The Whistleblower: Confessions of a Healthcare Hitman.

The Whistleblower: Confessions of a Healthcare Hitman Peter Rost Soft Skull Press www.softskull.com 224 pp., $14.95

It is not unusual for plaintiff lawyers litigating pharmaceutical cases to uncover business practices that put profits over safety. We read about it in documents we discover and hear about it in testimony we take during depositions. Unfortunately, that focus on sales, not safety, is common in the marketplace controlled by big pharma.

Peter Rost, a physician and former drug company executive, knows about it, too--but at an almost incomprehensible personal and professional sacrifice. The Whistleblower: Confessions of a Healthcare Hitman could not have been easy for Rost to write, never mind publish. In the hope of setting the record straight, he exposed the corrupt power of a pharmaceutical giant and laid a foundation for positive change in the future. But in doing so, he may have ensured the end of an impressive career.

Rost was vice president of marketing at Pharmacia, a rarely talked-about pharmaceutical company that Pfizer took over in April 2003. He was in charge of U.S. and global marketing of Genotropin, a human growth hormone and flagship drug for Pharmacia that was expected to generate global sales in excess of $600 million. Genotropin was intended for use in short children and adults with growth hormone deficiency.

Rost enjoyed life at Pharmacia. His coworkers were happy and energetic, and the atmosphere was positive.

Enter Pfizer. As Rost describes the takeover, Pfizer dehumanized the once-vibrant Pharmacia workplace. Managers were forced to attend "career transition" school--a course on how to fire the masses of Pharmacia employees who would be casualties of the takeover. And managers were forbidden to provide recommendations for employees leaving the company.

Even worse, Rost claims, was Pfizer's resolve to destroy anyone who stood in its way or who wanted--as Rost did--to tout the cost and health care benefits of importing drugs, and to tell the truth about Pfizer's decision to illegally promote off-label use of Genotropin as an anti-aging drug. Rost says the company entered into "favorable contracts" with distributors and doctors working in the anti-aging area and paid them kickbacks through "consulting agreements." Sales reps who did not agree to Genotropin's off-label promotion were fired or faced other adverse actions.

Rost, for his part, worked with Pharmacia's legal department to correct many of the illegal marketing practices. He then went on a truth-telling mission, which appears to have been aimed in part at trying to save his job both during and after the takeover. Pfizer, he thought, might not want to fire someone with enough information about illegal marketing activity to be a serious liability to the company.

But Rost's actions were not all sell: serving. In fact, they're cloaked with unimpeachable credibility because ultimately they address an issue--the industry's opposition to drug importation--not specific to him, his job at Pfizer, or even Pfizer itself. Rost took on the entire industry, not because he had an ax to grind, but because of his belief in access to health care and the free market system.

The drug industry's resistance to importation is, as Rost describes, due to the closed market it controls. Companies fear that importing drugs will cut into their bottom lines.

Rost thinks otherwise. He characterizes drug importation as one of the most important health care issues today and describes how 67 million Americans are without insurance for drugs. "The biggest argument against reimportation is safety," he writes. "What everyone has conveniently forgotten to tell you is that in Europe, reimportation of drugs has been in place for 20 years." If other countries could do it, and have done it, then why not the United States? As for company profits, Rost describes how lowering prices and making drugs more accessible can actually increase market share and ultimately create profits.

Notwithstanding ongoing pressure front Pfizer to keep quiet, Rost has demonstrated how one person can assert tremendous pressure against a corporate giant. He writes about how media appearances, newspaper articles, communication with various government agencies, and a general investigatory savvy helped him get his messages out and, at the same time, demonstrate to Pfizer that he was not simply going to go quietly into the night.

Ultimately, Rost was fired. He has brought a False Claims Act lawsuit against Pfizer.

He opens his book by noting some interesting statistics about whistleblowers from a study by Donald Soeken of St. Elizabeth's Hospital in Washington, D.C. After exposing fraud, 90 percent of whistleblowers were fired or demoted, 26 percent had to seek psychiatric or physical care, 17 percent lost their homes, and 8 percent were bankrupted. Still, only 16 percent said they would not blow the whistle again.

It's difficult to fathom putting your personal and professional life on the line. But that's exactly what Rost did, and he tells about it in a compelling story of courage and principle.

JASON MARK practices law in Great Neck, New York.