Recent mailings by CVS Caremark to doctors about Lilly’s Cymbalta antidepressant are causing a stir - and embarassing Eli Lilly. At issue is the notion that the big pharmacy chain and benefits manager is making available info about patients with - in this case, fibromyalgia - so that the drugmaker can target docs who may be inclined to prescribe the pill for this other indication.

The practice, however, has stunned some consumer advocates who says it’s really a paid promotion disguised as a professional mailing. “This kind of drug marketing should simply be forbidden,” Steve Findlay, senior health policy analyst at Consumers Union, tells The Indianapolis Star. “It does not fully inform doctors about drug treatment choices.” Eleanor Kinney, co-director of the Center for Law and Health at Indiana University School of Law-Indianapolis, is more emphatic: “The idea that it’s even permissable,” she tells the paper, “is atrocious.”

For Lilly, the Star notes, the issue raises “sensitive questions.” At a time when the drugmaker is holding itself up as an industry leader in ethics and transparency, the Cymbalta mailing raises new doubts about its dealings. It also serves as a reminder that some Lilly marketing practices have caused big trouble. In January, Lilly pleaded guilty to one misdemeanor and pay a $1.4 billion fine for promoting it Zyprexa antipsychotic for treating dementia, although the drug is not approved for such use.

Asked about the CVS mailings, a Lilly spokeswoman initially told the Star that docs value the mailings, denied any attempt to deceive them and insisted letters are used to warn docs about safety issues. “Lilly’s intent is to share medically accurate and relevant information with health-care professionals,” she told the paper. “To imply otherwise is just plain wrong.” But she later told the paper there are no plans to send more letters through CVS Caremark and the practice is being reevaluated.

The question, though, is why did it take a media inquiry for Lilly to recognize there may be a problem? Lilly boasts about being committed to a “corporate responsibility framework” that goes “beyond legal and regulatory compliance,” yet no one flagged the mailing as a potential issue. Mistakes happen, but this should have been an easy one to spot, yes?