Lilly - Viva Zyprexa: Slate's hot document... Martha, David and Christine

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Part pep talk and part "message" script, the memo instructs sales reps to tell primary care physicians to prescribe the anti-psychotic drug directly to their patients rather than refer them to psychiatrists (see page three) because such referrals are often "expensive" and "difficult to schedule."

On Page 9, Lilly sales reps are instructed to say that the most common side effect of Zyprexa is … "somnolence."

The memo sounds an awful lot as though Lilly wants its sales reps to tell primary-care physicians to prescribe Zyprexa for off-label uses.

The law permits doctors to do so, but Lilly's executive vice president of science and technology, has stated flatly: "We do not engage in off-label promotion."

That's difficult to square with the script on Page 3.

"Doctor, you know your patients better than any other clinician," the memo reads, before describing three patient types a primary care physician would commonly see in his office: "Martha," an aged widow who is difficult for her family to manage at home; "David," who suffers from a probable "mood disorder"; and Christine, a twentysomething who struggles with "a history of poor work performance." None of these hypothetical patients would appear to suffer from schizophrenia or bipolar disorder, which are the only two conditions Zyprexa is approved for.