses of anti-depressants seem to be scripted to larger people this becomes a more serious issue over several years. these problems don’t happen up front.
and as far as ‘new’ drugs go–new drugs don’t have a long term effect track and safety record so these are not quickly adopted in practice except when necessary nor should these be. one reason why a prescribing psychiatrist might adopt lexapro more rapidly than a completely new drug is the same reason you condemn the drug– it has a track record based on celexa’s behavior.
you might be right in the general case about what you are griping about but maybe you could have chosen a more interesting target. one drug which advertises here and probably doesn’t deserve a patent–or maybe a patent for the way these are combined– is merely a combination of two older anti-depressants that work on different receptors and could be titrated individually. and since a healthy young woman died of suicide in indiana during the testing of the drug that i am not mentioning maybe the whole thing wasn’t worth it.
i think the most moving thing about celexa is the story of how the head of forest pursued it in research order to help his depressed son who wrote a pulitzer prize winning book about depression called ‘the noonday demon.’
regrettably celexa did not help andrew if one believes the reports.
thank you for taking the time to read this and i recognize that my own experiences are not practical statistics for prescribing but merely anecdotal in nature.
i should add that forest licensed celexa from a danish company and did not do the original work on the drug because my closing statement is misleading.
once after seeing my dr i was coming home via the trains in nyc and had to pass thru penn station..this was right around 9/11 and they were doing bag searches. my doc had sent me home with tons of med samples which i greatly appreciated as i am on a fixed income. also that day there had been a “lunch” from a drug company…a clambake of all things…so she sent me home with a lobster and some other goodies. i felt like a drug dealer with well defined dining tastes when my bag was searched! the cop/soldier was shooting me these looks like “WTF?” obviosly i wasn’t a terrorist but what exactly was i? thankfully neeither item was seized and i made it home safely..i would have been mightily upset if they had claimed my lobster!
in this instance i think that drug company lunches for md’s were a GREAT thing!!!!
@314159pi – Nobody’s debating the merits of Lexapro over Celexa. I’m sure it can be just as helpful a drug as many other antidepressants.
But if the drug could stand on its own two feet, one wonders why any of this subterfuge and intense marketing efforts were needed for it. Why pay for ghostwritten articles and continuing medical education if the drug’s benefits were easily known?
Some drugs are clearly just “patent extenders” — that is, they take a prior drug, change a single molecule that likely has little impact on its therapeutic value, and re-market the drug with new patent protection for another 10 or 15 years. Lexapro appears to be just such a drug, in my opinion.
i agree with you and Dr Carlat about drug company marketing tactics. So does the hospital where my psychopharmacologist writes my Lexapro scripts because St Vincent’s Of Westchester,NY does not allow MDs to even accept free samples of this drug to give to patients. I do get copious quantities of free lexapro from my analyst in new york city, thankfully because my means are quite limited as a result of disabling depression.
While lexapro is marketed agressively, it is obviously not unique in the use of the selling tactics described in Carlat’s posting and the NYTimes article. While morally questionable, these tactics are not yet illegal and if all the big companies do it then Forest should and must do it too if only as a responsibility to their stock holders. I am not not suggesting Forest or any other Company is more moral. Moral people wouldn’t fall for this buncombe.
And whether or not you admit to debating the merits of Lexapro vs Celaxa apparently you continue to do just that. I quote your response “has little impact on its therapeutic value…’patent extenders’ .”
Even the NYTimes magazine article which provoked this discussion stipulates that most MDs believe Lexapro is the best SSRI in its class while you don’t unfortunately. Part of the point of the Times article IMO is the subtext of this evaluation and how prescribing Physicians are manipulated by CMEs and gifts into thinking what they do.
Dr Carlat was once a paid stooge for Forest and He is commendably open and honest about this because he wants the system changed for the better. It’s about the system not the drug.
That is why I am particularly vocal about your characterizations of the drug which may have saved my life–a drug whose cost will inevitably rise if prescribed less frequently– in spite of the fact that I agree with your Principled Opposition to big pharmas marketing machine.
I think this comment is somewhat relevant not only to the article itself, but the discussion.
I recently read a bool titled: ‘How Doctor’s Think’, by Jerome Groopnam, MD.
He is an oncologist in the Boston area, and the book is really great. He talks about his own experiences dealing with doctors in the patient role, and he interviews doctors about their thoughts and feelings. Patient experiences are also included. Yet, he doesn’t include psychiatry/psychology because the author doesn’t feel competent enough in that area. Yet, the book is valuable on so many levels, it is really hard to describe. For Everyone. Nothing radical
in this book, but surely stuff you did not know. Kat
@John M Grohol PsyD: Did you perchance read what you wrote?
“Despite the fact that Lexapro is basically no different than Celexa. Oh, there is one important difference — Lexapro is covered by a patent (and is therefore 5 to 8 times more expensive), and Celexa is not.”
Yes, this is true.
But, somewhere in the “BASICALLY NO DIFFERENT” you misses that there is ONE KEY difference:
SIDE EFFECTS.
314159pi has already pointed this out.
your response? “I’m sure it can be just as helpful a drug as many other antidepressants.”
Well maybe as a clinician, all you see is black and white. Does it help or not? Side effects are irrelevant.
Really though, your disregard for the suffering of those with mental illness is demeaning.
Is it really okay for those with mental illnesses to suffer?
Many women who had previously been using Prozac are now switched to Lexapro, because new research has shown that Prozac, and also other anti-depressants, and other medications,greatly interfere with a drug prescribed for breast cancer patients with hormone sensitive tumors, called Tamoxifen. (Nolvadex) A we are talking about millions of these mostly women, but also men.
I am wondering if there are any studies that show how people are doing when switched from Prozac to Lexapro, or Celexa.
‘Some Antidepressants May Thwart Tamoxifen’s Effect on Breast Cancer.’
http://www.medicinenet.com/script/main/art.asp?articlekey=100821
@mangry: it is insensitive of you to characterize dr grohol’s sensitivity to the human condition because he disagrees with us about lexapro and celexa. and unfortunately it also undermines our case so i hasten to point this out.
dr grohol founded psychcentral which has probably helped more suffering people in the past ten years than either you or i will do in our entire lifetimes.
just a thought.
rcclmeu- Thank you,vgeoiue.Great site.