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Cut Junk Mail Month
April 1 - May 1
Free Prozac in the Junk Mail Draws a Law Suit
FT. LAUDERDALE, Fla., July 3, 2002 The
unsolicited Prozac arrived in a hand-addressed manila envelope. It came
from a Walgreens drugstore not far from here, and there was a "Dear
Patient" form letter inside.
"Enclosed you will find a free one month trial of Prozac
Weekly," it said. "Congratulations on being one step to full recovery."
The mailing infuriated one recipient, a 59-year-old home
caregiver who filed a class-action lawsuit this week in state court
"They're going after me because I have a problem," said
the caregiver, who agreed to an interview in her lawyer's office here
on the condition
that her name be withheld. "It bothers me to think that somebody could
into my medical records and start sending me dangerous medications."
The suit says Walgreens, a local hospital, three doctors
and Eli Lilly, which makes Prozac, misused patients' medical records
invaded their privacy. It also accused the drugstore and Lilly of
in the unauthorized practice of medicine.
The plaintiffs' lawyers said they did not know how many
people received the mailings. "It could be anywhere from several dozen
to several thousand," said Gary M. Farmer Jr., one of the lawyers.
The suit seeks an unspecified amount of money and an
to prohibit further mailings.
Legal experts said that sending drugs through the mail
could be criminal if the recipient does not have a prescription. How
privacy law applies to medical records used in marketing is an open
A Lilly spokeswoman said that sending unsolicited drugs
through the mail was against company policy and inappropriate. "While
Lilly supports informing people about new treatment options and
encouraging them to discuss these options with their doctor, what
occurred in Florida appears to go beyond this," the spokeswoman, Debbie
Experts in medical privacy have been critical of
mailings of targeted marketing materials based on information in
patients' pharmaceutical and medical records. They say the mailing of
drugs is an unwelcome innovation.
"This is appalling in every possible way," said David L.
Pearle, a professor of medicine at Georgetown University. "It's an
of a deplorable practice."
Joy Pritts, senior counsel at the Health Privacy Project
in Washington, said that "this is one step beyond what we normally
On the other hand, Ms. Pritts continued, the Prozac mailing was part of
"the increasing trend for the commercialization of health care
"It's being bought, sold and used like any other
commodity," she said, referring to patients' medical information. "This
has nothing to do with treating the patient. This has everything to do
with generating profits."
Aggressive marketing tactics, experts said, are often
linked to plummeting sales. Lilly's patent for Prozac expired last
August, and the drug's sales have dropped more than 80 percent as
generic equivalents have become available. But Prozac Weekly is still
John Newton, a Florida assistant attorney general, said
that a whole range of pharmaceutical marketing practices was legally
"We are looking at these practices," Mr. Newton said.
"The office of the attorney general believes many of these practices
violate Florida unfair and deceptive practices laws."
The Prozac mailing, he said, may have been unlawful for
unrelated to privacy.
"The safety concern is a legitimate concern," he said,
referring to the danger that the drugs would be found by children or
"Another concern," he said, "is, if she doesn't have a
current prescription for Prozac, it's an illegal distribution" of a
The form letter that accompanied the Prozac was
apparently prepared by a sales representative for Lilly; it was signed
by the caregiver's doctor and two other local doctors.
"We are very excited to be able to offer you a more
convenient way to take your antidepressant medication," the letter
said. "If you wish to try Prozac Weekly, stop your antidepressant one
day before starting Prozac Weekly, then take Prozac Weekly once a week
Stephen A. Sheller, a Philadelphia lawyer who also
represents the plaintiffs in the lawsuit here, had a suggestion for
drug companies inclined to mail unsolicited samples.
"What they should be doing is developing a drug to
their greed," Mr. Sheller said.
The lawsuit says the lead plaintiff, the caregiver,
identified only as S. K., has had a diagnosis of depression, "which she
maintains in the strictest of confidence due to potential public
embarrassment and employment repercussions." It says she did not have a
prescription for Prozac.
"I hadn't been using Prozac for seven years or better,"
she said in the interview. "It was a matter of a few months. It didn't
She was living in Massachusetts when she tried the drug.
She said her doctor here, Lise Lambert, had not discussed Prozac with
much less prescribed it.
Dr. Lambert, one of the doctors who signed the "Dear
Patient" letter, is a defendant in the suit. She did not return calls
for comment. Her medical group referred questions to Holy Cross
Hospital, which is also a defendant.
A hospital spokeswoman said the hospital did not comment
on matters in litigation. In early June, however, the hospital issued a
statement to The Sun-Sentinel in South Florida.
"This particular effort," it said, "was the result of
well-intentioned, respected physicians being given an opportunity to
arrange for some of their patients to receive sample medications, at no
cost, through proper, licensed pharmacy channels."
The plaintiff here said Dr. Lambert admitted signing
blank letterhead, which the Lilly representative added text to and
delivered to the drugstore for mailing.
Whether or not Dr. Lambert reviewed the letter before
Dr. Pearle said, the mailing was improper.
"It's highly unethical," he said, "because it's clear
that the letter is not an outgrowth of the doctor's relationship with
The plaintiff said the packaging that Lilly uses for the
samples worried her, too.
"They were very attractive because they had little beads
inside a capsule," she said. "If my grandchildren were there and they
a hold of this little package, they would have thought it was candy."
Michael Polzin, a spokesman for Walgreen Company, said
drugstore did nothing improper.
"We received a valid prescription from the doctor," Mr.
Polzin said. "All of the prescriptions in this program were faxed by
doctors' offices. It was our understanding that it was going out to
people who are on Prozac."
Mr. Polzin said Lilly reimbursed the pharmacy for the
samples. It is not clear whether the doctors who signed the letter were
compensated for doing so.
Mr. Polzin said that prescription drugs were routinely
sent through the mail and that the practice did not pose any safety
Ms. Davis, the Lilly spokeswoman, apologized for the
"It is inappropriate for Lilly sales personnel to
support programs in which medicine is mailed to patients without the
patient's request," she said in a statement.
"We understand why people should be concerned about
receiving unsolicited prescriptions in the mail. To the extent Lilly
personnel may have
participated in this program, Lilly apologizes to those patients
affected by it."
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