AstraZeneca paid $355 million in 2003 after pleading guilty to charges that it encouraged physicians to illegally request Medicare reimbursements for its cancer drug Zoladex, and bribed doctors to buy it.
Other drug giants have also been embroiled in similar controversies and have admitted to using illegal marketing tactics. In March, Pfizer was told to pay $142.1 million for violating U.S. racketeering law by illegally promoting its epilepsy drug Neurontin for non-authorized illnesses. Pfizer also agreed in September to pay $2.3 billion for not branding its anti-inflammatory drug Bextra and promoting it for uses other than those specified on the label.
That case became the biggest health care fraud settlement ever. Eli Lilly agreed in January 2009 to pay $1.4 billion for promoting its anti-psychotic drug Zyprexa for uses not approved to by the FDA.
Experts said one of the key challenges is that the current law doesn't require pharmaceutical firms to disclose their research and data. So even if they have knowledge that a particular drug is more harmful than originally thought, they may not disclose it.
Because of that, even when pharmaceutical companies find problems with a particular medicine, "they continue to push the drug aggressively and hope they can make a billion dollars before someone finds out," said Jerome Kassirer, professor at Tufts University School of Medicine in Boston.
"When you think about the extent of the money involved in these settlements, it's relatively modest," Kassirer added. "When you think about the total worth of the companies, they can shake off a settlement like this without much in the way of influence on their bottom line or their stock prices. That's one of the reasons why they keep doing this."
Another problem is that because this data is not available to doctors, many of them can easily be duped without realizing they are being manipulated.
The company targeted its illegal marketing of Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder, such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons, according to the charges. Some doctors were paid cash, others were sent to lavish resorts to encourage them to market and prescribe the drugs for unapproved uses.
"It's an enormous problem and it's much more than a financial problem," Harvard's Abramson said. "The real issue is that doctors are being manipulated in prescribing very potent medicines. ... The real issue is the consequences to people's health."