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It’s a complicated issue, but once you sort through the details, it looks like Pfizer has pulled off a remarkably slimy example of putting marketing ahead of science.

Popular pharma-watcher Howard Brody, MD, PhD, has awarded a “brilliant sleaze” award to Pfizer Inc., the world’s largest research-based pharmaceutical company and numero uno in world-wide sales.

In his well-read blog, Hooked: Ethics, Medicine, and Pharma, Dr. Brody describes in painstaking detail how the company has schemed to increase sales of its major money-maker Lipitor, the anti-cholesterol statin drug, by deceiving physicians around the world with a questionable on-line heart attack risk assessment tool. Pfizer has been widely promoting use of the calculator, which indicates more patients are at risk — and therefore ripe for Lipitor prescriptions — than may be scientifically accurate.

The efficacy of the drug and of statins in general have been under considerable scrutiny lately, too, but that’s another matter, Dr. Brody says. “This entire theory of when statins are good for you is probably deeply flawed,” Dr. Brody says, “and as a whole shows how industry marketing has come to dominate science to an embarrassing extent. But for present purposes ignore all that. Imagine that the guidelines [for using statins] actually represent good science.”

He then goes on to explain how the NIH-based National Cholesterol Education Project (NCEP) developed two risk assessment tools, one automated, and the second a pencil-and-paper-based manual test. Higher risk for heart attack indicates a greater need for a statin drug like Lipitor. The differences in the two tests apparently were not unknown, but not widely known among the bulk of physicians who might prescribe statins.

According to Pfizer whistle-blower Dr. Jesse Polansky, who is embroiled in his own suit against Pfizer about alleged off-label marketing of Lipitor, the manual test mistakenly misclassifies a number of patients as high-risk who are actually at moderate risk, but never misclassifies patients downward by mistake. In fact, by finding more higher-risk patients, it does exactly what Pfizer would like it to do, which is increase Lipitor sales.

Two major Big Pharma players, AstraZenica and Merck, have risk calculators on their websites, but these are NCEP’s more accurate computerized calculators. Instead, Pfizer converted the paper-and-pencil test to an automated on-line version, and has since been promoting it’s use to physicians. Not only that, it appears Pfizer is distributing the computerized calculator to doctors as a PDA program, and distributing it by other on-line information sources.

Pfizer deserves a lot worse than the good doctor’s “brilliant sleaze” award. These are the kinds of actions that have destroyed not just the public’s trust in what was once an honorable industry, but the trust of medical institutions and the medical fraternity. Ethical breaches of this magnitude deserve hefty fines, and even prison time.