Drug Store Cowboys

By Dan Frosch, AlterNet. Posted November 16, 2004.

A pharmaceutical company gets sued for bribing doctors to promote a particular drug. An HIV-positive New Yorker sues a drug store chain for buying and entering his medical records in a database without his consent. Two companies get sued for sending out unsolicited free samples of prescription drugs like Prozac. And on and on.

Manufacturing legal drugs is a growth industry and the latest twist in the multi-billion dollar drug-pushing game is that your local pharmacy may be turning into a marketing agency for the big drug companies.

The Privacy Rights Clearinghouse (PRC), a consumer advocacy group, filed a lawsuit in September against supermarket giant Albertsons in California Superior Court, for allegedly selling the private prescription drug information of its customers to pharmaceutical companies. PRC also named 17 pharmaceutical heavyweights, like AstraZeneca, Eli Lilly and GlaxoSmithKline, as co-defendants, claiming that the companies use the information to promote their drugs through unsolicited phone calls and letters.

According to PRC, the drug companies have been paying Albertsons between $3.00 and $4.50 for every promotional letter written and between $12.00 and $15.00 for every phone call made to unwitting customers. Albertsons, the group maintains, stands to make millions in the process. PRC says both Albertsons and the drug companies are breaking California law because customers are never given the option of signing up to receive the calls or letters as mandated by the state's privacy regulations.

"What Albertsons is doing interferes with the patient-physician relationship and it visits terrible harm on people who rely on prescription drug notices and don't realize that they're being paid for by drug companies," says Jeffrey Krinsk, an attorney for PRC. "Perhaps most pernicious is the potential harm of third parties learning the existence of an underlying condition if the mail is mistakenly sent to the wrong address."

The drug companies footing the bill are equally culpable, adds Beth Givens, director of PRC. Though the actual letters and phone calls may come from Albertsons and appear to inform patients of the benefits of a particular drug or remind them to refill a prescription, the drug companies are clearly involved. A form letter and a training phone call transcript from Albertsons, provided by PRC, include clauses stating that the letter or phone call was "provided with financial support" or "sponsored by" a particular drug company, but that no information would be shared.

That, says Givens, is proof enough that information has indeed been exchanged between Albertsons and the drug companies, especially given the potential money both parties can make in the process. Further, Givens alleges that the refill reminders Albertsons sends on behalf of the drug companies are sometimes to customers whose doctors have not actually authorized a refill – a frightening charge.

Says Givens: "Albertsons wouldn't have any drug marketing program unless willing pharmaceutical companies signed on the dotted line."

Indeed, it's the ostensibly cozy relationship between pharmacies and drug companies that's raising eyebrows in this particular case. Prescription drug costs have risen sharply over the past decade – up an average of 7.3 percent annually from 1992 to 2002, according to the Kaiser Family Foundation, a non-profit health research organization. During that same time, the foundation reports, the number of prescription drugs purchased by Americans exploded by 74 percent. Subsequently, pharmaceutical companies have become the beneficiaries of a $400 billion a year business – more than enough incentive to keep their marketing machines running full steam.

Drug companies spend billons each year promoting their wares, in the form of television and print ads, as well as giveaways to physicians. A 2001 lawsuit against TAP Pharmaceuticals for bribing doctors to promote Livapro, a prostate cancer drug, has led to increased scrutiny, but the drug companies have invariably refined their techniques. The alleged backdoor scheme highlighted in the PRC suit seems to indicate a more nuanced marketing approach.

"Albertsons is acting as a vehicle for the drug companies," says Meredith Rosenthal, assistant professor of health economics and policy at Harvard University. "There have always been very worrisome ethical implications on the physician side in terms of pharmaceutical companies paying doctors, and I think this is similar in that consumers trust their pharmacies to be their unbiased advocate."

Dan Frosch is a New York-based journalist whose work has appeared in the Los Angeles Times, The Source and the Santa Fe Reporter.