Now you can read in someone elses words, "Why
I keep saying, 99% of what doctors know about hepatitis c
and interferons is what a drug company told them." It
is true, your doctor does not know much about hep c or interferons.
You need to learn about hep c and interferons for your self.
Keep your self informed and do not give "modern medicine"
power over your life.
Drug giant accused
of false claims Whistleblower alleges illegal
encouragement of off-label use
July 11 - The questions began with the confession of an insider
at one of the nation's largest pharmaceutical firms. He says
his former company deliberately distorted information about
one of its drugs, possibly putting lives at risk, and costing
patients and taxpayers millions of dollars. "Dateline"
went looking for some answers and has the results of a year-long
investigation into what may be one of the biggest medical
deceptions in history. NBC's John Hockenberry reports.
DAVID FRANKLIN: "I was trained to deceive, to lie to
John Hockenberry: "So these doctors were completely
Who would train and then pay someone to mislead doctors?
Scientist David Franklin says pharmaceutical company Warner-Lambert
paid him to do that back in 1996.
Franklin: "It was my responsibility to leverage the
trust that physicians had with pharmaceutical companies to
corrupt the relationship between the physician and the patient."
John Hockenberry: "Your job was to find trust, and exploit
it, to produce more sales for Warner-Lambert."
Since he was a little boy growing up in Rhode Island, Franklin
says, he wanted to be a scientist. But he wanted to use that
science to help people, doing medical research to cure disease.
So Franklin got his Ph.D. in biology at the University of
Rhode Island and from there became a researcher at the prestigious
Dana Farber Cancer Institute. After more than three years
as a researcher, Franklin wanted to get out of the lab. He
found a job at Parke-Davis, a division of Warner-Lambert.
He would be a medical liaison, using his scientific expertise
to explain the scientific merits of drugs to doctors.
Franklin: "The medical liaison was supposed to be fair
and balanced, where the physician could trust what the medical
liaison was telling them."
Hockenberry: "So, doctors wouldn't necessarily see you
as a company guy, as much as they would see you as a scientist.
As as a medical doctor, like them in a way."
Franklin: "Exactly. A person whose primary responsibility
is to care of the patients, making sure that the doctor, to
enable the doctor to practice the best possible medicine that
science would allow at this point in time."
Hockenberry: "So, a doctor needs more drugs for their
practice. They call the salesman. But if they have questions
about the medical use of that drug, they call you."
But almost immediately, Franklin says, he became little more
than a salesman. The job he thought would be about caring
for people turned out to be little more than caring for the
company's bottom line. With his Ph.D. and the title of doctor,
Franklin says he became part of a broad mission to deceive,
even entice doctors to prescribe drugs to patients whether
it was scientifically justified or not.
Franklin: "It was a matter of leveraging, corrupting,
if you would, perverting the science, to greatly increase
sales and profitability."
This corporate whistleblower, telling his story to "Dateline"
in his first broadcast interview, has rocked the pharmaceutical
industry to its core. Pieced together with confidential documents
and taped voicemails, you'll see a portrait of sales over
But mostly this is the story of how David Franklin helped
one little drug become a star: Gabapentin, one of the drugs
Franklin was responsible for, which goes by the brand name
Neurontin. Neurontin is a useful and generally safe drug.
The Food and Drug Administration approved it in 1993, but
for only one use - to help control epileptic seizures and
only if taken in conjunction with another drug.
But Franklin says he soon learned that Warner-Lambert had
plans for Neurontin, the little epilepsy drug, a plan to go
directly to doctors and get them to prescribe Neurontin for
all kinds of uses the FDA hadn't approved, called "off-label"
Hockenberry: "Warner-Lambert basically told you, 'The
FDA says, scientifically, Neurontin treats epilepsy. But we
can convince doctors. And here's how you'll do it, to use
Neurontin for a dozen other things."
Franklin: "Absolutely. This was holding their hands
and pushing them into to using Neurontin off-label."
And according to Franklin, the list of off-label uses was
long, everything from attention deficit disorder to alcohol
and drug withdrawal.
Now, off-label uses are nothing new. Doctors have been observing
surprising new uses for drugs throughout history. Some of
their discoveries become medical breakthroughs. One of the
best-known examples is aspirin, once thought only good for
pain, was found by doctors to increase blood circulation and
prevent heart attacks.
Hockenberry: "So it's legal for doctors to say, 'You
know what? I think this drug that is approved for your ear
might be good for your throat.'"
Franklin: "Not only is it legal, but it's good medical
But what is not legal is for a drug company to promote such
unapproved, off-label uses or to exaggerate or report unproven
breakthroughs to doctors as a way to get them to prescribe
their drugs. Assistant U.S. Attorney Jim Sheehan, one of the
country's leading prosecutors of health care fraud, says such
regulation exists because off-label use can be unsafe.
Sheehan: "Every prescription drug is an inherently dangerous
product with the potential to kill people as well as cure
them. That's why we have very strict regulation, that's why
we have rules about what marketing and promotion they can
do. That's why we have rules about what they can produce and
how they produce it."
Franklin says the rules went out the window from the moment
he arrived on the job. For instance, he was told not simply
to wait for doctors to ask him for his scientific opinions,
but to instead target doctors and convince them to prescribe
Neurontin, even though he knew that there was no FDA approval
for its off-label uses.
Franklin says he was actually "cold calling" doctors,
showing up like a salesman unannounced, and he found one thing
about him opened a lot of doors.
Franklin: "If I were to show up at a doctor's office
and say, 'Dr. Franklin is here to speak to Dr. Smith,' Dr.
Smith is much more likely to respond, as opposed to his receptionist
calling him in his office, and saying, 'The Warner-Lambert
sales rep is here to talk to you.'"
Franklin didn't say that he wasn't a medical doctor. Simply
having the title of doctor, the Ph.D. he was so proud of,
was all that mattered, Franklin says, and Dr. Franklin, it
turns out, wore lots of hats, depending on whom he was visiting.
Hockenberry: "So, you could have had a Ph.D. in economics
or metallurgy, and it would have been just as fine?"
Franklin: "As long as it granted me the title of Dr.
Hockenberry: "What were you told to tell doctors about
Franklin: "We actually trained the sales representatives
to introduce me as an expert in cardiovascular medicine."
Hockenberry: "Were you?"
Franklin: "Absolutely not. My Ph.D. was in microbiology.
At 9 in the morning I was an expert in cardiovascular medicine.
At 10 when we walked across the street to a neurologist office,
I was an expert in neurology."
And once inside, Franklin would make his pitch to the doctor.
As I played the doctor's part - he showed me what he would
say about Neurontin.
Franklin: "We're really being inundated with information
from across the country with physicians that are seeing a
profound improvement in patients with bipolar disease ...
so we would suggest that you titrate the patient up to 4,800
milligrams - you will see marked improvement in their symptoms."
Hockenberry: "So your suggestion to me is triple the
dose and I might see some positive results."
Franklin: "Absolutely. It's not a matter of might. You
will see an improvement."
He's a scientist who couldn't sound more certain. But is
there any scientific validity to what he is saying about,
for instance, bipolar disorder?
Franklin: "None at all. And in fact, much of it is a
fabrication. It is simply untrue."
Hockenberry: "Was there any data that really supported
the claims you were making?"
Franklin: "Not at all."
At best the claims were based on promising anecdotal and
untested preliminary information that Franklin says was, promoted
to doctors vigorously, directly and illegally.
Franklin: "Not only is it illegal, it's downright immoral.
It doesn't just hurt the medical community, it has the potential
of hurting patients."
But as you'll see, there was nothing potential about the
money to be made through these tactics. The billions to come
were real ... as real as the patients whose stories are just
beginning to emerge. Was their health compromised in a scientifically
invalid campaign to raise sales of Neurontin?
A PATIENT'S PERSPECTIVE
By the late spring of 1996, Franklin understood fully what
he was doing in supplying misleading information to doctors
about the drug Neurontin. What he didn't know, he says, was
the effect on real patients. It's a knot in his stomach that's
still there today.
Franklin: "There hasn't been a day in six years that
I haven't thought about this and wrestled with my involvement
Long after David Franklin began to have his first reservations
about his job, 54-year-old Regina Adams got her own education
about off-label uses of Neurontin.
Adams: "My whole life was turned upside down, and I
almost lost my life because of it."
Adams has bipolar disorder.
Hockenberry: "When were you first diagnosed with a condition
that might require ongoing use of pharmaceutical drugs?"
Adams: "About 11 years ago."
Hockenberry: "And the symptoms you were exhibiting were?"
Adams: "Mania, mostly mania. Because I had just lost
touch with reality."
Bipolar disorder occurs when the brain constantly cycles between
mania and depression. Those who suffer from it can experience
uncontrollable highs and lows.
Before she found a reliable treatment the disease played
havoc with Adams' life. She divorced and was in and out of
hospitals. Doctors finally found a therapy that seemed to
work, a drug called Depakote, FDA-approved for bipolar disorder.
Adams: "That worked really well, worked for my head.
But the side effect was weight gain."
Hockenberry: "Weight gain?"
Adams: "I gained 100 pounds."
Adams wanted the benefits of Depakote without all the weight,
so she asked her doctor for a different drug. The doctor recommended
Neurontin At first Adams felt better and lost weight, but
soon after things started to come apart.
Adams: "I became more and more out of control. My whole
personally - I'm very a sweet, nice person. And I got hostile."
Hockenberry: "Had you ever behaved like this before?"
Adams: "No. No. My ex-boyfriend said he had never seen
me, when I was manic, act like this."
Adams went back to her doctor for help.
Adams: "She just kept increasing the Neurontin. I didn't
want to go any higher. I didn't want to get harmed from it."
Hockenberry: "And your doctor's response was, Increase
Was there a risk? Adams' dosage was tripled. Neurontin is
known to have few if any side effects, one of its big selling
points. But Neurontin was now Adams' only treatment for bipolar
disorder, which was very risky because Neurontin, it turns
out, does essentially nothing for bipolar disorder - and that's
a scientific fact.
Dr. Gary Sachs: "Neurontin's a drug that has been studied
under double-blind conditions twice. And in neither case did
it prove to have any efficacy at all."
Hockenberry: "In neither case?"
Sachs: "In neither case."
Dr. Gary Sachs runs the Bipolar Treatment Center at Massachusetts
Hockenberry: "So, based on the science, someone with
bipolar who's only taking Neurontin is essentially untreated."
Sachs: "I think that's a fair assumption."
And for a bipolar patient like Adams, being untreated can
be life-threatening. On Neurontin, Adams' manic behavior became
uncontrollable. She says she tried to kill herself. She ended
up in the hospital.
Hockenberry: "If your doctor gives you something, your
assumption is that it works, and that somebody's shown that
it works, right?"
Hockenberry: "In the case of Neurontin, was any of that
Adams: "Not for me."
We tried to talk to Adams' doctor at Meridian Behavioral
Healthcare in Gainesville, Fla. - and Adams said she had no
problem allowing us see her medical records. But the company
refused our request, issuing only a statement from her doctor
acknowledging that Adams was treated with Neurontin but that
the drug was discontinued when she "experienced a manic
Adams is back on her old medication and doing fine.
Hockenberry: "What do you have to say to the drug company
that might have been very interested in doctors' prescribing
Adams: "I think that they're greedy, and they just are
after money. And they don't really care about the person who
takes the medicine, obviously."
David Franklin says he was surprised how easy it was for
him to get doctors to switch to Neurontin or to raise dosages.
Hockenberry: "And would they do it?"
Franklin: "It's remarkable the high percentage of physicians
that would do this."
Hockenberry: "How did you feel?"
Franklin: "I would leave a physician's office in pain.
There was no other way of describing it. This is - I was in
- a combination of embarrassed by what I had just done, felt
responsibility to the patient, to the doctor and the patient,
that I had just misled this individual. And that some third
party that wasn't even in the room, some patient, may actually
be impacted by it."
Parke-Davis' own internal documents obtained by "Dateline"
show the company couldn't have been more excited about: "new
indications for Neurontin," especially for people like
Adams with bipolar disorder: "Bipolar disorders offer
the greatest expected return on investment ... as much as
Even though the 1995 memo later states "there is no
pre-clinical evidence of efficacy in bipolar disorders."
In other words, no real scientific evidence that it would
work. Franklin says the company's enthusiasm about off-label
prescriptions translated into real pressure on the job - pressure,
he says, to sell.
Franklin: "I was pressured to fill the gap that the
sales team, the actual sales representatives weren't filling.
That the sales representatives weren't as effective as medical
liaisons. And that we had to, I think the quote was, to take
the ball and run with it."
And Franklin let "Dateline" experience this sales
pressure just as he did, through this recorded voicemail from
"You know there's a Neurontin push that's supposed
to be on.... So what we need to do is focus on Neurontin,
when we get out there - we want to kick some ass on
Neurontin - we want to sell Neurontin on pain all right?
And monotherapy...I don't know if you guys are embarrassed,
but I'm embarrassed with where we are with Neurontin."
Franklin saved this voicemail because he could barely believe
what his boss was saying: sell Neurontin expressly for uses
not approved by the FDA. Franklin was frightened. What he
was being asked to do, he believed, was illegal. So he began
to tape more conversations and messages from company officials.
Here's a quote from a senior Warner-Lambert executive on a
"I want you out there every day selling Neurontin...
holding their hand, whispering in their ear - Neurontin for
pain, Neurontin for monotherapy, Neurontin for bipolar, Neurontin
for everything.... I don't want to see a single patient coming
off Neurontin before they've been up to at least 4,800 milligrams
And then he said this:
"I don't want to hear that safety crap either.... It's
a great drug"
We showed Assistant U.S. Attorney Jim Sheehan that colorful
Sheehan: "It would seem to me that's a pretty clear
advocacy for off-label use by the company. And therefore a
violation of the FDA's rules."
Hockenberry: "You know, I don't know if I'd use the
word advocacy. I might use, like, threat."
Sheehan: "When I look at this, Neurontin not for pain,
not an on-label use, Neurontin for bipolar, not approved,
no application for that either. Neurontin for everything,
well, that's pretty obvious."
And company sales people got to make this pitch right in
the inner sanctum of doctors' offices. Franklin would tell
doctors they could get paid to let company sales reps go over
patient medical records and to actually be there in the examining
room while patients were being treated.
Franklin: "If you are willing to allow a sales representative
to spend a day with you as you see patients, we'll compensate
you for that. We'll pay you for it."
This is a voicemail Franklin recorded, in which a salesman
boasts about his success after a day spent with a doctor and
"The doctor would review the chart of each patient
with me in a one-on-one fashion. Then we would go meet
the patient, the patient would be examined. I saw the
actual prescription generated in front of me... that
was certainly nice. I certainly felt that me being there,
I had some influence on that medical decision."
Medical decisions that were very good business. From its
introduction in 1993, Neurontin the little epilepsy drug,
has rocketed to the top of the sales charts. Today it's a
more than $2 billion drug, outselling even blockbuster Viagra,
and more than three-quarters of Neurontin's sales, by the
parent company's own estimate, are from off-label uses.
But Franklin was having serious doubts about the safety of
off-label use, about his job and about what kind of legal
trouble he might be in. He would not make it through his first
year at Parke-Davis. In the summer of 1996, he decided he'd
By the early summer of 1996, after four months working as
a medical liaison for Warner-Lambert, David Franklin began
to realize it was time to get out. He believed what he was
doing was wrong and feared what would happen if he stayed.
Franklin: "I knew that in the period of time that I
had been there, my own personal behavior was illegal, that
I had done things that were simply illegal."
His biggest worry was that he was aiding and abetting a medical
fraud. The scientist who reluctantly became a salesman now
wondered if he had what it took to blow the whistle on a drug
company worth billions.
Franklin: ""Either I needed to own up to this now
and put it behind me, or at some point in the future, this
could come back, and I'd find myself on the wrong side of
this investigation. I did believe, when I left, that they
were so aggressively ramping this up, that at some point,
someone would expose what was going on there. And therefore,
I would find myself in the equally, or even more difficult,
position of trying to explain why I ignored an obvious illegal
and immoral activity within the company."
So on July 29, he drove to a co-worker's home, dropped off
his office keys and company car and turned his back on Parke-Davis
for good. Next stop? Greene and Hoffman attorneys at law.
Franklin: "I showed up to their office saying, I've-
I'm in trouble. And I need some help out of this."
Franklin filed a lawsuit against Warner-Lambert and its Parke-Davis
division charging the company with violations of the U.S.
False Claims Act. He says he was not motivated by the fact
that he stands to be in line for a percentage of the damages
if the company loses or if it settles out of court.
Tom Greene: "We had no idea the extent of the Neurontin
prescriptions, how successful this program had been."
Tom Greene is David Franklin's attorney. He has spent the
last seven years amassing Warner-Lambert and Parke-Davis documents
going back to 1994. He shared many of them with "Dateline"
- they fill more than 160 boxes, memos and reports that prove,
Greene says, that David Franklin was merely a cog in a grand
marketing strategy to deliberately and illegally encourage
Greene: "There are countless documents that support
what he says and go far beyond his story and bring the level
of knowledge of this illegal marketing program to the highest
levels of the company."
For example, one memo shows that plans for marketing Neurontin
for at least one off-label use were sent to top executives,
including Anthony Wild, the president of Parke-Davis' pharmaceutical
division, and Lodewijk de Vink, president of parent company
Warner-Lambert. Neither responded to our request for comment.
Other Parke-Davis documents, like one from 1997, show that
there were teams inside the company not merely pushing the
envelope on acceptable marketing practices but deliberately
advocating going around the expensive FDA approval process,
because the patent life of the drug was so short.
The "recommendation" is that Parke-Davis "not
file" an application with the FDA but instead take the
message straight to the doctors.
It was a full-court press. While sales reps and medical liaisons
like David Franklin supplied company information in doctors'
offices, documents show company messages being planted aggressively
in the scientific literature. Doctors simply trying to stay
educated about new drugs would find themselves inundated with
research, paid for by the company and made to look like independent
Greene: "They wanted to disseminate knowledge of these
off-label uses throughout the medical literature. They hired
outside companies to write articles about off-label uses so
that the message about off-label use of Neurontin could be
planted in the medical literature around the country, and
indeed around the world."
Here's one example of how what Parke-Davis called its "publication
strategy" worked: A company called Medical Education
Systems of Philadelphia (MES) was hired by Parke-Davis to
put together a series of articles on off-label uses of Neurontin.
MES would contact doctors hand-picked by Parke-Davis to author
the articles. But in some cases, it appears that articles
were essentially ghostwritten by MES, and the doctor's name
added later. As one MES status report notes: "MES draft
completed - we just need an author."
And what did the doctors get for becoming authors of papers
they sometimes didn't write? Fees of up to one thousand dollars
Sheehan: "You are attempting to create a false impression,
and you are making false representations, and you're doing
it for money. I just don't see how that approach can be supported
or can be viewed as appropriate."
Hockenberry: "You know, it's always been my impression
that the finding of an author precedes the actual writing
of the paper."
Sheehan: "One would hope that's what would happen."
Papers were just the beginning. Franklin says there was lots
of money to go around.
Hockenberry: "Did you pay doctors?"
Franklin: "I personally did not pay physicians. What
my responsibility was, was to let physicians know that there
was money available to them."
In fact the documents show there were all kinds of ingenious
ways for doctors to get paid for an education in the use of
Neurontin. For instance, "honoraria" are fees paid
to doctors to hear information or a presentation about Neurontin.
Parke-Davis records show that these scientific presentations
occurred in some unscientific places: "Bus to Yankee
Stadium," "World Yacht Cruise" and "Braves
Doctors were also recruited for teleconferences, seminars
and trips to places like Jupiter Beach, Fla., perhaps better
known for golf than for research.
Paying physicians like this, giving them drug company money
to listen to information about the products they prescribe,
may be legal and common practice in the industry, but to critics
like Dr. Arnold Relman, professor emeritus at Harvard and
former editor of the New England Journal of Medicine, it's
a conflict of interest - especially in the case of Neurontin.
Relman: "What you have is an unproven drug being widely
used for difficult problems by doctors who are given a powerful
economic incentive to do it, spurred on by a company that's
wildly aggressive in its marketing."
After seven years of legal motions and countermotions, Franklin's
lawsuit is now being scrutinized by the U.S. government and
all 50 states to see if government medical programs like Medicaid
may have been defrauded into spending millions on improper
And in fact, in recently filed court papers, the Justice
Department said that Franklin's case "has presented evidence
of an illegal off-label marketing scheme that is rife with
false statements and fraudulent conduct all of which had one
intended purpose and result - increasing sales ..."
Three years ago, Pfizer bought Warner-Lambert and Parke-Davis,
so now the biggest drug company in the world is the defendant
in one of the highest-profile cases in the history of the
industry. Pfizer officials would not speak on camera but did
provide this statement:
"...the events to which you referred are alleged
to have occurred well before - in some cases years before
- Pfizer acquired Warner-Lambert. Pfizer completed the
acquisition of Warner-Lambert in June 2000. It is long-standing
policy that Pfizer has not and does not promote its
products outside their FDA-approved labeling.... We
are unable to comment further because of the pending
But it's litigation that will mean little to Regina Adams,
who says she will always believe that her experience with
bipolar disorder and the drug Neurontin almost ruined her
Adams: "Now that I look back, and that I know what I
know now, I wouldn't have ever taken the drug. I want everybody
to know that's taking this drug the truth about it."
Last year the FDA approved the use of Neurontin in the treatment
of post herpetic neuralgia, severe nerve pain, in addition
to epilepsy. It is still widely prescribed for pain and a
variety of other unapproved uses, some of which have been
studied and endorsed by scientists and approved for use in
And as for whistleblower Franklin, he may have escaped legal
liability for what he did during his four months with Parke-Davis,
but he hasn't escaped his own conscience. He admits he should
have known from the start that he was heading down the wrong
Franklin: "Actually interviewing for this position,
I was asked about giving examples of where I had to bend the
rules in the past and how I handled that and how comfortable
was I working in gray areas."
This case could end up clarifying some of those gray areas
and end up costing defendant Pfizer millions of dollars. And
there's one more thing. Because his lawsuit is filed under
the federal False Claims Act, as a whistleblower Franklin
stands to get a piece of any monetary damages, up to 30 percent,
which could add up to millions. So the four-month job in sales
that caused so much agony for this scientist, ironically,
might in the end have set him up for life.
Hockenberry: "But even after you get a settlement, if
you do, or a judgment if you do, or the case just completely
goes away if it does, there are patients out there who took
drugs based on decisions doctors made relying on your judgment."
Hockenberry: "They could be hurt because of that."
Franklin: "They may have been hurt. And that's something
that I wrestle with."
Hockenberry: "What's to wrestle with? If they're hurting,
it's because of you."
Franklin: "It's because of me. There hasn't been a day
in six years that I haven't thought about this and wrestled
with my involvement in it and the guilt I feel associated
with it, and the sense that I need to correct it."