Johnson and Johnson has agreed to pay $2.2 billion for its illegal marketing and kickback program. At first blush, that seems like a tremendous blow. But when you dig deeper, you see that this is a penalty that J & J will gladly pay. The drug at issue is Risperdal, a drug approved by regulators to treat schizophrenia in adults. But from 2003 to 2010 when J & J was pitching off label uses of the drug for things ranging from dementia to anxiety, J & J sold $24.2 billion of Risperdal alone. In August J & J proclaimed that the resolution with the federal government would not have a material adverse effect on J & J’s finances. They were right: as reported in Bloomberg Businessweek, the $2.2 billion agreement represents just 12.5 percent of J & J’s revenue in this quarter alone. If there’s a lesson here for our Washington State readership, it’s to be very leery of Big Pharm marketing. From the time a drug is first marketed to the time it is prescribed, it’s a business process. Big Pharm is big business. We all know that. But even knowing this, sometimes we let our guard down when it comes to getting our prescription drugs. You can never be too careful - you can't ask your doctor too many questions (what alternatives are there? is this an off-label use?). You need to keep your eyes wide open when it comes to the business of prescription medicine.