Will even a $2.3 billion fine change drug marketing practices?

Pfizer today agreed to pay a $2.3 billion fine, and admit guilt, to settle cases arising from its marketing of Bextra, a painkiller removed from the market 4 years ago.

The case began with whistleblowers concerned the drug-maker was pushing the drug for unapproved uses.

Sounds hefty. But is it really?

Consider that Pfizer set aside just this amount, $2.3 billion, while announcing its acquisition of Wyeth in January. As BNET reports it's a subsidiary, Pharmacia & Upjohn, that is actually copping the plea. Pfizer issued no press releases about the case until the settlement was finalized.

The fine also settled accusations concerning the marketing of three other drugs -- Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug. The Justice Department release said the company would "enter into a corporate integrity agreement," a fancy word for probation, in hopes of keeping future cases from spiraling.

In sum, Pfizer "managed" this case just like any other corporate event, like the failure of a clinical trial. In acquiring Wyeth it turned the case from a cliff to a mere "bump in the road," as one analyst described its troubles to The New York Times.

The use, and marketing, of drugs for uses beyond those approved by regulators is a continuing scandal. Whether it's Pfizer pushing these drugs, an entertainer's doctor offering  propofol as a sleeping aid, or a university department head using Risperdal for ADHD, it's practically business as usual.

Drug makers, their agents, researchers, universities, and ordinary doctors are all implicated in this scandal, and the tools available to police them seem increasingly inadequate to the task at hand.

This post was originally published on Smartplanet.com