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Business and Markets

Lilly Pays the Price

Eli Lilly has been in trouble for some time now regarding off-label promotion of their antipsychotic Zyprexa – specifically, their sales reps seem to have gone around saying that it was useful in treating the dementia of Alzheimer’s patients, although there was no FDA approval for that indication. (Whether it actually is any good for that, or whether much of anything is, I don’t know).
Word is this morning that the company will pay a total of about 1.4 billion dollars to settle the regulatory and civil complaints. That appears to be the new record. The idea is to send a strong message to other companies about aggressive off-label promotion, and a billion dollars should certainly get attention. Lilly will also be operating under a special monitor for five years, which is no joke, either.
But still. . .this is going to happen again, at some point. As we run things in the US, physicians are free to prescribe medications as they see fit (and I have to say, I agree with that principle). Insurance companies can pay for these or not as they wish, but the doctors can write for what they like. Drug companies, on the other hand, can only market for the indications that they’ve been approved for, and in this gap you can lose 1.4 billion dollars.
Despite these problems, I think the lines need to stay about where they are, although this is always going to cause problems. There’s a temptation to try to broaden your market when you have only preliminary data – worse, there’s a temptation to broaden it when you have no data at all. That’s got to be kept in check somehow. If you want to mark the limits of my libertarian leanings, there’s one of them. I worry that if every company were free to market every drug for everything, the resulting free-for-all would drag us all back down to the level of the late-night infomercial hucksters. The potential profits are just too great; they’re a moral hazard, and they’re not commensurate with the benefits for society at large.
The only middle ground I can think of at the moment would be a category of “Some evidence exists for. . .”, which would be in between an approved and unapproved indication. Perhaps then the sales reps could mention it? Maybe not, though, because where would you draw the line for how much promotion you could do? How would we keep this from turning into a battle zone? And there are too many ways that it could be abused: running a few sloppy studies to try to get some arrows pointing the right way, for example, and then turning the marketing department loose. (You know, the sort of thing that critics of the industry figure that we do already). No, again, I think that the temptation would be too great.
So here’s a general principle: we need enough regulation in the industry to keep ourselves from turning into what our worst critics think we are already. Not the most stirring call to arms, but there it is.

14 comments on “Lilly Pays the Price”

  1. Apropos, I believe the FDA just issued guidelines on how reps can distribute to docs peer reviewed articles on off-label uses.
    It’s a very grey area, and the risk you mention that companies will fund junk studies & publish them in junk journals is a real one.

  2. Anonymous says:

    Random musings
    If you allow Deepak Chopra and Andrew Weir to spout their nonsense in a free speech environment, then a fairness doctrine would allow Lilly to spout it’s nonsense.
    The line is about where it should be, IMHO.
    Where the industry should police itself is in the expenditures on Promotion. See PLoS Med. 2008 January; 5(1): e1 for an interesting analysis. The imbalance isn’t on “proven” vs. “unproven” but rather the (estimated) $57 billion spent on promotion in 2004 vs. the $31 billion spent on R&D.
    Where does this $1.4 billion go? Why not (a) put it into escrow. The FDA gets the interest to help finance the needed infrastructure changes there (b) require Lilly to pay for a study, conducted by independent clinical investigators in a CRO, that evaluates their claims (c)if the claims are right, Lilly gets its money back, in a decade or so (d) If the claims are wrong, Lilly pays the $1.4 billion plus 50% punitive fees. (e) The $2.1 billion is ‘given’ to the FDA for infrastructure improvements.

  3. startup says:

    Derek, I think you should have called it “Lilly settles. Who will pay the price?”

  4. ( This ‘we are gonna pay out the $1.4 bill’ is 3 year old PR churned out from Lilly handlers)
    A big hurdle with the Zyprexa issue is Lilly’s credibility over their continuous PR on how they are going to pay out $1.4 billion in damages.As long as they keep up this rhetoric and don’t actually pay the issue won’t go away.
    They need to think about ‘putting their money where their mouth is’. I have NOT been paid yet .

    Daniel Haszard-

  5. Indy says:

    Don’t forget that Lilly will have to pay the $1.4 billion out of their profits which means that they will have to do additional millions in sales just for this alone!
    There is always risk involved with approved drugs, just read all the warnings on their labels and they will make you think twice before you take them in the first place.
    And this is with documented/known issues/side effects.
    What would you do if the say “Some evidence exists for. . .” where it is a different way to say “we don’t know for sure what else this drug could cause if used for…”
    We have seen time and time again how companies stretch the approved use of their drugs.
    Such practice is misleading and unfair to patients, specially when they put their lives a risk.
    My 2 cents.

  6. Retread says:

    Sometimes the labeling is flat out wrong. In the 60s when I was just starting in neurology, for a time diazepam (Valium) was contraindicated for continuous seizure activity (status epilepticus), because respiratory arrest had occurred during its use in a few cases. In fact, it is one of the most useful drugs we have for the condition, and was a mainstay of treatment during most of my career.
    Sometimes, off-label indications are backed into. The use of beta-adrenergic blocking drugs for the prophylaxis of migraine was brought to light when physicians using it for other reasons (hypertension etc.), had their patients tell them that their migraine was better.
    Also beta-adrenergic blocking drugs had a similar history of incorrect drug labeling as Valium. Initially they were thought to be contraindicated in patients with congestive heart failure. Subsequently, they became a mainstay of treatment for the condition.
    Inhibiting physicians from the helter-skelter off-label use of medications is the lack of a defense against a malpractice suit, should an untoward side effect occur (which it inevitably will with widespread use).

  7. a-non says:

    hi Derek,
    How is the labeling of drugs determined? My understanding is that the label describes the use that the drug was tested for and any side-effects that arose out of the clinical trial. Considering Retreads comments this can be in some cases too narrow. Is there not the possibility of relabeling drugs once new uses are found? (or adding side effects as they come to light)
    Pharma cannot test for every possible use for each drug, but then they shouldn’t be able to market for things not approved/accepted by the medical community.
    I guess that the issue there is that sometimes the wider use of drugs is only discovered after the patent has expired and companies don’t want to miss out on these earnings. The only way I can see around this is a revision of the way patents work…Otherwise there will always be a tension between the profit motive and health care.

  8. MTK says:

    Labeling is generally determined through a negotiation by the FDA and applicant. Basically, the applicant says “This is what we propose the label to be and here’s our justification for it.” The FDA then comes back with their suggestions, questions, objections, etc until a label is agreed upon. Labeling just doesn’t mean what the listed indications, contraindications, adverse effects are It is also labeling in the literal sense of “What does the proposed label look like?” How prominent should the warnings be? Does their need to be a black box warning?
    For those of you unfamiliar, all this should be done before the NDA is submitted, since approval is based on more than just “Is this a good drug?” The manufacturing, packaging, labeling, and other aspects are all considered for approval, so you want to make sure you have FDA buy-in for most of this before you submit.
    BTW, labeling does reflect the results from the clinical trials, but it’s also the other way around. Companies design their clinical plan to reflect the labeling they want. While that may sound sinister at first, that’s not what it is. For example, if you think your drug is first line therapy, then you design a clinical trial to prove that. If you think it’s better suited as a complementary therapy, you design a clinical trial to prove that. Deciding what labeling you are targeting is a very important part of development, since it will dictate the clinical plan.

  9. Sili says:

    Of course GPs should be allowed to prescripe the best possible treatment. But as you say, the trouble with the current system is that it’s the businesses who have their ears.
    My non-libetarian opinion is that all trials really need to be registered centrally so that no results can be swept under the table as they have been in the past.
    What Retread mentions about feedback from GPs should also be harnessed more systematically. A central database of prescriptions and thorough registration of ‘side effects’ ought to help researchers look for both possible issues with a given medication, but also notice if there might indeed be indications for off-label use.
    In short more evidencebased medicine and less spin, please.

  10. srp says:

    I’m afraid I must dissent from the consensus here. Simply require the companies to describe uses as FDA-approved or not-FDA-approved, but let them talk to doctors about anything they want. The current regime has severe First Amendment problems–a detail man isn’t allowed to say that other doctors have told him that drug A worked on problem B even if that is the truth? Come on.
    What is happening now is that the FDA is “crowding out” the responsibility of doctors and their professional organizations to evaluate research, which then goes up the chain to the medical schools who don’t train doctors to assess research. The idea that somebody can’t show a published article to somebody else because the FDA hasn’t signed off on it is not only absurd, it is in the long run destructive of a culture of choice and responsibility.

  11. Dana H. says:

    srp: a very goood point on the crowding-out effect. The whole premise of those who want to silence advertising and marketing efforts is that people are too stupid to know the difference between marketing hype and reality. If your doctor is indeed this stupid, do you really want him treating you?
    (Of course, if doctors weren’t wasting so much time themselves complying with various regulatory requirements, they might have more time to evaluate the latest research. But that’s a topic for another day.)

  12. Joe says:

    The price Lilly paid was small in relationship to that paid by so many mental health consumers …. For some it was diabetes, for others it was coronary disease and for too many it was the hope betrayed that Zyprexa and other SGA’s would be safer and more effective then FGA’s.
    Lilly is fortunate that my peers are not the litigious sort in a litigious society. To date, only 32,000 Zyprexa users have sued Lilly. Lilly is one lucky company given that the user population includes those who are least empowered – persons with dementia, persons coping with a mental illnesses and children.

  13. Dan says:

    TheUnSealing Of Documents
    Not long ago, I got the joy and despair of viewing many documents that were initially not to be seen, by order of the Department of Justice, yet found their way on various locations on the internet- specifically, the website: The documents are, or were, in fact, evidence against Eli Lilly entirely representing their decade of deception promoting and over-medicating others with their drug called Zyprexa, which is in a class of medications called atypical anti-psychotics. While a new a new molecular entity by definition, this new class called atypical antipsychotics in fact is chemically similar to the older and typical anti-psychotics that existed, such as Haldol, which were available over 50 years ago. In many ways, the older antipsychotics are safer as well as being similar in efficacy compared with the atypicals such as Zyprexa. Perhaps this is why Eli Lilly did the things they did because they knew Zyprexa caused perhaps more harm than good for those who took the medication. Of the several available atypical anti-psychotics now available, Zyprexa and Clozaril, which was the first atypical anti-psychotic, are believed to have the most toxic adverse events to those who take these two in this class of medications.
    Launched in 1996, Eli Lilly did not appear to consider the evidence regarding the adverse effects that may occur to those who take this drug, yet it is believed that there was reason to state by Lilly that there should be caution regarding the use of Zyprexa in those patients prescribed this drug. With the belief that the maker of Zyprexa is and will be exonerated from any responsibility related to this drug, the promotional campaign was implemented, and has continued ever since. Evidence of this is a warning letter received by Lilly by the FDA as a warning due to the false and misleading claims Lilly was making about Zyprexa less than 2 months after this drug was approved by the FDA.
    At the time Zyprexa was granted approval for marketing, the medication was indicated only for schizophrenia and mania that exists in those with bipolar disorder. Schizophrenia has been defined as a disease that causes the sufferer to deviate from true reality, along with visual and auditory hallucinations. Bipolar disorder is another mental disorder where the victim alternates from states of heightened neurokinetics to periods of what can be brutal depression for the sufferer.
    Eli Lilly, known in recent years by many for their focus on marketing over science or research, greatly desired and hoped that Zyprexa would be a welcome blockbuster for them, which is a medication that exceeds a billion dollars a year in sales as a minimum. And Eli Lilly appeared to have constructed the obedient and manipulated sales force presumed to be a necessity for this monetary goal to occur without interference. Yet in actuality, they created a sales force to break federal law from at least the years of 1999 to 2003.
    A note about pharmaceutical promotion: pharmaceutical representatives overall are attractive and young individuals with little if any medical knowledge or training, but are determined to have charming personalities along with a perception of obedience related to the pharmaceutical culture, and this is all Eli Lilly in particular wanted from the members of their sales force. The sales vocation is normally associated to contain members with a high affinity for money, it is believed, so corruptive acts such as off label promotion or overt kickbacks is not typically a consideration of such people, overall, as history has shown. Therefore, if Eli Lilly’s sales representatives who happen to be instructed to sell Zyprexa for dementia or depression, the orders will likely be followed by such promoters. Or if this sales force is instructed to pay specifically targeted doctors large amounts of money for doing little or no work for this money given to such doctors, it still is not a problem for the sales force to maintain their obedience to their corporate God. This is the perception of not only myself, but many others as well. Plan of action meetings (POAs) are meetings that are held a few times a year by sizable pharmaceutical corporations to dispense orders to their sales representatives regarding the promotion of their drugs.
    A few years after Eli Lilly launched Zyprexa, the maker appeared, according to documents, anxious due to their obvious disappointment regarding the initial prediction that was speculated about the growth of this drug that was not meeting their expectations, so they had POA meetings throughout the nation and shared with the members of their sales force that there is fact a great benefit from a monetary paradigm of implementing ‘seeding trials’, as they are a mechanism for generating needed, although fabricated data void of any scientific gain of knowledge (this will be discussed later). This amazingly was done and implemented afterwards rather overtly. Even more unbelievable is that around this time, the Zyprexa sales force was instructed by Eli Lilly management to seek out clinical trial sites, along with investigators for these trials. Preferred by Eli Lilly was that the investigators had to either be Eli Lilly prescribing supporters or high volume prescribers. This protocol described was written internally, along with the etiology for performing these sham clinical trials. Anything in writing can be golden, from an illegal situation such as this.
    In addition to the clinical trial plan of action of no scientific benefit identified, Eli Lilly instructed its sales force to utilize what was in fact inaccurate promotional material that Eli Lilly gave its Zyprexa sales representatives to be used on their sales calls without exception. Even though this material was largely if not entirely false and misleading, which was the intent of Eli Lilly, they encouraged their hired promoters that such material was entirely accurate. To further saturate and corrupt the Zyprexa sales force, they were coerced to blunt assertively what are at this time widely recognized adverse effects of this medication, such as massive weight gain, along with glucose and lipid abnormalities- all of which are dangerous to the user of this medication.
    The corrosive promotion of Zyprexa by Eli Lilly continued as this dangerous medical corporation continued their efforts by intentionally altering certain Zyprexa articles by essentially rewriting them, followed by being reviewed internally and not externally by those who are called, ‘regulators’. The purpose was to stimulate what Eli Lilly believed was clearly absent, which was much needed commercial interest related to Zyprexa. It unfortunately worked to a noticeable degree. This is according to what appear to be internal documents from Eli Lilly.
    Then it came time to essentially buy benign support groups, if not create what are essentially front groups, in hopes that this would improve the growth of Zyprexa. One example is that Eli Lilly paid the American Diabetes Association for their assistance in obtaining endocrinologist consultants, which is a medical specialty that treats, among other things, diabetes. To reduce any possibility of an unexpected contingency doing this, they went ahead and hired a good sized team of diabetes educators. In 1999, Eli Lilly altered a Zyprexa report that originally illustrated the glucose problem with the medication, and did so with deliberate intent and reckless disregard for others. Eventually, the American Diabetes Association became quite the critic of Eli Lilly because of their harmful behavior regarding Zyprexa.
    A speculative thought regarding the freedom if not acceptance for this type of promotional behavior: there exists amazing alliances between Eli Lilly and the Bush administration have existed as well. George H.W. Bush became an Eli Lilly director after leaving the CIA and lobbied to infect third world countries with Lilly medications. He also did his best to maximize tax breaks further for this industry that now employs both himself and his political affiliation. In fact, many members of this administration have some connection with Eli Lilly. It seems to be a revolving door issue once again. One could speculate that the Zyprexa campaign continued for so long because of the relationships the maker of the drug had and has with other powerful people.
    The next related psychotic tactic (pun somewhat intended) Eli Lilly created was an advisory board paid well by this company to focus on the progressing concerns of Zyprexa. This tactic did work briefly, but did not change the view of the drug by the medical community in any way perceptually regarding their embellished drug.
    Understandably, the health care professionals in the medical community began to get vexed and irritated by Eli Lilly’s deceptive and overtly destructive promotional tactics regarding Zyprexa- which included the company’s own speakers that were utilized in the past expressing concerns overtly. Such events materializing resulted in many ways Eli Lilly being ostracized was because of their disregard for those they are obligated to serve in the medical community, which are those in need of restoration of their health.
    Perhaps most disturbing and harmful was the Eli Lilly’s intentional holding of crucial safety information related to Zyprexa even before the drug was even approved. For example, Eli Lilly’s Zyprexa representatives were instructed without doubt to neutralize the legitimate concerns doctors may have about Zyprexa, if not outright fear regarding this deadly drug they now perceived as being a clear reality. The representatives were in agreement of continuing to dodge or neutralize legitimate concerns about Zyprexa, with the promise of Eli Lilly’s management team to fill their wallets more if they maintain obedience regarding this directive that caused harm in the form of such physiological disorders as metabolic syndrome associated with Zyprexa, yet the sales force still denied the association due to the insistence of their employer. Essentially, the Zyprexa representatives with Eli Lilly were trained, perhaps aggressively, to disarm negative perceptions about Zyprexa, even though these perceptions continuously proved to be valid. This deeply troubled many Zyprexa representatives, as at this point they were aware of the dangers of the drug they were promoting, yet likely continued to do so in order to maintain employment.
    Also, and of no great surprise, off label promotion with Zyprexa if not other products by Eli Lilly was a norm within the organization and certainly encouraged by Eli Lilly’s management team. Encouraging doctors to prescribe Zyprexa for unapproved FDA indications are an example. Amazingly, reflecting back on the behavioral flaws by Eli Lilly for quite some time, they did not alter their method of business even though there was a strong perception regarding this company being both aggressive and greedy, and likely criminal in the way they chose to conduct their business. And depression was not the only off label claim with Zyprexa. Eli Lilly considered such criminal acts as off label promotion as ‘redefining the market’. This is yet another example of their absurdity. The overt demonstration of profits over patients is clearly absurd and inexcusable in any situation.
    In the year 2000, Eli Lilly greatly expanded what was called their long term care sales force to increase the utilization of Zyprexa intake in the elderly to nearly 200 specialty sales representatives. This patient population prescribed Zyprexa can be deadly- as Zyprexa is harmful to older citizens- specifically pneumonia and eventual premature death result from Zyprexa intake in this patient population. The intent was to promote Zyprexa for those certain elderly patients with dementia and Alzheimer’s disease, as a set of symptoms are thought to occur in such patients called, “Sunshiner’s syndrome- which includes elevated agitation and confusion in such patients in the evening hours primarily. The syndrome is vague and non-specific with unknown etiology, yet the intent was to sedate such patients with Zyprexa for this syndrome. Furthermore, the purpose was to have Zyprexa to be used in these patients to sedate them, a process known as ‘snowing’. As a result, each long term care Lilly sales representative increased revenues for their employer more than other sales representatives in different divisions within the organization.
    Yet in the year 2002, Eli Lilly was having financial disappointments, which again did not shock many. So to stay in form, they went on a mission to develop speakers to align with them and to not educate others, but to pacify other doctors in hopes that their problems with Zyprexa would disappear. After the speaker episode, Eli Lilly had the audacity to claim that Zyprexa was indeed the best in the class of atypical antipsychotics. Such a statement appears psychotic, to say the least. And now the market for atypicals is about 5 billion a year, so there seemed to be no end as to what Eli Lilly might try next. Also in this year our FDA called Eli Lilly ‘a sponsor’. I find that a bit disturbing. As disturbing as the covert meetings Eli Lilly had with the FDA as well.
    As the new millennium progressed over the next few years, lawsuits became a concern for Eli Lilly regarding Zyprexa. Doing what any responsible corporate entity would most certainly do, the upper management of Eli Lilly had the audacity to blame the media for the way they handled their drug Zyprexa. Around this time, Eli Lilly needed and did hire a public relations firm because of their image crisis that was likely well-deserved. About this same time, Eli Lilly implemented a nationwide program entitled, “Operation: Restore Confidence”. I’m not sure how a fully rational and conscious group of Eli Lilly people could create something so ridiculous and unrealistic considering what has materialized due to their crimes. Equally deviating from reality of Eli Lilly’s behavior is that they actually thought they could increase Zyprexa growth by hammering home astronomical efficacy of Zyprexa and continue on the path they have created.
    Another failure to add to what has been annotated so far was when Eli Lilly hired an organization called Lifespan Marketing, who colluded with Eli Lilly to create a brand new market establishing Zyprexa as the standard of care. Maybe Eli Lilly needs to adopt a standard of care for itself. This, it is understood, was largely ineffective.
    At least one human insider within Eli Lilly wanted to let everyone know he did not, nor will he ever forget his experience as a Zyprexa representative with Eli Lilly for years. His name is Shahram Ahari and he aligned with a non-profit advocacy group called Pharmedout after this experience, which was created due to a state settlement from another pharmaceutical company’s wrongdoing. Sharam spends his days now making others aware of things such as what you have read so far. I’ve spoken with Shahram, and I admire his assistance with others trying to correct this medical mess. He sacrificed much, and continues to do so.
    Eli Lilly appears pathologically persistent in frightening ways: next was a national implementation plan of action which focused on training the Zyprexa sales force to use what was called a J.C.P. study to emphasize the numerous off label benefits of Zyprexa. At the same time, Eli Lilly determined that primary care doctors should be their number one Zyprexa targets for increasing the growth of their drug. With this new focus, the sales force for Zyprexa were somehow convinced to tell doctors that fatigue is really the only side effect that presents itself with Zyprexa use by their patients, which of course is false. Again, citizens are overall not catatonic about such actions if they are aware of them with understanding.
    While on this off label role with Zyprexa combined with being void of fair balance regarding presenting this drug to others, Eli Lilly attempted to revive their long term care efforts by taking on Aricept, and Alzheimer’s drug, and encouraged others to switch to Zyprexa. The reaction for this misbehavior was Zyprexa being removed from Medicaid in 2004, according to documents that are authentic, and are available to others. While Lilly filed with the FDA an indication for Alzheimer’s disease as well as dementia, Zyprexa lacked the evidence to prove that this drug did more good than harm for such patients.
    Allan Reier was the Zyprexa product team leader at one point for this drug. He may have developed the unbelievable strategy of visiting psychiatrists to assure them they will not be sued if they prescribe Zyprexa for their patients. Literature and documents prove this strategy was implemented. That in itself illustrates the concern Lilly has about Zyprexa.
    So, now we are at a point where Eli Lilly had a flash of reality and preferred no media contact. Gosh, what a surprise. There was also the disclosure of Eli Lilly continuing to create, if not fund, the deceptive front groups to screen others in order to sell more Zyprexa as well.
    The next tactical plan from Eli Lilly was to re-implement blunting techniques regarding Zyprexa. My guess is that they dragged this into a week- long meeting with their sales force. This of course included dodging concerns by doctors that they are normally encouraged to partner with, historically. Such tactical plans of action were associated with such clever names as, ‘Viva Zyprexa’, or Zyprexa Limitless”. Maybe the next one will be ‘Zyprexa Revenue Regression’. Zyprexa for atrophy, maybe?
    Another tactic authorized by Eli Lilly was to use those bonafide contract research organizations (CROs) to manufacture safety, health, and outcomes database studies. A deceptive publication plan followed.
    CROs are commercial research organizations that include often what may be substandard research investigators to work with the sponsor of such clinical trials. Eli Lilly, as a sponsor, has the ability to alter aspects of such trials for their own benefit. This was done- as they still encouraged as a result children to consume Zyprexa- near a million of them involved due to an arrangement that Zyprexa will be promoted by Lilly’s ADD drug Strattera.
    As stated earlier, previously sealed and damaging documents got exposed at the end of 2006, and are accessible on the internet and some websites, such as, which is what this article is based upon, overall, these internal documents that appear to be authentic.
    Perhaps the documents should have been exposed immediately instead of being held from public view. Perhaps prosecutors should not keep such information from others due to a collusive relationship with such corporations. One may only speculate as to why this occurs.
    Eli Lilly makes over 4 billion dollars a year on Zyprexa, and has made close to 40 billion dollars on their drug so far.
    Eli Lilly has had to pay well over a billion dollars for Zyprexa damage to others between 2006 and 2007. The company recently paid the largest one-time payment to settle accusations of their wrongdoing regarding Zyprexa at nearly 1.5 billion dollars- with pending cases involving over half of the United States. I’m sad to say I’m unconvinced this will change their behavior regarding their tactics. Cynical, perhaps I am. History proves this is often the case:
    “We deeply regret the past actions covered by the misdemeanor plea (1.4 billion dollar settlement with the DOJ). At Lilly, we take seriously our responsibilities to abide by all the laws governing our business practices, and we realize that we have a tremendous responsibility to the patients and healthcare professionals we serve. Every day and with every interaction we strive to operate in a responsible and compliant manner. Doing the right thing is non-negotiable at Lilly, and I remain personally committed to all of us at Lilly maintaining the highest standards of conduct. The company’s comprehensive compliance program is an embedded part of the company’s culture. These are not just words to us- we continue to implement a range of programs and policies to help ensure that we operate in a manner consistent with all applicable laws and regulations. These programs apply to all parts of our business, and all of our employees are aware of the imperative for them to be models of compliance and of ethical behavior. —— John C. Lechleiter, C.E.O., Eli Lilly
    Psychosis- One with a personality disorder manifested in aggressive, perverted, criminal, or amoral behavior without empathy or remorse.
    Dan Abshear
    Author’s note: What has been written is based upon information and belief.

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