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Off-label promotion under the radar Physicians can prescribe drugs off-label (for non-FDA-approved uses), but it is illegal for pharmaceutical companies to promote drugs off-label. Douglas Melnick, MD MPH, a former pharma insider, tells Adriane Fugh-Berman, MD how companies get around the bans. Medical science liaisons are company doctors and pharmacists that can legally answer questions about off-label use, so drug reps may coax questions about off-label uses from doctors, and then refer those questions to MSLs. Company representatives also manipulate compendia, which are compilations of drug uses – including off-label uses – that are used by insurers to determine what drugs to pay for. Dr. Melnick, a preventive medicine physician, is a consultant to PharmedOut.org, a publicly funded project to educate physicians about inappropriate pharmaceutical promotion. Dr. Fugh-Berman is the principal investigator of PharmedOut.org. Transcript of this video is available at www.pharmedout.org. PharmedOut is an independent project funded through the Attorney General Consumer and Prescriber Education grant program that educates physicians on how pharmaceutical companies influence prescribing.