But the article paints a broader picture of widespread wrongdoing in
the industry. Eli Lilly, Bristol-Myers Squibb and four other drug companies have paid a total of $7 billion in fines and penalties, with six of them admitting in court that they have marketed
medicines for unapproved uses, Evans recounts. And critics charge that it's not a harmless game.
"Marketing departments of many drug companies don't respect any boundaries of
professionalism or the law," says Jerry Avorn, a professor at Harvard Medical School. "The Pfizer and Lilly cases involved the illegal promotion of drugs that have been shown to cause substantial harm
and death to patients."
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But the fines are a pittance compared to the profits the companies can realize, and they regard the risk of getting caught as just another cost of doing business, says Lon Schneider, a professor at the University of Southern California's Keck School of Medicine in Los Angeles. "There's an unwritten business plan," he says. "They're drivers that knowingly speed. If stopped, they pay the fine, and then they do it again."