The marketing practices of Johnson & Johnson, the world's thirteenth largest advertiser (by 2004 adspend), are under investigation by the US Justice Department.

Of particular interest to Michael J Sullivan, the US attorney in Massachusetts, is the company's aggressive marketing of its heart-failure drug Natrecor.

Sullivan, who enjoys a reputation as 'the scourge of healthcare fraud', declined to disclose the specific reasons for his interest. His office, however, has subpoenaed information on Natrecor's "sales and marketing" practices.

Observers note that about 80% of the patients treated with the drug - mostly in outpatient clinics - are covered by Medicare, the US social security health system.

It is illegal for pharma companies to promote so called off-label (non-approved) uses of a pharmaceutical product, but accusing fingers have been pointed at J&J, alleging it encourages widespread and frequent use of intravenous Natrecor therapy in outpatient clinics.

This, say critics, oversteps the rules by actively promoting outpatient use of Natreco. J&J, however, disputes it has ever done so.

But J&J's rebuttal looks somewhat hollow in the light of an article published last week in the New England Journal of Medicine by Dr Eric Topol, chairman of cardiovascular medicine at the Cleveland Clinic.

This alleges that J&J's Scios unit actively encouraged physicians to launch their own private infusion centers to bill Medicare for the heart-failure treatment.

The Topol article cites Scios documents that instruct doctors to bill Medicare $408 for eight hours of observation during the infusion, a fee beyond the actual cost of the drug, which approaches $500 a vial.

Data sourced from New York Times; additional content by WARC staff