Pfizer: sponsored nurse audit programmes and “value added” services linked to Lipitor targeting (AUTH/1807/3/06 & AUTH/1810/3/06)

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Key facts

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Case numbers	AUTH/1807/3/06 and AUTH/1810/3/06
Parties	The Sunday Times/Director and a General Practitioner v Pfizer
Issue	Sponsored nurses; nurse-led audits/clinics and whether services were linked to promotion/inducement to prescribe
Source trigger	Sunday Times article “Nurses earn bonuses for use of latest drugs”
Applicable Code	2003
Breach clauses	Clause 2, Clause 9.1, Clause 18.1 (2003 Code)
Key programme in breach	Cardiovascular risk management nurse advisor programme positioned internally as a “Lipitor value added programme” with instructions to offer only where Lipitor would be statin of choice
Other programmes assessed	COPD audit (PCT), CHD audit/clinic support, outcomes guarantee programme, COPD Response programme, and other similar programmes (no breach found)
Sanctions	Undertaking received; Advertisement
Complaint received	09 March 2006 (Director case); 13 March 2006 (GP complaint)
Completed	02/03 July 2006 (completed early July 2006; no appeal)

Reviewed by Dr Anzal Qurbain (FFPM) — ABPI Final Signatory

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A Sunday Times article (“Nurses earn bonuses for use of latest drugs”, 3 March 2006) alleged Pfizer paid nurses via an agency to run free audits in GP surgeries and that nurses could “influence” new prescriptions, supported by sales teams.
The PMCPA Director opened a complaint (AUTH/1807/3/06). A GP also complained, alleging nurse advisors had a conflict of interest and were involved in marketing medicines (AUTH/1810/3/06).
Pfizer described multiple nurse-led programmes (eg COPD audit, CHD audit clinics, cardiovascular risk management, outcomes guarantee, COPD Response) and provided contracts, protocols and briefing materials.
The Panel assessed whether the services were legitimate patient-care/NHS-benefit services or whether they were being used as an inducement or linked to promotion.
Key issue: representative briefing for a cardiovascular risk management programme described as a “Lipitor value added programme”, instructing reps to “always sell Lipitor first” and only offer the service where they were confident Lipitor would be used as statin of choice for defined patient groups; outcomes slides showed 78% of patients not at target were initiated/titrated on Lipitor.

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Breach found for the cardiovascular risk management nurse advisor programme because the service was linked to expectations about Lipitor use (unacceptable linkage between service provision and promotion/prescribing outcomes).
No breach for other programmes reviewed (including a PCT COPD audit, a CHD audit/clinic support arrangement, an outcomes guarantee programme, the COPD Response programme, and other similar programmes) where the Panel did not consider the services to be an inducement to prescribe and where arrangements were described as stand-alone and not dependent on Pfizer product use.

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