The pharmaceutical industry has made major contributions to the health of the US public, but it must also be considered part of the nation’s well-organized crime, says an industry critic.

Last week’s $2.3 billion settlement between Pfizer and the US Justice Department for unlawful prescription drug promotion may sound large, but it is not enough to ensure drug companies will curb their bad behavior - in fact, it just shows there is competition in the pharmaceutical industry, according to Sidney Wolfe, director of US advocacy group Public Citizen’s Health Research Group.

Pfizer has broken a record set by Eli Lilly in January for what was then described by the Justice Department as the “largest individual corporate criminal fine” in U.S. history - more than $500 million in criminal penalties for off-label promotion of Zyprexa (olanzapine), its treatment for psychotic conditions including schizophrenia and bipolar disorder - but now, just seven months later, Pfizer has broken this record with a criminal fine of $1.2 billion, the largest ever imposed in the US for any matter, he says. The rest of the $2.3 billion represents civil penalties.

“The US pharmaceutical industry, long one of the most profitable in the country with profits last year of close to $50 billion, has engaged in an unprecedented amount of criminal activity in the past decade, all aimed at increasing sales, often by illegally promoting drugs for diseases for which evidence that benefits outweigh harm is lacking - also known as illegal off-label promotion,” says Dr Wolfe. When doctors are induced, either by being bribed or misled by drug companies, to prescribe drugs for such purposes, there is “a reasonable chance” that the drugs will do more harm than good and patients may be seriously injured or killed by such promotion, he warns. _

In addition to Pfizer - which also pleaded guilty to criminal charges for off-label promotion of its anticonvulsant Neurontin (gabapentin) in 2004 - and Lilly, other drug companies found to have engaged in criminal activity in the past 10 years include Abbott, Schering-Plough, AstraZeneca, Purdue and Bayer, says Dr Wolfe. However, he adds: “the ever-escalating fines are unlikely to stop drug companies from continuing to bribe doctors because they represent just a fraction of drug company profits and no one has gone to jail.”

Until “corporate titans are forced to fork over a much larger proportion of their illegally-gotten profits and are put behind bars, nothing will change,” he concludes.