[NYT] Texas Medication Algorithm Project; Doctors write Prescriptions- Pharmas write checks

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> SSRI-Research

> Mon, 23 Aug 2004 17:06:42 -0700 (PDT)

> [sSRI-Research] [NYT] Texas Medication

> Algorithm Project; Doctors write Prescriptions-

> Pharmas write checks

>

>

> The pharmas are busily promoting the concept that

> the " old fashioned " drug trials of the product being

> compared the placebos is now a thing of the past.

> Recent revelations of the drug makers " cherry

> picking " results, and hiding unfavorable results has

> resulted in a lot of bad press. They are replacing

> this system with what is called " best practices " , a

> survey of " experts " who deal directly with the

> patients. These folks are simply polled on what

> meds they use in a given situation.

>

> Up till the time GARDINER HARRIS wrote this story a

> few months ago, the exact process of how these

> " experts " were selected was a total mystery.

>

> Here what the late Paul Harvey would have called,

> " the rest of the story " .

>

> -

>

> As Doctors Write Prescriptions, Drug Company Writes

> a Check

>

> By GARDINER HARRIS

>

> Published: June 27, 2004

>

> Michael Stravato for The New York Times

>

>

> Dr. Chris Pappas, a liver specialist and clinical

> researcher, said Schering-Plough funded

> " pseudo-trials. "

>

> The check for $10,000 arrived in the mail

> unsolicited. The doctor who received it from the

> drug maker Schering-Plough said it was made out to

> him personally in exchange for an attached

> " consulting " agreement that required nothing other

> than his commitment to prescribe the company's

> medicines. Two other physicians said in separate

> interviews that they, too, received checks unbidden

> from Schering-Plough, one of the world's biggest

> drug companies.

>

> " I threw mine away, " said the first doctor, who

> spoke on the condition of anonymity because of

> concern about being drawn into a federal inquiry

> into the matter.

>

> Those checks and others, some of them said to be for

> six-figure sums, are under investigation by federal

> prosecutors in Boston as part of a broad government

> crackdown on the drug industry's marketing tactics.

> Just about every big global drug company — including

> Johnson & Johnson, Wyeth and Bristol-Myers Squibb —

> has disclosed in securities filings that it has

> received a federal subpoena, and most are juggling

> subpoenas stemming from several investigations.

>

> The details of the Schering-Plough tactics, gleaned

> from interviews with 20 doctors, as well as industry

> executives and people close to the investigation,

> shed light on the shadowy system of financial lures

> that pharmaceutical companies have used to persuade

> physicians to favor their drugs.

>

> Schering-Plough's tactics, these people said,

> included paying doctors large sums to prescribe its

> drug for hepatitis C and to take part in

> company-sponsored clinical trials that were little

> more than thinly disguised marketing efforts that

> required little effort on the doctors' part. Doctors

> who demonstrated disloyalty by testing other

> company's drugs, or even talking favorably about

> them, risked being barred from the Schering-Plough

> money stream.

>

> Schering-Plough says that the activities under

> investigation occurred before its new chief

> executive, Fred Hassan, arrived in April 2003, and

> that it has overhauled its marketing to eliminate

> inducements.

>

> At the heart of the various investigations into drug

> industry marketing is the question of whether drug

> companies are persuading doctors — often through

> payoffs — to prescribe drugs that patients do not

> need or should not use or for which there may be

> cheaper alternatives. Investigators are also seeking

> to determine whether the companies are manipulating

> prices to cheat the federal Medicaid and Medicare

> health programs. Most of the big drug companies,

> meanwhile, are also grappling with a welter of suits

> filed by state attorneys general, industry

> whistle-blowers and patient-rights groups over

> similar accusations.

>

> In many ways, the investigations are a response to

> the evolution of the pharmaceutical business, which

> has grown in the last quarter-century from a small

> group of companies peddling a few antibiotics and

> antianxiety remedies to a $400 billion bemoth that

> is among the most profitable industries on earth.

>

> Offering treatments for almost any affliction and

> facing competition in which each percentage point of

> market share can represent tens of millions of

> dollars, most drug makers now spend twice as much

> marketing medicines as they do researching them.

> Their sales teams have changed from a scattering of

> semiretired pharmacists to armies of young women and

> men who shower physicians with attention, food and -

> until the drug industry recently agreed to end the

> practice - expensive gifts, just to get two to three

> minutes to pitch their wares. A code of conduct

> adopted in 1990 by the American Medical Association

> suggests that doctors should not accept any gift

> worth more than $100, but the guidelines are widely

> ignored.

>

> A quarter-century ago, the Food and Drug

> Administration was the lone cop on the drug industry

> beat. But the F.D.A.'s enforcement powers over drug

> marketing have been severely curbed since 1976 by a

> series of court rulings based mainly on the

> companies' free-speech rights. That left a vacuum

> that many companies decided to exploit, said William

> Vodra, a former F.D.A. lawyer.

>

> " A lot of people decided there was no check on what

> they were allowed to do, " Mr. Vodra said. Using

> fraud, kickback and antitrust statutes, federal

> prosecutors, state attorneys general and plaintiffs

> lawyers stepped into the void, asserting that the

> companies' sales pitches have cost the government

> billions of dollars in payments for drug benefits.

>

> This legal scrutiny can be expected to intensify.

> Once the new Medicare drug benefit takes full effect

> in 2006, the government will pay for almost half of

> all medicines sold in the nation. So the marketing

> programs will cost the government even more money

> and, if they are uncovered and determined to be

> illegal, will probably result in even larger fines.

>