"They may be good medicines. ... Why not spend the money to prove they're good medicines?" said Bill Vaughan, senior health policy analyst for Consumer's Union. "There is a mind-set in this industry, because it is such a profitable industry, that cheating is OK. ... If we have to pay these penalties, tough, we'll make up for it [in sales]."
Industry insiders say drug companies often forgo legal considerations in favor of profit.
If companies, people or entities "are able to make that decision and determine that there's an economic incentive to break the law, they'll break the law," said Reuben Guttman, attorney for Glen Demott, a former Pfizer drug representative.
Change in a financially driven industry depends on whether a few billion dollars of penalty will affect the company's net profits or share costs. In 2008, Pfizer earned $48.3 billion in revenue.
"It won't make a dent if the conduct that led to the settlement is not addressed as part of health care reform," said Abramson, who was the expert consultant for the plaintiff attorneys in the Bextra case in 2007.
"The real problem is this behavior is not isolated to Bextra nor Pfizer but in essence is the way the pharmaceutical industry expands the sales of its drugs," Abramson said. "Unless health care reform can address misrepresentations, withholding science and control claims made to consumers, Americans will continue to pay too much for health care that is not as effective and is expensive."
While it may seem an unnecessary risk to prescribe a drug for off-label use, Abramson said some doctors are still naive about what pharmaceutical companies tell them and what they don't.
"Practicing physicians are busy, they have a ton of information coming at them," Abramson said. "They still hold on to the idea that they'll sort through the information they're getting and decide what's applicable to their patient. But you can't sort through information you've never seen."
Although Pfizer's settlement is the largest to date, it is only one among many such settlements made across the pharmaceutical industry each year. Drug companies have paid more than $11 billion over the last eight years in fines for illegal promotions, among other thing.
"Until there are penalties that cause shareholders to demand that officers no longer engage in this kind of behavior ... this behavior is going to continue," Abramson said.