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Cover 04/10/2013

Big Pharma's Troubling History of Pushing Drugs on Foster Kids

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Meanwhile, Pfizer continued to pay doctors to market Geodon beyond its FDA-approved uses.

Alex Booker, a sales representative out of Pfizer’s Missouri office, blew the whistle after he was fired for complaining about the pervasive off-label marketing. In court documents, he claimed Pfizer told sales teams to target child psychiatrists with a high number of Medicaid patients — one document filed in court shows Pfizer’s “Medicaid Pull-Through” strategy, listing some two dozen child psychiatrists in the St. Louis area Pfizer hoped would someday write Geodon prescriptions.

Other court filings show that sales reps encouraged Texas Medicaid doctors to boost Geodon doses to up to 360 milligrams per day; the drug was only approved for doses of 160 milligrams, therefore prescriptions over that amount would count as two prescriptions, a quick, easy way for sales reps to exceed quotas and start earning bonuses.

Pfizer, according to the lawsuit, would even go so far as to put undercover sales reps in continuing education seminars. The “plant” would ensure that the group got Pfizer-paid speakers to discuss off-label prescriptions for children.

Booker complained to Pfizer’s compliance hotline in October 2009, claiming, among other problems, that Pfizer urged sales reps to manipulate or conceal Geodon’s safety profile. Hearing nothing back, on January 5, 2010, he followed up with an email to corporate compliance.

Pfizer fired him the next day.

Brant Mittler sought similar records in the local lawsuit against Pfizer. By early this year, all defendants had settled except for the drug manufacturer. For months, Pfizer fought the release of those records, including marketing materials and internal communications between regional and local sales staff.

When earlier this year it appeared Bexar County Probate Court Judge Polly Jackson Spencer might force Pfizer to produce, the company started to talk settlement.

Dr. Joseph Hernandez, Jo Angel’s Rodriguez’s admitting doctor at Laurel Ridge, said the use of Geodon became a bright red flag almost immediately after Rodriguez died, according to deposition testimony lawyers filed in court.

Hernandez said he spoke to Dr. Benigno Fernandez, Laurel Ridge’s medical director, wanting to know why the Geodon was given, why he was never called when the girl’s condition worsened, and why it took so long to transfer Rodriguez to the emergency room when she crashed.

When he spoke to Dr. Lindy Bankes, who ordered the drug, “she was obviously upset,” Hernandez recalled. “She was asking me questions about Geodon.”

According to Bankes’ deposition, the Texas Medical Board notified her someone lodged a complaint against her due to the incident — such complaints are confidential, so there’s no telling who filed it. Despite Hernandez’s obvious concerns with the handling of the case, Fernandez and one of Bankes’ trainers from UTHSC wrote letters to the TMB trying to absolve her of any blame, Bankes testified.

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