In the latest British Medical Journal (which seems to be now the most quoted journal on Health Care Renewal) is a fascinating review by Jeanne Lenzer of Peter Rost's new book, The Whistleblower: Confessions of a Health Care Hitman. (Lenzer J. Telling the inside story? Brit Med J 2007; 334:261.) (We posted about Rost here and here.) Lenzer summarized Rost's somewhat bizarre career with Pfizer Inc and its predecessors:
Peter Rost, erstwhile drug company executive, self proclaimed whistleblower, and now book author, first became a cause célèbre in August 2004 when he wrote an endorsement of The Truth about the Drug Companies, the book by former New England Journal of Medicine editor Marcia Angell. He posted a commentary on Amazon.com, saying, 'I should start with a disclaimer. I'm a vice president within one of the largest drug companies in the world and I have spent close to 20 years marketing drugs. So I guess I'm not supposed to like this book. But the truth is I thought it was fantastic.'
Rost's posting was picked up by the media and he became a much sought after guest on television and radio shows. He took up the cause of drug reimportation, a practice that would allow foreign drug companies to sell drugs in the United States. Reimportation, argued Rost, is widely practised in Europe and could drastically reduce drug prices in the US. His position was in sharp contrast with that of his employer, Pfizer, and to virtually all major US drug companies, which vehemently argued that reimportation would allow unsafe drugs to enter the US and would threaten the health and safety of its citizens.
But Rost began to run into trouble long before he became a public advocate of reimportation. In 2001, as the new head of the endocrine care division of Pharmacia, he learnt, according to his account, that the division's flagship drug, Genotropin, a synthetic form of human growth hormone, was being promoted for off-label uses. Off-label promotion of growth hormone is a felony under federal anti-doping laws. Pfizer, which bought out Pharmacia in April 2003, failed to put a stop to the off-label promotions, says Rost.
Rost alleges that it was his complaints about the marketing of Genotropin that led Pfizer executives to fire him. He was first informed in an email message on 3 February 2003 that he was to be sacked, but he managed to hold on to his job for two and a half years, until 30 November 2005.... Rost filed a qui tam, or whistleblower, lawsuit against both Pharmacia and Pfizer in December 2005. In the suit and the book, Rost claims to describe some of the inventive marketing techniques used by the companies to promote sales of Genotropin to "anti-aging" clinics and for the treatment of short children who did not have growth hormone deficiency.
Lenzer was not enchanted with many aspects of the book, including Rost's defenses of some his own actions which Lenzer found indefensible. Nonetheless, she concluded,
Rost's book claims to chronicle problems in the way the drug industry manages to circumvent rules prohibiting off-label drug promotions. In addition, Rost's endorsement of reimportation is perhaps one of the most articulate defences made in the US. The Whistleblower may also reach some lay readers who were not moved to pick up any one of a number of more academic books on the drug industry. Finally, his overview of serious violations by nine top drug companies in his chapter 'How corrupt is the drug industry?' should make one thing crystal clear: fines simply don't work. They are, as has often been said, simply the price of doing business.
'Working for a corporation,' writes Rost, 'is like running with a wolf pack. Everyone helps out and is friendly as long as it benefits the group, but each wolf cares only about himself and will do anything to survive. Compassion, loyalty, caring . . . these are all buzzwords invented to control the masses.' Rost's take on the nature of industry might leave one wondering whether Rost isn't simply a very clever wolf himself.
The good news is that when the titans do battle—the fallout can be instructive.
Note that Rost has become a prolific blogger. Seem more of his provocative writing on Question Authority.