"Unlimited spending! Schedule all the programs you can." That was the management directive announced at the regional business meeting I attended when I first became a pharmaceutical rep. When I heard the announcement I felt like I was on an Enron train that was roaring down the tracks, and the company expected everyone to be on board. The company was giving its sales force unlimited funds to hire physicians as paid speakers, sometimes to influence other physicians to prescribe the company's drugs, at other times to simply financially reward physicians who wrote high volumes of prescriptions every month for the company's drugs.
Former Merck regional sales manager, Gene Carbona, told the New York Times that the only thing the company considered when selecting physicians to provide presentations was "the volume or potential volume of prescribing that the doctor could do." This is true of all pharmaceutical companies. According to The Wall Street Journal (August 31, 2009), Eli Lilly alone paid physicians $22 million dollars in just the first quarter of 2009.
The higher a physician is on the influential ladder, the greater the financial rewards to be reaped. Pharmaceutical companies pay influential leaders who can sway public opinion and influence research. And the area of medicine receiving the greatest amount of pharmaceutical money is psychiatry. The American Psychiatric Association (APA) is the most drug industry financially supported medical association. In July 2008, Senator Charles Grassley's demands that the APA provide an accounting of its finances revealed that in 2006 the pharmaceutical industry accounted for about 30 percent of the APA's financing; more than $20 million dollars.
The New York Times found psychiatrists were paid more by drug companies than any other medical specialty in Minnesota, the only state requiring full reporting of financial relationships between physicians and drug companies. Between 1997 and 2005 psychiatrists in Minnesota collected $6.7 million from drug companies. The New York Times also found drug companies were not selective about psychiatrists paid to conduct clinical trials of drugs. At least 103 of the physicians had been disciplined, criticized, or had their license to practice revoked by the Minnesota state medical board. In the case of one psychiatrist, the FDA concluded he had violated the protocols of every drug study he led that the FDA had audited. The FDA found he had reported inaccurate data to the drug makers. Despite all this, drug makers continue to hire this psychiatrist.
Senator Grassley continues to investigate the strong financial ties between the pharmaceutical industry and influential physicians. His efforts have disclosed drug industry payments to individual psychiatrists in extremely influential positions. Such as former Director of the National Institute of Mental Health (NIMH) and former radio host, Dr. Frederick K. Goodwin, who was taking money from drug companies and promoting their psychiatric drugs on his weekly National Public Radio (NPR) program, "The Infinite Mind." Dr. Goodwin never warned the public about the extremely dangerous side effects of psychiatric drugs. When the head of NPR learned of Dr. Goodwin's financial relationships to pharmaceutical companies, the program was ended.
Based on his investigations, Senator Grassley accused the APA current president-elect, Alan F. Schatzberg, MD, chairman of psychiatry at Stanford University, of failing to disclose ownership of about $6 million in shares in Corcept Therapeutics. Dr. Schatzberg is listed as principal investigator of a government-funded trial of a drug Corcept is trying to commercialize.
In October 2008, Sen. Grassley discovered that Charles Nemeroff, M.D., Chairman of Psychiatry at Emory University, had earned more than $2.8 million in consulting fees from pharmaceutical companies from 2000 2007. During that time Dr. Nemeroff was researching drugs with government money in the form of NIH grants. He failed to report this income to Emory and violated federal research rules.
Another influential psychiatrist at Emory Senator Grassley's investigations disclosed had strong relationships with drug companies is Dr. Zachary Stowe. Senator Grassley uncovered an email that demonstrates the degree of control that drug companies have with physicians in influential positions. The email was sent to the pharmaceutical company GlaxoSmithKline (GSK) from a public relations firm that worked for them. GSK is the manufacturer of Paxil, an antidepressant drug with severe side effects, including suicide. The email was titled "For Your Review/Paxil Breast Milk Press Release." The email states:
"Please review the attached press release and forward me anycomments/edits. As you may know, Dr. Stowe is on boardfor publicity efforts and name withheld and I are coordinatingtime to meet with him next week to arm him with the keymessages for this announcement, which is slated for earlyFebruary. We are sending the release for your review at thesame time in efforts to secure distribution on Emory letterhead(as you know, would provide credibility to data for the media)"
GSK paid Dr. Stowe at least a quarter of a million dollars in 2007 and 2008 according to Sen. Grassley's investigations. Dr. Stowe also received money to promote psychiatric drugs from Eli Lilly, Bristol-Myers Squibb, Pfizer, and Wyeth. (See my website to learn about the severe health risks to fetus and infants when pregnant women and nursing mothers take antidepressant drugs.)
Two child psychiatrists from Harvard Medical School, Dr. Joseph Biederman and Dr. Timothy E. Wilens, reported to Senator Grassley that they each earned several hundred thousand dollars from drug companies from 2000 to 2007. However it was found they each earned at least $1.6 million. Dr. Bierderman's support of the use of powerful antipsychotic drugs in children led to a sharp increase in the use of these dangerous drugs in children as young as three years old.
While psychiatrists are being paid by pharmaceutical companies to promote psychiatric drugs, people who are taking the drugs are dying. One in 145 adults died in clinical trials of those taking the antipsychotic drugs Zyprexa, Risperdal, or Seroqual according to FDA data. Dr. Biederman has financial ties with Johnson and Johnson, owners of the company that makes Risperdal.
"We know the drug companies are throwing huge amounts of money at medical researchers, and there is no clear-cut way to know how much and exactly where," Senator Grassley said in a news release.
The public and practicing physicians cannot trust the research results and the promotion of drugs by what appears to be eminent sources. The pervasive financial control by the pharmaceutical industry has destroyed their credibility, and left us in a position where:
Hearing the truth about drugs is like trying tohear a mouse tap dance during a hurricane.
References:
"Eli Lilly's Payments to Doctors Revealed" by Shirley S. Wang, The Wall Street Journal, July 31, 2009.
Minnesota psychiatrists is from "After Sanctions, Doctors Get Drug Company Pay," by Gardiner Harris and Janet Roberts, The New York Times, June 3, 2007.
"Radio Host Has Drug Company Ties" by Gardiner Harris, The New York Times, Nov. 21, 2008.
"Grassley Seeks More Info on Conflict of Interest Policies at Medical Schools" by Evelyn Pringle, website lawyersandsettlements.com, June 25, 2009.
"Psychiatric Group Faces Scrutiny Over Drug Industry Ties," by Benedict Carey and Gardiner Harris, The New York Times, July 12, 2008.
FDA data for deaths in clinical trials is from Allen Jones' whistle-blower article,http://psychrights.org.
http://www.opednews.com/articles/Pharmaceutical-Industry-an-by-K-L-Carlson-100727-454.html?
Along with so many other things, keeping a lid on spending seems to have gotten lost in the health care overhaul. Individuals lose some incentive to save a couple of bucks by having fewer tax-free dollars in their health savings accounts. A panel to oversee Medicare disbursements based on the cost of clinical effectiveness of treatments--zapped, thanks to intense lobbying by drugmakers, doctors and every other medical interest group. That leaves medical providers and health plans, which have little motivation, unless the employers who buy insurance turn the screws.
