By NICHOLAS KRISTOF – Sept. 17, 2015
Risperdal is a billion-dollar antipsychotic medicine with real benefits — and a few unfortunate side effects.
It can cause strokes among the elderly. And it can cause boys to grow large, pendulous breasts; one boy developed a 46DD bust.
Yet Johnson & Johnson marketed Risperdal aggressively to the elderly and to boys while allegedly manipulating and hiding the data about breast development. J&J got caught, pleaded guilty to a crime and has paid more than $2 billion in penalties and settlements. But that pales next to some $30 billion in sales of Risperdal around the world.
In short, crime pays, if you’re a major corporation.
This tale is told in a devastating 58,000-word epic by Steven Brill that is being serialized on The Huffington Post. Some has already been covered in The Times and other papers, or in Senate investigations and innumerable court decisions, but it’s still wrenching to read the comprehensive account of how a company put profit above everything and then benefited handsomely for doing so.
The story begins when J&J’s previous antipsychotic medicine ended its patent life, so sales plunged as generics gained market share. In 1994, J&J released Risperdal as a successor, but the Food and Drug Administration said it wasn’t necessarily better than the previous version and in any case was effective primarily for schizophrenia in adults. That’s a small market, and J&J was more ambitious. It wanted a blockbuster with annual revenues of at least $1 billion.
So J&J reinvented Risperdal as a drug for a broad range of problems, targeting everyone from seniors with dementia to children with autism.
The company also turned to corporate welfare: It paid doctors and others consulting fees and successfully lobbied for Texas to adopt Risperdal in place of generics. This meant that the state paid $3,000 a year for each Medicaid patient taking it, rather than $250 a year for each, Brill says.
Building on that, J&J reached out to Omnicare, a company that provided pharmaceutical services in nursing homes. The two companies cut a deal so that Omnicare doctors would prescribe Risperdal, and the profits would be shared with Omnicare. (Yes, that’s called a kickback.)
Even though Risperdal wasn’t approved for the elderly, J&J formed a sales force, called ElderCare, with 136 people to market it to seniors. The F.D.A. protested and noted that there were “an excess number of deaths” among the elderly who took the drug.
J&J seems to have shrugged. It was making vast sums, and the F.D.A. didn’t have teeth.
At the same time, J&J was also expanding into another forbidden market: children. The company began peddling the drug to pediatricians, so that by 2000, more than one-fifth of Risperdal was going to children and adolescents.
In 2003, the company had a “back to school” marketing campaign for Risperdal, and a manager discussed including “lollipops and small toys” in sample packages, Brill says.
A version of this op-ed appears in print on September 17, 2015, on page A35 of the New York edition with the headline: Drug Crime That Paid Billions