40 replies to this topic

[stocks]

A Harvard study of 3,167 physicians across six specialties (not psychiatry) has found that 94 percent of them reported some kind of relationship with the pharmaceutical industry. Twenty-eight percent received payments for consulting, giving lectures, or enrolling patients in trials. Two main observations of the study:

"The industry may focus marketing efforts on physicians who are perceived as influencing the prescribing behaviors of other physicians.

Physicians in solo or small practices are more likely to have all types of relationships with the industry than physicians in hospitals and clinics, possibly because they have more freedom to prescribe, because hospitals and clinics may place restrictions on physician-industry relationships, or because physicians in small practices may be more dependent on the pharmaceutical industry as a source of information.

http://content.nejm....ull/356/17/1742


Meanwhile, an article in PLoS, co-authored by former drug rep Sharhram Ahari, reveals some of the industry’s bag of tricks. This includes money: $15.7 billion on promoting prescriptions drugs in the US in 2000, $4.8 billion spent on detailing.

In training, Mr Ahari was told: "When you're out to dinner with a doctor, the physician is eating with a friend. You are eating with a client." Reps then use "the friendship" to request favors in the form of prescriptions. Skeptical doctors are plied with medical literature and wooed as teachers. If a particular doc is unapproachable, attention is lavished on office staff.

Gifts of coffee mugs and such are items kept close at hand, with the drug name remaining uppermost on the physician’s subconscious. Reps also recruit "thought leaders" as speakers.

The industry tracks prescription records from information provided by pharmacies. Patient names are not included, but physicians may be identified by their state license number and other data. "High prescribers" are treated to "educational" grants.

Concludes the article:

"Pharmaceutical companies spend billions of dollars annually to ensure that physicians most susceptible to marketing prescribe the most expensive, most promoted drugs to the most people possible. The foundation of this influence is a sales force of 100,000 drug reps that provides rationed doses of samples, gifts, services, and flattery to a subset of physicians. If detailing were an educational service, it would be provided to all physicians, not just those who affect market share."

http://medicine.plos...al.pmed.0040150

[calmcookie]

Hi Stocks, I enjoyed reading your post. Best to all, C.C.

[calmcookie]

It's an unfortunate system, driven by normal human behaviour. I don't wish to blame anyone and must say that the doctors in the hospital where I work are really good about not overprescribing. But that doesn't happen everywhere. The answer, I believe, is to encourage people to take responsibility for their own health ... to develop good health habits. We can't continue along the current path and remain a "superpower." How can we, as a nation, be "powerful" when more and more people are literally too fat to walk to the bathroom? Every month I have at least 2 or 3 patients who are over 600 pounds and completely bedridden. That was unheard of 20 years ago. And childhood obesity is STILL on the increase. As long as people believe that health comes in a bottle ... then the system will continue. I do see significant signs of change ... and that's wonderful! Long life to all, C.C.

Edited by calmcookie, 05 June 2007 - 01:05 PM.

[maineman]

Well, since you don't believe in medicine or doctors, then this information is of no value to you, right? Or do you believe in medicine and doctors but you want your doctor to be more, "ethical" or "independent"? Or do you think your doctor should only get his information from, where? Medical journals? If so, which ones are "honest"? Which medical source do you feel is "right" for your doctor? Curious about your thinking here.... mm

[stocks]

US drugmaker Bristol-Myers Squibb and a subsidiary have agreed to pay more than $515m (£251.7m) to settle allegations of marketing certain drugs illegally.


The US DoJ concluded on Friday that the company and a wholly-owned subsidiary called Apothecon had used incentive schemes to encourage doctors and wholesalers to stockpile their drugs and so help Bristol-Myers achieve its sales targets.

This included maintaining "fraudulent and inflated" prices for a wide range of cancer and generic drugs knowing that federal health care programmes established reimbursement rates based on those prices.

Bristol-Myers was also accused of knowingly misreporting its best price for the anti-depression drug Serzone to Medicaid, the government-backed health insurance scheme.

In addition, the DoJ claimed that the company had promoted the use of the treatment-specific anti-psychotic drug Abilify to a wider client base than recommended by the Food and Drug Administration.

"Patients are entitled to unbiased decision-making from their physicians and should not have to worry that financial inducements or lavish entertainment have influenced their physicians' prescribing choices," said Michael Sullivan, the US attorney in Boston.

http://news.bbc.co.u...ess/7019083.stm

[stocks]

As the reps became comfortable with me, they began to see me more as a sales colleague. I received faxes before talks preparing me for particular doctors. Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors' prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors' prescriptions every week.

The process is called "prescription data-mining," in which specialized pharmacy-information companies like IMS Health and Verispan buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies. This may include deciding which physicians to aim for or it can help sales in other ways.

The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors' names to the data-mining companies, but they will release their Drug Enforcement Agency registration numbers. The AMA licenses its file of U.S. physicians, allowing the data-mining companies to match agency numbers to specific physicians. The AMA makes millions in information-leasing money.

http://www.iht.com/a...oney/wbdrug.php

[stocks]

Amid a nationwide effort to crack down on freebies given to doctors by drug manufacturers, legislation that would do so in New York is facing stiff opposition from business groups and some members of the medical community.

The bill is being considered as several other states are tightening restrictions on gifts to doctors. In April, lawmakers in Massachusetts approved a bill that bans pharmaceutical company gifts of any value to physicians and their office staff. Minnesota has a ban on gifts worth more than $50, and in Vermont, gifts worth more than $25 must be disclosed. Senators Kohl, a Democrat of Wisconsin, and Grassley, a Republican of Iowa, have also backed legislation that would require drug manufacturers to disclose the amount of money they give to doctors.

http://www.nysun.com...-doctors/80228/

[stocks]

Menopause, as Brought to You by Big Pharma

Part of the Premarin saga shows how a drug maker successfully and cannily expanded a franchise whose central ingredient is horse estrogens into a billion-dollar panacea for aging women. Yet several hundred pages of court documents also raise questions about another aspect of Premarin’s trajectory: how Wyeth worked over decades to maintain the image and credibility of its hormone drugs even as the products were repeatedly under siege.

Pfizer representatives say court documents paint an unfair picture of Wyeth’s practices and that plaintiffs’ lawyers have cherry-picked documents for out-of-context comments to sway juries.

Still, the documents offer a snapshot of Wyeth’s efforts. Taken together, they depict a company that over several decades spent tens of millions of dollars on influential physicians, professional medical societies, scientific publications, courses and celebrity ads, inundating doctors and patients with a sea of positive preventive health messages that plaintiffs’ lawyers say deflected users’ attention from cancer concerns.

Even as evidence mounted of an association of the drugs with cancer — first in the 1970s with Premarin and endometrial cancer, then in the 1990s with Prempro and breast cancer — Wyeth tried to contain the concerns, the court documents show. (A note handwritten in 1996 by a Wyeth employee responding to a new report of breast cancer risks associated with hormone therapy said: “Dismiss/distract.”)

http://www.nytimes.c...s...rss&emc=rss

[stocks]

Drug company accused of hiding hazards of diabetes drug Avandia

it posed significantly greater risks in terms of heart-related complications.

Findings such as these are obviously disappointing for drug company executives and the shareholders they seek to serve, but they have obvious relevance to those taking the drug, as well as the doctors who advise on its use and prescribe it. Here, from the New York Times article, is an excerpt from an internal email written by former SmithKline Beecham executive Dr Martin Freed in 2001: “Per Sr. Mgmt [senior management] request, these data should not see the light of day to anyone outside of GSK.”

Another shocking revelation comes in the form of what appears to be a cosy relationship between GSK and certain elements within the Food and Drugs Administration (FDA) in the US. The FDA recently considered whether or not rosiglitazone should be pulled from the market, but in the end decided it should not. One of those arguing for the retention of this drug was Dr John Jenkins, director of the FDA’s office overseeing new drugs. According to the New York Times, Dr Jenkins briefed GSK extensively on the debate going on within the FDA.

If any of this is sounding remotely familiar, that might be because another apparent example of a drug company hiding data that caused significant suffering and cost many their lives came to light last year. It concerned the drug company Merck’s burying of data regarding the safety of its painkilling drug rofecoxib (Vioxx). See here for more about this.

I find it depressing and saddening that what we have here are apparent examples of drug companies allowing individuals to expose themselves to secretly known risks that could cost them their lives.

Carol says:
I read these stories with dismay but I’m never surprised. I worked in the medical industry for most of my working life. It is mostly staffed by good people but with the bottom line as the ONLY consideration. Management is driven purely by money, despite their high-minded talk of benefitting patients. They spend more money on marketing than on real R&D and the most terrible truth is that these companies employ doctors whose solemn oath is “first do no harm”. Where were they when these results were being buried?

http://www.drbriffa....tazone-avandia/

[stocks]

On The Take: How Medicine's Complicity with Big Business Can Endanger Your Health

Jerome Kassirer, a former editor-in-chief of The New England Journal of Medicine

Fact-dense, well referenced, yet balanced in tone and easy to read, this book is the best exposé I have ever read on the financial conflicts of the medical profession caused by the efforts of Big Pharma, which for this review will include device and test manufacturers as well as drug makers. From pens and pads to cruises and fake consulting arrangements, Big Pharma has caused financial conflicts in many physicians and others "on the take". Many of the consulting deals are to give talks, ostensibly based on good medical science, that promote a product. Much of this is shown to occur at Continuing Medical Education courses sponsored by Big Pharma in which gifts are freely dispensed, reprints of journal articles favorable to products are handed out, and financial ties of the "consultants" giving talks are minimized or concealed.

Academic researchers are tainted as well. By being encouraged by their universities to obtain grants with overhead from Big Pharma, they must do research that helps in product development. Agreements may delay, prevent or pollute the publication of results. When a product possibility from a government (usually NIH) grant is seen, federal legislation passed 20 years ago allows the researcher to patent discoveries, form a company, and do clinical trials on his own potential product. While this may have led to valuable results, the potential for bias at every step due to financial conflict is clearly laid out.

Journals fare little better, even the prominent JAMA, NEJM and Annals of Internal Medicine. Papers that may have been ghost-written by Big Pharma on clinical trials with selectively favorable results are published [see Joel M. Kauffman, Bias in Recent Papers on Diets and Drugs in Peer-Reviewed Medical Journals, J. Am. Physicians & Surgeons, 9(1), 11-14 (2004)]. Editors and peer-reviewers may have ties to Big Pharma. Editorials and comments in medical journals may be written by authors with financial conflicts of interest. Revealing such conflicts is mostly on the honor system at present.

Clinical guidelines for physicians are promulgated by committees whose members often have close ties to Big Pharma. The products included in formularies of HMOs, Medicare and other insurers, the only products that will be paid for, are influenced by Big Pharma, whose general lobbying efforts are already legendary.

http://www.amazon.co...r/dp/0195176847