On the take : how medicines complicity with big business can endanger your health

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  1. On my list to read | Bookshelf | Business, Health, Medicine
  2. A Look at CMAJ: A Misty Image Indeed
  3. On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health
  4. Browse more videos

In an investigation that took five years, Willman discovered that in Varmus had quietly rescinded the policy that barred institute directors from accepting consulting fees and payments of stock from companies. Thereafter scientists could develop financial relations with industry as long as they received permission from their supervisors; permission was generally given. In addition, most of the financial arrangements were kept secret. He found, for example, that Dr. Willman reported that Dr.

Willman also reported that Dr. In each instance, the scientists had received permission from their supervisors. Many had received permission from Dr. Ruth Kirschstein, then acting director of the NIH. When these revelations were published, Dr. Zerhouni, promised a thorough one. Taken together, all these sources are not sufficiently complete to identify whether a given individual has a financial conflict with a company about whose drug he has spoken or written.

Moreover, the extent of the financial involvement with industry is almost never disclosed. Such information often sits in the archives of medical schools and academic medical centers and never sees the light of day.

The picture that emerges here is a profession that blithely accepts gifts, dinners, trips, phony consulting arrangements, and free continuing education. Even though the extent of physician involvement with industry is not made public, evidence suggests that a great many are collaborating, and that many have financial deals with multiple companies. In fact, conflicting responsibilities are a commonplace characteristic of everyday life, in politics, and in business. The numerous examples in this chapter all lead to the same results: risk or injury to patients, flaws in medical information, and serious ethical lapses.

Whore is a strong descriptor, but I heard it repeatedly from colleagues about physicians who tour the country for drug companies, changing their talks repeatedly to hawk the products of the company that is sponsoring their visits. Initially she offered the information that Dr. Omega often was out one or two nights a week, and that when expenses mounted for college tuitions, he could be away for as much as two weeks at a time.

She said that even though various companies pay him, he never promoted any specific product. However, I later learned that Mrs. When I asked a colleague at another medical center to name some physicians who clearly had promoted certain products at lectures that he had heard in the past year, one physician he mentioned immediately without prompting was Dr. He said it was obvious that Dr.

Omega had not only been pushing one particular medication over others, but did not disclose that his lecture fees and travel expenses had been sponsored by the company that sells Dr. There are many Dr. How many, I do not know. These lists are circulated to hospitals and physician groups across the country, which select speakers for their various educational programs. There are dangers in signing on to be a speaker sponsored by a pharmaceutical company.

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On my list to read | Bookshelf | Business, Health, Medicine

One danger is the obligation of reciprocity, which can subconsciously or consciously influence a physician to become a marketing agent for the sponsor. At the extreme are instances in which physicians knowingly become spokespersons for the marketing efforts of a company without disclosing it. This is a ploy used to allow the trial participants to claim, honestly, that they had no financial conflict during the time that they are involved in the trial. An off-label use of a drug is the prescribing by a doctor of a drug that has been approved by the Food and Drug Administration FDA for one particular condition, but the prescription is being used for a condition for which the drug has not been approved.

Although it is entirely legal for a doctor to use a drug off-label, it is illegal for a drug company to advertise a drug for any purpose other than the one or ones approved by the FDA. By recruiting physicians to discuss off-label uses, therefore, the drug companies, in essence, bypass official channels and create a potent marketing force of physicians. One flagrant example of physicians aiding in marketing came to light when a whistleblower charged that Warner-Lambert now a branch of Pfizer had engaged in unlawful off-label marketing of the anti-epilepsy drug, Neurontin.

A Look at CMAJ: A Misty Image Indeed

Some speakers were paid tens of thousands of dollars annually to recommend off-label uses of the drug. She also reported that a Harvard professor, Dr. Medical publications also market off-label drugs. Provigil is a new drug produced by Cephalon, Inc.

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At the present time the FDA has approved it for use in narcolepsy, an uncommon condition in which sufferers have an overwhelming feeling of sleepiness. Cephalon also has paid the lead authors of all eight papers in the supplement, either through honoraria, consultant activities, speaking engagements, or in one case research funds.

This supplement is a shameful marketing tool. Marketing by Doctors It has been easy to recruit physicians to help pharmaceutical companies market their new drugs. Just send them to a resort, dub them consultants, and pay them. A case in point was the campaign by Searle now Pfizer to Money-Warped Behavior 29 increase sales of their new pain reliever Celebrex.

Introduction

Searle recruited physicians to come to Orlando for a weekend to learn about the drug. In my opinion, this represents extraordinarily unseemly behavior. Early in , one of my colleagues sent me a copy of a letter that invited him to speak for Berlex Laboratories. It turned out that Berlex had paid Health Learning Systems, a medical education company, to hire academic physicians to prepare a set of slides on heparin-induced thrombocytopenia, a specific complication of treatment with heparin a blood thinner. Berlex has had a drug on the market for a few years Reflutan that effectively treats the complication.

A competing drug for the same condition Argatroban is made by GlaxoSmithKline. Academic physicians at the University of Pennsylvania were paid several thousand dollars each to prepare a slide set about the condition. The slide set, which considered the value of both drugs, Reflutan and Argatroban, was considered unbiased in an independent review at Penn. Nonetheless, I asked an expert on heparin-induced thrombocytopenia at another university to assess whether the slides were biased toward one drug or the other. In other words, the clinical data was subservient to irrelevancies.

So, my initial impression was that Drug R was being promoted slightly more than Drug A. Of greater concern was the implication that a drug was needed in every circumstance for every patient who ever is diagnosed even with potential HIT [heparin-induced thrombocytopenia], whether a clot was ever diagnosed. Drug R no available antidote, although means exist to improve. It would appear that there is a greater toxicity to A vs. My impression was that drug R was more promoted than A. On balance, I would say the audience would have however learned much about the subject, and would have used Drug R when challenged with the clinical problem, after hearing the talk.

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

My expert may be correct that the audience probably learned much about the subject. Clearly, the information may allow physicians who hear these lectures to care for their patients more effectively, but through a chain, beginning with the academic physicians who prepared the material, to the university department that offers postgraduate credits for the physicians who participate in the lectures, the academics have become marketing agents for Berlex.

What a mess. Zalman Agus, the head of CME at the University of Pennsylvania, why he chose faculty members who had a financial conflict of interest with the company that funded the educational program.

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Is it worth the financial gain? These several examples illustrate how industry engages physicians in their marketing efforts. In some instances the physicians are merely helping to sell products, but in others, the financial arrangements with industry may be inducing them to develop biased educational materials. Ghostwriting Medical journals publish many useful educational articles that summarize the latest facts about a disease or a treatment.

The physicians who submit these articles gain prestige and often a small honorarium. Journals expect that authors of such articles adhere to a time-worn ethic, namely that they are the legitimate authors of the work.