Industry documents that have emerged in a federal civil lawsuit in Boston show that big pharmaceutical companies sometimes calculated to the penny the profits that doctors could make from their drugs. Sales representatives shared those profit estimates with doctors and their staffs, the documents show.
In one PowerPoint presentation from 2000, a Bristol-Myers Squibb executive told employees that oncologists’ biggest concern was “Reimbursement Today, Reimbursement Tomorrow, Reimbursement!”
Dr. Robert Geller, an oncologist who worked in private practice from 1996 to 2005 before leaving to join a biotechnology company, said that cancer doctors knew the profits they could make and in some cases would change treatment regimens or offer unnecessary care to make extra money.
“It’s clear that physicians stopped making decisions based on what made scientific or clinical sense in lieu of what made better business sense,” Dr. Geller said.
While many of the documents in the lawsuit remain sealed, the exhibits used in the first trial are part of the public record. They show that representatives for the companies brought spreadsheets to oncologists’ offices to show doctors how much they could make.
For example, in 1998 Schering-Plough told its representatives that its drug Intron-A, a treatment for bladder cancer, could produce a profit for each patient of “$2,373.84 for our physicians just on the drug alone.”
Pitching Zoladex, a treatment for prostate cancer, a sales representative for AstraZeneca was more blunt. “DO THE MATH!” he wrote in a letter to a group of urologists in Arizona.
More from Alex Berenson in NYT
2 comments:
Alex Berenson's report on cancer treatment driven profits, spelled out for physicians by pharmaceutical manufacturers' representatives, raises important questions regarding the necessity of drug reps. Here are 3 of them - and note that the issue is not limited to representatives of cancer drug manufacturers.
How does "pitching the spread" improve the value offered by the manufacturer? Answer: This tactic has huge negative impact on net present value. Pick any search engine and type in "Medicare Fraud" for details of HUGE fines paid by Astra Zeneca, Bayer, GSK, Dey, Pfizer, and TAP.
Why do drug reps think its OK to promote features of a drug that do not connote clinical benefit to the patient? Answer: Because the "drug rep profession" has accepted the role of promoting drugs that cannot be clinically differentiated from competitors. Pick any search engine and type in "me too drugs" to verify this pervasive issue.
Exactly when might a face to face encounter with a manufacturers representative become a liability for a physician? At present, the answer is unknown - but the apparent ease with which a sales force will engage in nonclinical sales tactics suggest that we'll be hearing more about this one.
The shift, more than 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation's cancer patients has prompted in large part additional costs to the government and Medicare beneficiaries. The Chemotherapy Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.
This was first brought to attention at a Medicare Advisory Panel meeting in 1999 in Baltimore. There was a gastroenterologist in attendance who complained that Medicare had cut his reimbursement for colonoscopies from $400 to $108 and how all the doctors in his large, multi-specialty internal medicine group were hurting, save for two medical oncologists, whom he said were making a killing running their in-office retail pharmacies.
Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But medical oncologists bought chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products and then administered them intravenously to patients in their offices.
Not only do the medical oncologists have complete logistical, administrative, marketing and financial control of the process, they also control the knowledge of the process. The result is that the medical oncologist selects the product, selects the vendor, decides the markup, conceals details of the transaction to the degree they wish, and delivers the product on their own terms including time, place and modality.
A joint Michigan/Harvard study authored by Drs. Joseph Newhouse and Craig C. Earle, entitled, "Does reimbursement influence chemotherapy treatment for cancer patients," confirmed that before the new Medicare reform, medical oncologists chose cancer chemotherapy based on how much money the chemotherapy earned the medical oncologist. A survey by Dr. Neil Love, "Patterns of Care," showed results that the Medicare reforms still were not working. It was still an impossible conflict of interest.
A patient wants a physician's decision to be based on experience, clinical information, new basic science insights and the like, not on how much money the doctor gets to keep. A patient should know if there are any financial incentives at work in determining what cancer drugs are being prescribed.
It's not that all medical oncologists are bad people. It's just that the system is rotten and still an impossible conflict of interest. Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. There are so many ways for humans to rationalize their behavior.
There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no Chemotherapy Concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time when people make their most important decisions in life, they are in the most idealitstic period of their lives.
The government wasn't reducing payment for cancer care under the new Medicare bill. They were simply reducing overpayment for chemotherapy drugs, and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive.
Although the new Medicare bill tried to curtail the Chemotherapy Concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and let them be doctors again.
http://www.healthyskepticism.org:80/news/2007/Jun.php
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