Telling the inside story?
Authors: Jeanne Lenzer
Journal: BMJ (2007)

Peter Rost, erstwhile drug company executive, self proclaimed whistleblower, and now book author, first became a cause celebre in August 2004 when he wrote an endorsement of The Truth about the Drug Companies, the book by former New England Journal of Medicine editor Marcia Angell. He posted a commentary on Amazon.com, saying, “I should start with a disclaimer. I'm a vice president within one of the largest drug companies in the world and I have spent close to 20 years marketing drugs. So I guess I'm not supposed to like this book. But the truth is I thought it was fantastic.” 

Rost's posting was picked up by the media and he became a much sought after guest on television and radio shows. He took up the cause of drug reimportation, a practice that would allow foreign drug companies to sell drugs in the United States. Reimportation, argued Rost, is widely practised in Europe and could drastically reduce drug prices in the US. His position was in sharp contrast with that of his employer, Pfizer, and to virtually all major US drug companies, which vehemently argued that reimportation would allow unsafe drugs to enter the US and would threaten the health and safety of its citizens. 

But Rost began to run into trouble long before he became a public advocate of reimportation. In 2001, as the new head of the endocrine care division of Pharmacia, he learnt, according to his account, that the division's flagship drug, Genotropin, a synthetic form of human growth hormone, was being promoted for off-label uses. Off-label promotion of growth hormone is a felony under federal anti-doping laws. Pfizer, which bought out Pharmacia in April 2003, failed to put a stop to the off-label promotions, says Rost. 

Rost alleges that it was his complaints about the marketing of Genotropin that led Pfizer executives to fire him. He was first informed in an email message on 3 February 2003 that he was to be sacked, but he managed to hold on to his job for two and a half years, until 30 November 2005, when he was finally let go. Rost filed a qui tam, or whistleblower, lawsuit against both Pharmacia and Pfizer in December 2005. In the suit and the book, Rost claims to describe some of the inventive marketing techniques used by the companies to promote sales of Genotropin to “anti-aging” clinics and for the treatment of short children who did not have growth hormone deficiency. 

Rost, who paints himself as a regular guy in his book, is the quintessential marketer. Along with the publication of The Whistleblower, he has a Hollywood agent looking for potential movie deals; he has written a fictional thriller about the drug industry entitled, The Wolfpack; and he is scheduled to be interviewed for Sicko, Michael Moore's documentary movie, on the healthcare industry. 

A niggling aspect of The Whistleblower is that Rost repeatedly wastes the reader's time defending his motives for his various actions as he sought to hang on to his job. Some of his actions appear simply indefensible. Rost, who earned over $600000 (£305 000; €460 000) annually (exclusive of benefits, annual bonus awards, and stock options) is hardly a man without warts. When Pfizer asked him to fire a number of his colleagues, Rost fired them—while bemoaning their fates in the book. He is at his worst, perhaps, when he spends an entire chapter on irrelevant speculation about the sexual activities of Pfizer's bosses. Rost makes no bones about why he wants to pursue possible sexual improprieties, even though he has no first hand knowledge of the events. “If they feared what I knew about them,” he writes, “they would be less prone to take away the lifeline I had left—my salary.” 

Rost's book claims to chronicle problems in the way the drug industry manages to circumvent rules prohibiting off-label drug promotions. In addition, Rost's endorsement of reimportation is perhaps one of the most articulate defences made in the US. The Whistleblower may also reach some lay readers who were not moved to pick up any one of a number of more academic books on the drug industry. Finally, his overview of serious violations by nine top drug companies in his chapter” How corrupt is the drug industry?” should make one thing crystal clear: fines simply don't work. They are, as has often been said, simply the price of doing business. 

“Working for a corporation,” writes Rost, “is like running with a wolf pack. Everyone helps out and is friendly as long as it benefits the group, but each wolf cares only about himself and will do anything to survive. Compassion, loyalty, caring . . . these are all buzzwords invented to control the masses.” Rost's take on the nature of industry might leave one wondering whether Rost isn't simply a very clever wolf himself. 

The good news is that when the titans do battle—the fallout can be instructive.