Until 2010 when the Physician Payments Sunshine Act, which requires disclosure of Pharma payments, passed, the only thing better than working for Pharma was being a doctor wined and dined by Pharma.
Pfizer jetted 5,000 doctors to Caribbean resorts where they enjoyed massages, golf and $2,000 honoraria, charges Blue Cross & Blue Shield, to sell its painkiller Bextra (withdrawn from the market in 2005 for heart risks). GSK sent doctors to lavish resorts to promote Wellbutrin, charges the Justice Department. Johnson & Johnson bestowed trips, perks and honoraria on Texas Medicaid officials to get its drug Risperdal preferred on the formulary, charged a state lawsuit. Bristol-Myers Squibb enticed doctors to prescribe its drugs with access to the Los Angeles Lakers and luxury box suites for their games, say California regulators. In China GSK is charged with using a network of 700 middlemen and travel agencies to bribe doctors with cash and sexual favors and Victory Pharma, an opioid drugs maker, was charged with treating doctors to strip shows. Nice.
Of course, Pharma reps did as well as the doctors. Thanks to their Barbie and Ken doll looks and the free samples, gifts and lunches they would bring medical staff, they would often waltz in to see the doctor before waiting and sick patients. Some had their own lounges at medical offices. Pharma reps were so famous for feeding their prescriber prospects, during a question and answer period at a medical conference about cutting financial ties to Pharma, a doctor asked in all earnestness, “but what will we do for lunch?”
The shameless schmoosing of Pharma reps even sparked jokes like these.
The Devil offered a Pharma rep $3 million a year if he would consign his wife and children’s souls to hell. “What’s the catch?” he asked.
A doctor was drinking at the bar and every few minutes took a picture out of his pocket and looked at it. “What are you doing?” asked the bartender. “I have my drug rep’s picture in there,” said the doc. “When he starts to look honest, I’ve had enough to drink.”
Trips to resorts and strip clubs will likely continue to diminish under the Physician Payments Sunshine Act but there are many other ways, often sneaky, that Pharma can entice doctors to prescribe its expensive, patent drugs.
Spying on prescribing
Like the NSA spying program, shameless spying on doctors’ prescribing habits spares almost no one. Recently, the full sweep of IMS Health Holdings’ prescription data mining was revealed by ProPublica that reported that IMS’ collection includes over 85 percent of the world’s prescriptions and “comprehensive, anonymous medical records for 400 million patients.”
In 2007, there was a backlash against another seller of medical information: the AMA itself. By selling the names, office addresses and practice types of almost every doctor in the US to marketing firms, the AMA netted almost $50 million a year, the American Medical Student Association and the National Physicians Alliance charged at the AMA’s convention. The database of 900,000 doctors does not violate privacy, counters the AMA, since doctors can opt out.
Psychiatrist Dan Carlat wrote in the New York Times that he was “astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits” and that his drug reps told him “they received printouts tracking local doctors’ prescriptions every week.” A 2011 Supreme Court ruling found the collection and dissemination of prescribing behavior was “speech” and protected by the First Amendment. (See: a corporation is a person . . . )
CMEs
In order to keep their state licenses and satisfy insurance regulations, doctors must enroll in a certain amount of CMEs—continuing medical education courses. Not surprisingly, these classes are often “taught” for free by Pharma-funded specialists, sparing doctors from having to pay for them but providing the objectivity of a time-share presentation. One such class, called “Atypical Antipsychotics in Major Depressive Disorder: When Current Treatments Are Not Enough,” funded by Seroquel maker AstraZeneca was taught by former Emory University psychiatrist Charles Nemeroff, who lost his department chairmanship due to unreported Pharma income.
Another CME called “Bipolar Disorder: Individualizing Treatment to Improve Patient Outcomes,” was “taught” by Trisha Suppes, who admits to funding by Abbott, AstraZeneca; GlaxoSmithKline, Janssen, Novartis, Pfizer, Wyeth, Bristol-Myers Squibb, Eli Lilly, Shire and four more Pharma companies.
Another CME, “Individualizing ADHD Pharmacotherapy with Disruptive Behavioral Disorders” was taught by the Johnson & Johnson-funded Robert L. Findling and refers to Risperdal or its generic version, risperdone, 13 times.
Many CMEs teach doctors about the lucrative new disease category of Adult ADHD and how to keep kids from going off their ADHD meds when they get to college. Ka-ching.
Ghostwriting
Being published in medical journals is essential to academic doctors but researching, writing and reworking papers is a formidable job. Luckily for doctors, Pharma is willing to help—as long as the doctors write what Pharma wants.
In just three years, medical writers associated with Parke-Davis, which became Pfizer, wrote 13 papers extolling the benefits of Neurontin, including in the prestigious Cleveland Clinic Journal of Medicine, in the names of the “author” doctors.
Medical writers at Wyeth, also now Pfizer, wrote more than 50 papers pushing the now discredited hormone replacement therapy (HRT) in the names of doctor “authors.”
“Is There an Association Between Hormone Replacement Therapy and Breast Cancer?” asked one article in the Journal of Women’s Health. Guess what it concludes? “The Role of Hormone Replacement Therapy in the Prevention of Postmenopausal Heart Disease,” another ghostwritten paper, despite HRT’s established heart risks, appearing in the Archives of Internal Medicine. And despite HRT’s links to dementia, another paper, which also ran in the Archives of Internal Medicine, was titled “The Role of Hormone Therapy in the Prevention of Alzheimer’s disease.” Maybe there needs to be a new joke about the Pharma-funded papers: The Devil tells doctors they can contribute to medical journals if they’re willing to write marketing messages instead of about medical research. “What’s the catch?” some ask.
Clinical trials
Pharma-funded clinical trials can be paydirt to doctors, yielding as much as $10,000 per patient in some cases. In 2010, Sen. Charles Grassley (R-Iowa) addressed the frequent conflict of interest of doctors accepting major Pharma revenue while also accepting NIH money, our tax dollars. The medical institutions where the doctors work also are swimming in Pharma money, of course.
It is a situation exacerbated by the “technology-transferring” Bayh-Dole Act of 1980 which dangled the riches of “industry” before medical institutions, just as the former were floundering and the latter was booming, says Marcia Angell, former editor-in-chief of the New England Journal of Medicine. “Harvard’s Clinical Research Institute (HCRI), for example, originally advertised itself as led by people whose ‘experience gives HCRI an intimate understanding of industry’s needs, and knowledge of how best to meet them,’” writes Dr. Angell, “as though meeting industry’s needs is a legitimate purpose of an academic institution.”
And not all clinical trials are kosher. Another sneaky way Pharma gets doctors to prescribe its drugs is to set up faux clinical trials. A 1995 study billed as assessing the safety, efficacy, and tolerability of Neurontin was nothing but a ruse to get the 772 participating doctors to prescribe the drug themselves, said an article in the Archives of Internal Medicine, because it gave them familiarity and experience with the drug. In addition to misleading the doctors who thought the trials were valid, the study also misled the patients who did not know it was a marketing, or “seeding” study, and whose participation was overseen by investigators with insufficient training and clinical experience. Eleven of the 2,759 patients in the trials died, 73 suffered severe adverse events and 997 experienced less serious side effects.
Read more about unethical drug company practices in Martha Rosenberg’s award-cited book, Born with a Junk Food Deficiency—How Flaks, Quacks and Hacks Pimp the Public Health.
