New research by ProPublica shows that Big Pharma is paying docs hundreds of millions of dollars to pitch their product. Seven companies have now disclosed their payout information (only 36% of pharmaceutical companies). Those 7 companies doled out $257.8 million to about 17,700 providers from the beginning of 2009 through June of 2010. Almost 400 people received over 6 figures and 43 physicians made more than $200,000 — including two who topped $300,000.
Moving away from freebie spiffs like pens and ties, big pharma has relied more heavily on the people trusted most by doctors — their peers. Today, tens of thousands of U.S. physicians are paid to spread the word about pharma’s favored pills and to “advise” the companies about research and marketing.
According to a recent article, those doctors, “recruited and trained by the drug companies, those physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.”
For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.
Here is one example of what’s happening:
Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.
At an FDA hearing, he borrowed David Letterman’s shtick to deliver a “Top Five” list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug’s risks had been overblown.
“I still feel very convinced in the drug,” Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.
Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.
Roseman’s public profile comes from his work as one of Glaxo’s highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.
Avandia is more than twice as expensive as its generic counterpart, Glucophage.
That’s not all. A recently unsealed whistleblower lawsuit against Novartis, the nation’s sixth-largest drug maker by sales, alleges that many speakers were chosen “on their prescription potential rather than their true credentials.”
Speakers were used and paid as long as they kept their prescription levels up, even though “several speakers had difficulty with English,” according to the amended complaint filed this year in federal court in Philadelphia. In several instances, those former employees say that physicians were told to push “off-label” uses for various drugs.
Other allegations include:
Allergan, the maker of Botox, created faux advisory boards solely “to reward hundreds of its top injectors,” federal prosecutors charged this month. More than 200 doctors, for example, were put up at an oceanfront resort in Newport Beach, Calif., in 2005 and 2006 and paid $1,500 to listen to presentations, according to their sentencing memorandum.
Allergan settled with the government for $600 million last month and pleaded guilty to a misdemeanor for misbranding Botox. Allergan said in a statement that it is “committed to conducting its business with the highest ethical standards and in compliance with all applicable laws.”
Forest Laboratories created “preceptorship” programs in which physicians were paid up to $1,000 each to allow a sales rep to spend time observing their practice. “In reality, Forest sales representatives used the preceptorships to induce physicians to prescribe [anti-depressants] Celexa and Lexapro,” according to a 2009 complaint filed by federal attorneys in Massachusetts.
The reps filled out “return on investment” forms to justify the payments from 1999 until 2003. One rep noted that a psychiatrist’s prescription “numbers were trending up,” and “we need to keep a good thing going as long as we are still getting this kind of growth,” the complaint said.
Many more examples are now seeing the light of day thanks to a new law requiring all pharmaceutical companies to report their payments to doctors. That law takes full effect in 2013.