Doctors do not receive kickbacks

January 27, 2004

Isn't it a bit presumptuous to make such a bold statement based upon experience

with a single physician?

There are good doctors and then there are bad, and I'm sure the bad ones don't

advertise to their employees when they accept bribes.

Just my thoughts...

Carol aka dizz

January 28, 2004

Fortunately the word is getting out. Some major medical conferences (cruises,

etc) backed by drug companies were canceled after some stories about this were

printed. I think the word " kickback " is too strong. It is more like doctors

get " perks " from drug companies, or get jobs on the side by them as you mention.

They are definitely influenced by them. With all the information available many

doctors learn most of their new knowledge from studies that are presented by the

drug reps to them (one sided studies funded by them of course.)

Doris

January 28, 2004

Lorraine

I have worked for drs and have seen one that got kickbacks from lawyers in

regards to disability claims for approving them for disability. They all work

together in this. Just because yours was reputable doesn't mean they all are.

[ ] Doctors do not receive " kickbacks "

Doctors get NO kickbacks from pharmaceutical reps. I work for a doctor for

many years and I do know that. However, insurance companies have their

" formularies " and basically tell the doctors which ones to prescribe for a

patient.

For example, a doctor may prescribe celebrex and then is told by the pharmacy

that the person's insurance company requires " pre-authorization " for the drug.

This " pre-authorization " then requires letters of medical necessity,

previous drugs tried, etc. etc. It is a game. By this time the patient may

have

already waited 2-3 days for an answer or approval. (Most times it is a

denial).

So I know that my doctor always tries to do what is best for the patient, but

is not always permitted to by the patient's insurance company.

Yes, the pharmaceutical reps do leave pens, pads, literature, etc. for

" advertisement " purposes. To be honest, half the time they leave them behind

at our

office and we don't even see the pamphlets til later in the day or whenever

we are out in the reception area. At any given time, you will see tons of

pamphlets for drugs that actually compete against eachother, giving equal time

to

all. Eventually, they get changed or thrown away. I can assure you that

doctors get no kind of " kickbacks " or compensation from pharmaceutical reps.

Angel Blessings,

Lorraine

January 28, 2004

There are definitely good and bad doctors. The good ones we treasure and

trust, the bad ones can hurt us for their own benefit. My girlfriends husband

recently went to a doctor for mild symptoms of depression. The doctor blindly

put him on manic depressive med ..a new up and coming med...without asking A.

what his exact symptoms were B. if he was on any other meds C. and never

explained the side effects. Thank God for the computer, where I was able to

access info. that helped them resolve the situation. Beware of the bad ones and

always ask questions...your health is your responsibility. Docs are human and

can be questioned.

January 28, 2004

Hello Cheers4U@...,

In reference to your comment:

è all. Eventually, they get changed or thrown away. I

è can assure you that doctors get no kind of

è " kickbacks " or compensation from pharmaceutical

è reps. Angel Blessings, Lorraine

******Lorraine......I'm new here and will give my history soon. I'm a

retired nurse and was in Practice Management (doctor/hopsital/nursing home)

consultant for many years, after I stopped working in the hospital settings. I

was

also an oncology nurse (in cancer research at Hospital and VA Hospital)

in St. Louis for over 4 years.

******I will say this, YES doctors in offices get kickbacks, which come in

many forms.....Drug reps have full lunches delivered to doctor offices when it

is hard for the staff to leave. When the staff can leave they are taken out to

lunch in expensive restaurants and at Christmas time are given a very

expensive Christmas party at expensive restaurants, at the EXPENSE of the drug

company. They also pay for trips and are compensated in many many ways.

Example:

doctors who run " clinical trials " are paid for each patient that they put in

that trial, sometimes as much as $4000 per patient. I have had staff, including

myself, sent to California for a 4 days ALL EXPENSE paid trip, Disneyland

included, to sit all day on a Saturday and listen to lectures about new drugs

coming out. I have had many many nurse employees, who were in charge of the

" sample " room receive very nice gifts. High traffic offices like Internist

staff

receive very nice birthday gifts from the drug reps.

******Perhaps you worked for a doctor who took it all himself and there are

those that do that. Their staff is never the wiser of what, when and how much

the doctor receives. Perhaps you worked for a doctor who didn't share how

much and what he got from drug companies, but let me tell you THEY GET TONS of

kickbacks. As a matter of fact I have some articles published by many media

investigators who have facts on how much, who, when and where the kickbacks are

given too. YES, it is wrong and YES against most medical policy, but it is

done DAILY. Many doctor's office staff are paid poorly, so the docs let the

drug

reps bring in the bennies to the staff.

>>>>I personally do not agree with the kickbacks and all hell broke loose

when I tried to stop my contracts from receiving these bennies.....I finally

relented, gave in so to speak, as it was a waste of time preaching about how

unprofessional it is. Besides who am I to set policy when it benefits the

staff.

My job was to make sure the practice ran smoothly, that risk management was

followed, that patients got the best care/attention, and that the finances were

in order.

*****Christmas before last when the " first Harry Potter " movie was released

one of the drug companies rented for 4 days a closed exclusive theater (in

Phoenix, Arizona) for a private showing to all medical staff of hundreds of

doctors offices. A Buffet lunch was provided daily, along with Harry Potter

memorabilia given to all children.

********I didn't respond to this email to get into any type of flame war, but

I can assure you millions is spent yearly on these " kickbacks " that ALL

receive. Kickbacks are why so much of our medicine is so costly.....someone has

to

pay for the marketing of these drugs, hence it is the patient in the end.

****Were you all aware that many medical papers are written by drug companies

and they pay doctors HANDSOMELY to say they wrote it???

Angel Huggzzz

or Angel

January 28, 2004

ABCs' report on how drug companys gp about influencing our doctors (

> Feb.21,'02)

>

> Influencing Doctors

> How Pharmaceutical Companies Use Enticement to 'Educate' Physicians

>

> By Ross and W.

>

> Feb. 21 - It was doctors' night out last June at the world-renowned Museum

> of Modern Art in New York City, and the Saturday night party, put on by

> Pfizer Inc., was lavish.

> The event was strictly private, closed to reporters, as the pharmaceutical

> company entertained a very select list of doctors and their guests. But

> Primetime's undercover cameras saw the kind of big-money splurge that some

> say drives up the cost of prescription drugs and corrupts the practice of

> medicine.

>

> Further investigation into the $6 billion spent by drug companies for what

> they say is a way to educate doctors showed that tactics like lavish gifts

> and trips are surprisingly common.

>

> & quot;It's embarrassing, it's extravagant and it's unethical, & quot; said

> Dr. Arnold Relman, a Harvard Medical School professor and the former

> editor of the New England Journal of Medicine. & quot;It makes the doctor

> feel beholden . it suborns the judgment of the doctor. & quot;

>

> But doctors seemed thrilled to have been invited for a weekend in New York

> City with some seminars along the way, with all expenses paid by Pfizer on

> behalf of one of its drugs, Viagra.

>

> One Small-Town Doctor: $10,000 in Goodies

>

> Few doctors were willing to talk publicly about their relationships with

> pharmaceutical companies, but one upstate New York doctor was willing to

> come forward.

>

> & quot;It's very tempting and they just keep anteing it up. And it's

> getting harder to say no, & quot; said Dr. Rudy Mueller. & quot;I feel in

> some ways it's kind of like bribery. & quot;

>

> Disgusted by how the free gifts and trips add to the high price of

> medicine, and moved by the plight of patients forced to skip needed

> medication, Mueller agreed to provide Primetime with a rare glimpse of the

> astounding number of drug company freebies he was offered by various drug

> companies in a four-month period.

>

> He was presented with an estimated $10,000 worth, including an

> all-expenses-paid trip to a resort in Florida, dinner cruises, hockey game

> tickets, a ski trip for the family, Omaha steaks, a day at a spa and free

> computer equipment.

>

> & quot;It changes your prescribing behavior. You just sort of get caught up

> in it, & quot; said Mueller, who said he was offered a cash payment of

> $2,000 for putting four patients on the latest drug for high cholesterol.

> The company called this a clinical study; Mueller called it a bounty.

>

> & quot;I've never been offered money before, & quot; he said. & quot;I don't

> remember that 10, 15 years ago. & quot;

>

> Though Mueller normally declines the offers, he agreed to attend a dinner,

> which Primetime secretly taped. Not only were the doctors wined and dined,

> but each was also offered a payment of $150 for just showing up to listen

> to a pitch for a new asthma treatment for children.

>

> The company called it & quot;an honorarium, & quot; but Mueller saw it

> differently. & quot;Again, it's bribery, & quot; he said. & quot;This is very

> effective marketing. & quot;

>

> There's a wide range in value of the free gifts offered to doctors - from

> lavish trips to free Mother's Day flower bouquets for doctors willing to

> hear a pitch about a new osteoporosis medicine.

>

> In the latter example, when asked whether a floral shop was the most

> effective place for a discussion on pharmaceuticals, one of the

> representatives said, & quot;I'm sorry, we're not allowed to comment on

> anything. & quot;

>

> Detail Men

>

> The goodies are dispensed by an army of drug company representatives known

> as detail men and women, of whom there are 82,000 nationwide.

>

> It's the job of the detail people to quietly befriend doctors, keeping

> close track of which doctors take the free gifts and then determining

> which drugs the doctors later prescribe.

>

> & quot;I think it's sleaze, & quot; said Relman. & quot;Anybody who's been in

> that position knows that yes, those gifts, $60, $100, $40, again and

> again, do influence your attitude about that company . and will influence

> the prescriptions that you write. & quot;

>

> And the multibillion-dollar drug company blitz extends throughout the

> profession, even at the yearly gathering of one of the most prestigious

> medical groups, the American College of Physicians. It was like a

> carnival: Doctors could be seen taking free massages, free food, free

> portraits, free Walkman players, free basketballs, and from one company

> pushing a new antacid drug, free fire extinguishers.

>

> Many doctors say it's no different than any other business or convention,

> and that it doesn't affect their medical judgment. But that's not the view

> of the new president of the American College of Physicians, Dr.

> Hall, who says anything beyond a pen or a mug could have an impact.

>

> & quot;Whether we like it or not, it can cloud our clinical judgment, & quot;

> he said. & quot;Unequivocally, I would say that. & quot;

>

> So why are some of the very practices Hall publicly criticizes permitted

> at his group's supposedly scholarly convention? & quot;I think there it's a

> situation where every physician is going to have to balance what's right

> or wrong, & quot; said Hall.

>

> & quot;We are concerned about it., & quot; he added, saying that at some

> point the system may be changed.

>

> But right now, Hall's group receives $2 million a year from the drug

> companies to have their exhibition booths at the convention, yet another

> example of how the big drug companies spend billions to influence doctors

> in this country.

>

> & quot;The basic mistake we're making with our health-care system now is

> that we regard it as just another business. And it's clearly not just

> another business. Patients, sick patients and worried patients, are not

> like ordinary consumers, & quot; said Relman. & quot;Doctors ought to be

> incorruptible . That's the doctor's sacred obligation. They're being

> corrupted and undermined by this kind of salesmanship. & quot;

>

> gp about influencing our doctors ( Feb.21,'02)

> Influencing Doctors

> How Pharmaceutical Companies Use Enticement to 'Educate' Physicians

>

> By Ross and W.

>

> Feb. 21 - It was doctors' night out last June at the world-renowned Museum

> of Modern Art in New York City, and the Saturday night party, put on by

> Pfizer Inc., was lavish.

> The event was strictly private, closed to reporters, as the pharmaceutical

> company entertained a very select list of doctors and their guests. But

> Primetime's undercover cameras saw the kind of big-money splurge that some

> say drives up the cost of prescription drugs and corrupts the practice of

> medicine.

>

> Further investigation into the $6 billion spent by drug companies for what

> they say is a way to educate doctors showed that tactics like lavish gifts

> and trips are surprisingly common.

>

> & quot;It's embarrassing, it's extravagant and it's unethical, & quot; said

> Dr. Arnold Relman, a Harvard Medical School professor and the former

> editor of the New England Journal of Medicine. & quot;It makes the doctor

> feel beholden . it suborns the judgment of the doctor. & quot;

>

> But doctors seemed thrilled to have been invited for a weekend in New York

> City with some seminars along the way, with all expenses paid by Pfizer on

> behalf of one

> ..[Message truncated]

>

============MORE===========

BMJ 2002;324:1113 ( 11 May )

News

Doctors accept $50 a time to listen to drug representatives

Spurgeon, Quebec

A new American company called Time-Concepts LLC is offering doctors $50 (£34;

55) each time they listen to a short sales pitch from a drugs company

representative in their office.

The new company receives $105 from the drug manufacturer each time it secures

a consultation, $50 of which goes to the doctor, $5 of which goes to a

charity that the doctor selects, and $50 of which it keeps.

Doctors are accepting the payments, despite the fact that guidelines from the

American Medical Association specify that they should not accept cash

payments from drug companies.

Dr Neal Moser, a pulmonary and critical care physician with a 13-doctor group

in Edgewood, Kentucky, for example, told amanews.com, the American Medical

Association's newspaper for physicians, that he signed up because the plan lets

him control when and how he talks to sales representatives. He said that it

gave him a more efficient way to get the drug information he needed. He saw no

ethical problem with the arrangement and said that the fee barely covered the

cost of his time.

But Dr Riddick, chairman of the American Medical Association's council

on ethical and judicial affairs, said that accepting cash payment contravenes

the association's guidelines for physicians. The guidelines say that

physicians are entitled to accept gifts of low value ($100 or less) if they

serve an

educational, practice related, or patient care function.

" If the purpose of the contact is to educate the physician, then there is no

need to pay the physician, " he said.

The new scheme is similar to a scheme launched last year by a group of

doctors in Cincinnati, called the Queen City Physicians. The group set up a

subsidiary company called Physician Access Management, which charges sales

representatives $65 a time to talk to Queen City physicians for 10 minutes.

Ms Pamela Coyle-Toerner, president and chief executive officer of

Cincinnati's Queen City Physicians and one of the owners of its subsidiary, said

that the

proceeds helped to pay for an electronic medical records system.

Time-Concepts LLC claims its methods are efficient and ethical.

Footnotes

More information is available on the American Medical Association's website

at www.ama-assn.org/sci-pubs/amnews/pick_02/bil20506.htm

January 28, 2004

Drug Company Sued for Promoting Drugs in Exam Rooms

By Melody sen

Newly unsealed court documents reveal that some physicians, in exchange for

money, have allowed pharmaceutical sales representatives into their

examining rooms to meet with patients, review medical charts and recommend

what medicines to prescribe.

And some of those salespeople tried to influence doctors to prescribe drugs

for uses that were not approved by the federal Food and Drug Administration,

those documents show.

This so-called shadowing program, apparently involving hundreds of patients,

is just one way that Warner-Lambert tried to increase sales of a drug called

Neurontin, not just for epilepsy, for which it was approved, but also for

more than a dozen medical conditions it was never approved to treat,

according to a federal whistle-blower case that is now the subject of a

criminal and civil investigation by the United States attorney's office in

Boston.

The case details marketing practices that experts say have become standard

practice for many pharmaceutical companies as they spend billions of dollars

trying to persuade physicians to prescribe their drugs. A recent survey of

physicians in land, for example, found that 37 percent said they had

accepted some kind of compensation from pharmaceutical companies.

According to court documents, Warner-Lambert, which has since been acquired

by Pfizer, tracked whether doctors prescribed Neurontin, rewarding those who

were considered high-volume prescribers by paying them as speakers and

consultants and also paying them to enter patients in clinical trials.

Warner-Lambert also tried to influence doctors who wrote medical journal

articles about Neurontin by paying them, sometimes secretly, and even hiring

a marketing company to write first drafts. The drug is expected to reach $2

billion in sales this year.

Dr. Marcia Angell, the former editor of The New England Journal of Medicine,

said having sales representatives tell doctors what to prescribe while

examining patients was " inexcusable. "

" Drug companies have no business being involved in education or clinical

care, " she said.

In the case of Warner-Lambert, one sales representative boasted that he had

persuaded a doctor to prescribe Neurontin for unapproved uses, according to

a voice-mail message obtained by the whistle-blower. " While the patient was

dressing, the doctor and I one-on-one would discuss the patient and

therapeutic options, " the sales representative said. " I felt I had

influenced her. "

The lawsuit, brought by Dr. P. lin, a former Warner-Lambert

employee, is based on thousands of pages of internal company documents. The

documents do not reveal whether doctors told their patients who the third

person was in the examining room.

Dr. lin accuses Warner-Lambert's sales representatives of encouraging

doctors to experiment by prescribing Neurontin for unapproved uses including

pain, bipolar disorder and attention deficit disorder in children.

It is illegal for a drug company to promote a medicine for uses not approved

by the government, though it is not illegal for doctors to prescribe

medicines for so-called off-label uses.

Warner-Lambert's shadowing program involved an estimated 75 to 100 doctors

in several Northeast states, Dr. lin estimated in court documents. Each

doctor was paid $350 or more for each day they let sales representatives

watch as they examined patients, according to court documents.

Other companies also pay doctors to open their doors to sales people.

The federal investigation, which stems from the whistle-blower lawsuit,

centers on marketing activities that took place in the mid- to late-1990's,

before Pfizer bought Warner-Lambert in 2000. The lawsuit argues that

Medicaid paid tens of millions of dollars it should not have for Neurontin

prescriptions written for unapproved uses.

Pfizer said that in 2000 more than 78 percent of Neurontin prescriptions

were written for unapproved uses. Sales of the drug are growing at a rate of

50 percent a year - fueled mostly by those off-label uses.

Neurontin has been approved by the F.D.A. for a very narrow use: controlling

seizures in epileptics who already take another drug. But one marketing

executive at Warner-Lambert, in a recorded voice-mail message that is part

of the lawsuit, told sales representatives: " If we are going to market

Neurontin effectively, we have to do it for monotherapy, for epilepsy, also

for pain and bipolar and other psychiatric uses. " (Monotherapy refers to

using a single drug to treat a condition, which is not an approved use of

Neurontin.)

But researchers working independently from the company say they are finding

that Neurontin does not work for some of those unapproved uses cited in the

lawsuit. In a few cases, these researchers say, Neurontin may make patients

worse.

Dr. Wehner Lea and other doctors at the Northwest Missouri

Psychiatric Rehabilitation Center said they recently had found that some

patients taking Neurontin for schizophrenia or bipolar disorder appeared to

become more aggressive after starting on the drug.

" Neurontin is being used like water for disorders where there is not much

evidence it is effective, " said Dr. Sporn, clinical fellow in the

mood and anxiety program at the National Institute of Mental Health. Dr.

Sporn led a clinical trial funded by the government that showed that

Neurontin worked no better than a sugar pill for patients with

obsessive-compulsive disorder.

Many doctors, however, say that Neurontin appears to help some patients with

pain. Last year, eight years after Neurontin was put on the market, Pfizer

filed data with the Food and Drug Administration from clinical studies to

try to gain approval for the medicine's use for pain.

In his first public interview since filing the whistle-blower case, Dr.

lin, a 40-year-old former research fellow at Harvard Medical School,

said that soon after joining the company in 1996 he was asked to participate

in what he now says was an illegal marketing scheme that put patients at

risk.

Dr. lin said he was most troubled by the company's insistence that he

press doctors to prescribe Neurontin in much higher doses than had been

approved. " It was untried ground, " Dr. lin said. " We were not sure what

would happen at these high doses. I recognized that my actions may be

putting people in harm's way. "

Dr. lin said several Warner-Lambert marketing executives had told him

that because Neurontin appeared to be safe in high doses it was reasonable

to encourage doctors to try it for almost any neurological condition " just

to see what happens. "

Dr. lin's lawsuit also accuses the company of paying dozens of doctors

to speak about Neurontin to their peers - some earning tens of thousands of

dollars a year. One internal memo listed doctors the company considered to

be " movers and shakers, " including some at prestigious medical schools such

as Harvard, Cornell and Columbia.

Warner-Lambert also hired two marketing firms to write articles about the

unapproved uses of Neurontin and find doctors willing to sign their names to

them as authors. According to an invoice from one of the marketing firms,

Warner-Lambert agreed to pay the firm $12,000 to write each article and

$1,000 to each doctor willing to serve as author.

Internal memos filed in court detail how the marketing firm often wrote a

first draft of an article, but sometimes had problems finding an author. The

articles were then reviewed and approved by Warner-Lambert before they were

sent to journals for publication, records show.

Other drug companies also use marketing firms to help them " ghost write "

medical studies, a practice that angers editors of the leading medical

journals.

" It is a form of marketing, although it is disguised not to look like

marketing, " said Dr. off, the former editor of the ls of

Internal Medicine. " Authors should be authors and should not be signing on

to work by someone else, particularly not for money. "

Dr. lin, the whistle-blower, now works as director of market research

at Boston Scientific, a developer and marketer of medical devices. He

resigned from Warner-Lambert only a few months after being hired, and said

some company executives had threatened to make him a scapegoat if he went

public with his concerns.

" I was terrified, " said Dr. lin, who sought help from M. Greene,

a lawyer in Boston. Dr. lin filed his suit several months later.

New York Times May 15, 2002

=================

Vancouver Province

December 17, 2000

" Drug Firms: Pushers for Profit "

by Kathy Tait, Medical Reporter

" The pharmaceutical industry misuses medical research to the point that

people may develop lifelong dependence on drugs with little real

benefit, says a new University of British Columbia study.

The study claims that industry manipulation of research results can

place patients at risk of dangerous side effects. Drug companies

artificially create demand for prescription drugs by raising public fear

of a disease. Under the guise of creating more informed consumers, the

drug companies get people to pressure their physician for drugs.

For example, industry promotion of cholesterol screening and bone

density testing often leads to patients being put on a course of drug

therapy that is not backed up by research evidence.

80% of new drugs are merely 'me-too' drugs that do the same job as an

older one. These aren't innovations, but come with a price increase and

result in an increase in the value of the company's stock.

The report says that the drug industry now dominates Canada's clinical

research, skewing results to improve corporate profits rather than

patient health. And it accuses Health Canada of failing to protect the

public from the drug firms. The report says the drug industry:

- pressures and co-opts medical researchers and government regulators

- promotes some research results while it suppresses others

- attempts to silence researchers who speak out in the public interest

The report calls for a watchdog to oversee Health Canada's drug approval

system, since Health Canada doesn't have the expertise or the time to

review research properly.

The report says the rising cost of drugs, the fastest-growing component

of Canada's $95 billion health care system, is exacerbating the current

health care crisis. "

January 28, 2004

Subject: Former NEJM Journal editors call for congressional

investigation of pharmaceutical industry_WashPost

Date: Wed, 20 Jun 2001 13:11:09 -0400

From: " CIRCARE "

" President W. Bush " ,

" Vice Pres Dick Cheney "

CIRCARE: Citizens for Responsible Care & Research

A Human Rights Organization

Tel: 212-595-8974 FAX: 212-595-9086

veracare@...

Vera Hassner Sharav 142 West End Ave, Suite 28P New York, NY 10023

Writer Adil E. Shamoo, Ph.D. is vice president and co-founder of CIRCARE

Former editors of the New England Journal of Medicine, Marcia Angell

and Arnold Relman call for Congressional hearings to contain abuses by

the pharmaceutical industry whose business interests collide with both

the public interest and the integrity of science.

" The pharmaceutical giants spend two or three times as much on

marketing and administration as they do on R & D,

and their profits are about twice their R & D costs. "

" The number of innovative drugs reaching the market has actually

declined in the past five years. "

~~~~~~~~~~~~~~~~~~~~~

Prescription for Profit

By Marcia Angell and Arnold S. Relman

Washington Post Wednesday, June 20, 2001; Page A27

Few Americans appreciate the full scope and consequences of the

pharmaceutical industry's hold on our health care system. Prescription

drug costs are rising at an unsustainable rate-- 19 percent per year --

and will soon exceed payments to doctors as the largest item

on the health bill after hospital costs.

The drug companies maintain that this is the price of success. They

portray their industry as a highly risky one in a competitive market --

just able to cover its enormous research and development costs but

managing nonetheless to deliver a stream of innovative drugs in the

public interest.

Here are the facts. The pharmaceutical giants spend two or three times

as much on marketing and administration as they do on R & D, and

their profits are about twice their R & D costs. To cite a typical

example, last year GlaxoKline spent 37 percent of its revenues

on marketing and administration and only 14 percent on R & D,

while making a 28 percent profit. Overall, the pharmaceutical

industry is by far the most profitable in the United States.

As for being innovative: Yes, the industry has brought important new

drugs to market over the past few decades, but many of them stemmed

from basic research at the National Institutes of Health or in academic

laboratories supported by the NIH. Others were first developed by

smaller biotech companies and then licensed to the large companies.

It was recently reported that only two of Bristol-Myers Squibb's top

10 drugs were discovered in-house. Moreover, the number of

innovative drugs reaching the market has actually declined

in the past five years.

The pharmaceutical giants are now putting a major part of their

resources into the development and marketing of

" me-too " drugs -- variants of drugs already on the market.

Among many examples, Claritin is one of a number of similar

antihistamines; Zoloft is like many other antidepressants; and

Zocor is just one of a family of cholesterol-lowering drugs. " Me-too "

drugs are relatively easy to develop but require massive promotion

campaigns to attract consumers to a particular brand and persuade

physicians to prescribe one instead of another. Hence, the huge

marketing budgets.

Far from being an exemplar of the free market, the pharmaceutical

industry enjoys many government protections and subsidies. In addition

to benefiting from publicly funded research, drug companies have

low tax rates, because they can deduct their marketing expenses as well

as their research and development costs.

Most important, their drugs enjoy l7-year (or longer) patent

protection. Once a drug is patented and given a brand name,

no one else may sell it, and the company is free to charge whatever

the market will bear without fear of competition from generics.

No wonder drug companies fight to extend the life of their patents

and to obtain new patents for old drugs. That can be done merely

by proposing a new use or a different dosage form, or by

combining two old drugs into a single new pill. The anti-diabetes drug

Glucophage XR, for example, is Bristol-Myers Squibb's newly patented

once-daily replacement for the twice-daily Glucophage, whose patent

expired last fall.

The drug companies devote enormous sums to promoting their interests.

They have the largest lobby in Washington, and contribute copiously to

political campaigns. Half the FDA's budget for the evaluation of new

drugs now comes from drug company users' fees, making the agency

dependent on the industry it regulates -- an obvious conflict of

interest. The industry also spends lavishly to influence doctors,

who write the prescriptions, and medical researchers,

who test the drugs.

Last year drug companies spent more than $8 billion and employed

83,000 sales representatives to woo doctors. They provided them

with gifts, meals and trips, as well as another $8 billion worth of

free drug samples. The companies fund and thereby influence much

of the continuing medical education doctors need to renew their

licenses, and they handsomely support the scientific meetings of

medical societies, where they hawk their wares and often sponsor

their own programs.

The companies also want to influence researchers who test drugs

in human subjects. Increasingly, they are entering into financial

arrangements with academic medical centers and their faculties,

arrangements that threaten the objectivity and credibility of clinical

research. A growing number of drug trials are being managed by

investor-owned businesses that are even more beholden to the

drug companies because the companies are their only clients.

Furthermore, in their contracts with academic researchers, drug

companies now often insist on controlling how the research is done

and reported, and whether the results will even be published at all.

Recently, there have been several widely publicized instances of

drug companies suppressing research results that were

not favorable to their drugs.

Prescription drugs are not like discretionary consumer products. For

millions of patients, they are necessary to health and even survival.

Yet, the drug companies often behave as though their only

responsibility is to their shareholders.

It's time to take a hard look at the pharmaceutical industry and hold

it accountable. This is particularly urgent now, given the move to add

a drug benefit to Medicare. The industry would like to see such a

benefit without any new regulation, but that would cause drug prices

to rise even faster and hand the companies yet another windfall.

Future policy on this and other matters related to prescription drugs

should be based on a thorough understanding of the industry's

behavior, best achieved through in-depth congressional hearings.

We can't think of a more urgent investigative assignment for the

Senate Committee on Health, Education, Labor and Pensions.

Marcia Angell is a senior lecturer and Arnold S. Relman is professor

emeritus at Harvard Medical School. Both are former editors-in-chief of

the New England Journal of Medicine.

***********************************************************

Marcia Angell M.D.

Academic Title: Senior Lecturer on Social Medicine

Administrative Title: Not present in entry.

Department: Social Medicine

Address: New England Journ. of Medicine

10 Shattuck St. Boston, MA 02115

Phone: (617) 734-9800 Fax: (617) 739-9864

Institution: Harvard Medical School

http://www.prospect.org/print/V11/23/angell-m.html

Placebo Politics by Marcia Angell

in The American Prospect Vol. 11, No. 23

Marcia Angell, M.D. is a senior lecturer at Harvard Medical School and

former editor-in-chief of The New England Journal of Medicine.

Vol. 11, No. 14: Conversation: Open Science or Junk Science?

Vol. 5, No. 17: Health Care: Reformers' Rounds Organizing Reform

" The United States is unique in treating health care as a market

commodity distributed according to the ability to pay instead of as

a social good distributed according to medical need.

The fact that the system targets market transactions, not

medical need, is highly inefficient because it requires

constant tinkering to deal with the inevitable result:

People who cannot pay still get sick and need to be taken care of. "

http://aspe.hhs.gov/sp/coi/angell.htm

Remarks of Marcia Angell, M. D. Delivered 8/16/00

at the HHS Conference on Financial Conflicts of Interest

" What about the integrity of the scientific literature?

As Tom Bodenheimer summarized so well at this conference, there is

plenty of good evidence that investigators with financial ties to

companies whose products they are studying are indeed more likely

to publish studies favorable to those products. And in my two decades

at the NEJM, it was my clear impression that papers submitted by

authors with financial conflicts of interest were far more likely to be

biased in both design and interpretation. "

http://www.pbs.org/healthcarecrisis/Exprts_intrvw/m_angell.htm

Marcia Angell " Are we in a health care crisis? " [photo]

" We certainly are in a health care crisis. If we had set out to design

the worst system that we could imagine, we couldn't have

imagined one as bad as we have. Here's a system in which we spend

over twice what the next most expensive country spends on

health care -- that's Switzerland. We spend roughly $4500 for every

American, whether they have insurance or not. Switzerland

spends maybe $2500 for every citizen. Canada spends

maybe $2,000. Great Britain, poor little Great Britain,

spends about $1,000 for every British citizen. And what do

we get for it? What do we get for that $4500? Well, we

certainly don't get our money's worth. We have roughly 43

million people with no insurance whatsoever, and among the

rest of us, many of us are underinsured. That is, we have

shrinking packages. This might be covered, but that won't

be covered.

Our life expectancy is shorter. Our infant mortality is higher.

Our childhood immunization rate is lower. And look at how

often we get to see the doctor, how long we get to stay in

the hospital. Canadians see their doctors far more often

than we do. Americans really can't afford to go see their

doctor. There's always some co-payment, some deductible,

or they have to pay out of pocket, or something isn't

covered. But in Canada, where everybody is covered for

everything, they go to the doctor much more often. When

they are hospitalized, their hospital stays are longer. If

they're having a baby, they get to stay four or five days.

Japan has very long hospital stays. Ah, it's almost a rest

cure. People in Japan who are hospitalized might lie around

the hospital for a week or two just to take a rest. So we're

really not getting our money's worth. It's going to all sorts

of things, but not to doctors and patients.

What are the dangers that we're facing right now?

Well, the danger is that our health care outcomes will start

to drop. As I said, they're not all that good in the

developed world. We're of the 25 richest countries in the

world, we're somewhere around 22-23 in terms of our health. "

http://web.med.harvard.edu/healthcaucus/ac_angell.html

Biographical Sketch of Marcia Angell, M. D., F.A.C.P.

Marcia Angell, M. D., is Senior Lecturer in the Department of Social

Medicine at Harvard Medical School.

She stepped down as Editor-in-Chief of the New England

Journal of Medicine on June 30, 2000.

A graduate of Boston University School of Medicine, she trained

in both internal medicine and anatomic pathology and is a

board-certified pathologist. She joined the editorial staff of the

New England Journal of Medicine in 1979, became Executive

Dr. Angell writes frequently in professional journals and the popular

media on a wide range of topics, particularly medical ethics,

health policy, the nature of medical evidence, the interface of

medicine and the law, and care at the end of life. Her

critically acclaimed book, Science on Trial: The Clash of

Medical Evidence and the Law in the

Breast Implant Case, was published in June, 1996,

by W. W. Norton & Company. In addition, Dr. Angell is

co-author, with Dr. Stanley Robbins and, later, Dr. Vinay Kumar,

of the first three editions of the textbook, Basic Pathology.

She also wrote chapters in several books dealing with ethical issues.

Dr. Angell is a member of the Association of American Physicians, the

Institute of Medicine of the National Academy of the Sciences,

the Alpha Omega Alpha National Honor Medical Society,

and is a Fellow of the American College of Physicians.

In 1997, Time magazine named Marcia Angell

one of the 25 most influential Americans.

Arnold Seymour Relman M.D.

Academic Title: Professor of Medicine, Emeritus

Administrative Title: Not present in entry.

Department: Emeritus

Address: Brigham and Women's Hospital

75 Francis St. Boston, MA 02115

Phone: (617) 278-0185 Fax: (617) 278-0186

Institution: Brigham and Women's Hospital

==========

This Article is from 1999 But is VERY imformative on Clinical Trial &

Kickbacks to Doctors! Its printed in 5 parts. Be sure to read it all

http://www.1800lawinfo.com/articles/article2321.cfm

==]===][========

Pharmaceutical Facts

$ According to industry estimates, drug companies spent $15.7 billion dollars

on promotion in 2000, up from $13.9 billion in 1999. (IMS Health)

$ Sixty million " details " were made by 83,000 drug reps in the year 2000.

Astra-Zeneca added 1,300 reps solely to promote Nexium. (-Levin Consulting)

$ $7.2 billion dollars worth of free samples were distributed in the year

2000. (IMS Health)

$ The " Research-based " pharmaceutical industry spends more on promotion and

administration than it does on research and development. (Families USA)

$ Drug costs increased 18.8% to $131.9 billion dollars in 2000. Over a third

of this increase was due to a shift to the use of more expensive drugs. (

National Institute for Health Care Management)

$ Two and one-half billion dollars were spent on advertising to consumers in

2000, a 35% increase from 1999; $468 million dollars were spent on journal

ads. (NIHCM)

$ Increases in the sales of the 50 drugs most heavily advertised to consumers

were responsible for almost half (47.8%) of the $20.8 billion increase in

spending in 2000.(NIHCM)

$ In 2000, Merck spent $161 million on advertising for Vioxx. That is more tha

n Pepsico spent advertising Pepsi. ($125 million), and more than

Anheuser-Busch spent advertising Budweiser.($146 million) (NIHCM)

$ The increase in Vioxx sales in 2000 accounted for 5.7% of the 1 year

increase in drug spending. (NIHCM)

$ Since 1995, R & D staff of U.S. brand name drug companies have decreased by

2%, while marketing staff have increased by 59%. Currently, 22% of staff are

employed in research and development, while 39% are in marketing. (PhRMA

Industry Profile 2000)

$ In a study by Avorn, et al, forty-six per-cent of physicians reported that

drug reps are moderately to very important in influencing their prescribing

habits (Amer Journal of Med, 1982).

$ A study by Chew, et al (JGIM, 2000), found that in the treatment of

hypertension, over 90% of physicians would dispense a sample that differed from

their

preferred drug choice.

$ The AMA generates $20 million in annual income by selling detailed personal

and professional information on all doctors practicing in the United States

to the pharmaceutical industry (NY Times, November 16, 2000)

========Scandal of scientists who take money for papers ghostwritten by drug

companies

Doctors named as authors may not have seen raw data

Boseley, health editor

Thursday February 7, 2002

The Guardian

Scientists are accepting large sums of money from drug companies to put their

names to articles endorsing new medicines that they have not written - a

growing practice that some fear is putting scientific integrity in jeopardy.

Ghostwriting has become widespread in such areas of medicine as cardiology

and psychiatry, where drugs play a major role in treatment. Senior doctors,

inevitably very busy, have become willing to " author " papers written for them by

ghostwriters paid by drug companies.

Originally, ghostwriting was confined to medical journal supplements

sponsored by the industry, but it can now be found in all the major journals in

relevant fields. In some cases, it is alleged, the scientists named as authors

will

not have seen the raw data they are writing about - just tables compiled by

company employees.

The doctors, who may also give a talk based on the paper to an audience of

other doctors at a drug company-sponsored symposium, receive substantial sums of

money. Fuller Torrey, executive director of the Stanley Foundation Research

Programmes in Bethesda, land, found in a survey that British psychiatrists

were being paid around $2,000 (£1,400) a time for symposium talks, plus

airfares and hotel accommodation, while Americans got about $3,000. Some

payments

ran as high as $5,000 or $10,000.

" Some of us believe that the present system is approaching a high-class form

of professional prostitution, " he said.

Robin Murray, head of the division of psychological medicine at the Institute

of Psychiatry in London, is one of those who has become increasingly

concerned. " It is clear that we have a situation where, when an audience is

listening

to a well-known British psychiatrist, you recognise the stage where the

audience is uncertain as to whether the psychiatrist really believes this or is

saying it because they them selves or their department is getting some financial

reward, " he said.

" I can think of a well-known British psychiatrist I met and I said, 'How are

you?' He said, 'What day is it? I'm just working out what drug I'm supporting

today.' "

Marcia Angell, former editor of the New England Journal of Medicine, wrote a

year ago that when she ran a paper on antidepressant drug treatment, the

authors' financial ties to the manufacturers - which the journal requires all

contributors to declare - were so extensive that she had to run them on the

website. She decided to commission an editorial about it and spoke to research

psychiatrists, but " we found very few who did not have financial ties to drug

companies that make antidepressants. "

She wrote: " Researchers serve as consultants to companies whose products they

are studying, join advisory boards and speakers' bureaus, enter into patent

and royalty arrangements, agree to be the listed authors of articles

ghostwritten by interested companies, promote drugs and devices at

company-sponsored

symposiums, and allow themselves to be plied with expensive gifts and trips to

luxurious settings. Many also have equity interest in the companies. "

In September her journal joined the Lancet and 11 others in denouncing the

drug companies for imposing restrictions on the data to which scientists are

given access in the clinical trials they fund. Some of the journals propose to

demand a signed declaration that the papers scientists submit are their own.

The success of Prozac, the antidepressant which became a cult " happy " drug in

the 1990s, substantially raised the stakes in psychiatry. Its promotion

coincided with the decline of state funding for research, leaving scientists in

all

areas of medicine dependent on pharmaceutical companies to fund or commission

their work. That in turn gave the industry unprecedented control over data

and ended with research papers increasingly being drafted by company employees

or commercial agencies.

The responsibility of scientists for the content of their papers takes on

serious significance in the context of court cases in the US, where relatives of

people who killed themselves and murdered others while on SSRIs (selective

serotonin reuptake inhibitors) - the class of drug to which Prozac belongs -

claimed the drugs were responsible. According to Healy, a north

Wales-based

psychopharmacologist who has given evidence for the families, the companies

have relied on articles apparently authored by scientists who may in fact have

not seen the raw data.

Dr Healy, who had unprecedented access to the data that the companies keep in

their archives, said: " It may well be that 50% of the articles on drugs in

the major journals across all areas of medicine are not written in a way that

the average person in the street expects them to be authored. "

He cites the case brought last year against the former Kline Beecham

(now GlaxoKline) by relatives of Schell. The court found that the

company's best-selling antidepressant, an SSRI called Seroxat, had caused Schell

to murder his wife, daughter and granddaughter and commit suicide.

The company's defence was based on scientific papers which analysed the

results of trials comparing Seroxat with a placebo and found there was no

increased

risk of suicide for depressed people on Seroxat. But the raw data probably

does not support that, argues Dr Healy. Some of the placebo suicides took place

while patients were withdrawing from an older drug. When the figures are

readjusted without these, he says, they show there is substantially increased

risk

of suicide on Seroxat.

This raises the question of whether the eminent scientists whose names were

on the papers ever saw the raw data from the trials - or saw only tables

compiled by company employees, he says. Dunner, a professor at the

University

of Washington, who co-authored one of the papers in 1995, admits he did not

see the raw data. " I don't know who saw it. I did not, " he said. " My role in the

paper was that the data were presented to us and we analysed it and wrote it

up and wrote references. "

His co-author Stuart Montgomery, then of St 's hospital medical school in

London, declined to answer calls and emails from the Guardian. The third name

on the paper is that of Geoff Dunbar, a company employee.

The World Health Organisation has expressed concern about the ties between

industry and researchers. Quick, director of essential drugs and

medicines policy, wrote in the latest WHO Bulletin: " If clinical trials become a

commercial venture in which self-interest overrules public interest and desire

overrules science, then the social contract which allows research on human

subjects in return for medical advances is broken. "

January 28, 2004

In a message dated 1/27/2004 11:10:05 PM Eastern Standard Time,

CarolKerr@... writes:

There are good doctors and then there are bad, and I'm sure the bad ones

don't advertise to their employees when they accept bribes.

They are not offered bribes. That is my point.

January 29, 2004

I found this article offensive. I know my lyme doctor doesnt even have time to

get a vacation, never mind one payed for by " kickbacks " . Most LLMD's work an

immense amount of hours. If you are concerned about your doctor getting

kickbacks, maybe he or she is not the doctor for you. One has to be able to

trust his or her doctor fully. If it is a LLMD, you can usually tell how

passionate they are about lyme disease and their patients wellness.

NanB

January 29, 2004

Nan

I think you misunderstood we were talking about other categories of Drs in

General. We weren't referring to LLMD's who go out of their way to help one get

better. We were talking about the general medical community.

Re: [ ] Doctors do not receive " kickbacks "

I found this article offensive. I know my lyme doctor doesnt even have time

to get a vacation, never mind one payed for by " kickbacks " . Most LLMD's work an

immense amount of hours. If you are concerned about your doctor getting

kickbacks, maybe he or she is not the doctor for you. One has to be able to

trust his or her doctor fully. If it is a LLMD, you can usually tell how

passionate they are about lyme disease and their patients wellness.

NanB

January 30, 2004

Hello 1/29/04,

In reference to your comment:

è I found this article offensive. I know my lyme doctor

è doesnt even have time to get a vacation, never mind

è one payed for by " kickbacks " . Most LLMD's work an

è immense amount of hours. If you are concerned about

è your doctor getting kickbacks, maybe he or she is not

è the doctor for you. One has to be able to trust his or

è her doctor fully. If it is a LLMD, you can usually tell

è how passionate they are about lyme disease and their

è patients wellness. NanB

******Nan I believe most of us were offended to even think that " kickbacks "

go on in the medical communities, however they DO!! I can guarantee you that

when your doctor attends his continuing education (which is a license

requirement yearly) that he has received some form of compensation. When I

posted

these articles it was for the sole purpose of bringing awareness to those who

didn't know this happens daily in our medical communities......It isn't a matter

of not trusting, it is an unfortunate " fact. " There is no doubt in my mind that

doctors are passionate for the most part and truly care about their patients.

I'm sure LLMD's docs are especially concerned and compassionate for their

Lyme patients, but awareness and empowering patients to take control of their

own healthcare is vitally important for the well being of ALL patients...

****I have been on both sides of the fence and have seen more than I care to

admit goes on. The bottom-line here is to EMPOWER ourselves to make certain,

that we ARE getting the healthcare we should be getting from the docs we have

chosen to be a part of our healthcare team. Over the last 7 years that I have

been on Medicare/Medicaid, I personally have fired over 5 doctors. Yes, I

fired them and told them that " I " am the leader of my healthcare team and they

are merely a member of that team, and should they not meet my expectations then

I will fire them. I have done this within the Medicaid system. I recently

fired my thoracic surgeon and got me a new one. It is true that doctors and

nurses make the worst patients, simply because we know how things should be

done. I will say this, there are some doctors that should NOT be allowed to

practice medicine....they are a danger to the lives of many!!!

*****I do feel however that this is a subject that should always be discussed

to EMPOWER others to take charge of their own healthcare journey. Thank GOD

for the Internet, IMHO I believe it has saved many lives and empowered

patients to take charge. Many doctors don't like the Internet because it in

many

cases it teaches patients more than what the doctors know. Smart doctors will

listen and learn right along with their patients and be honest with their

patients about their lack of knowledge about healthcare issues. This attitude

will

actually help to protect their " risk management " of their patients and

protect their malpractice insurance. Unfortunately, there are egotistical docs

who

will be intimidated by patients who are knowledgeable and sometimes more

knowledgeable of their disease than their own docs, just like what is happening

with Lyme's disease.

*****Bottomline......YOU are in charge and please never forget that.....do

not let a doctor push you around....remind them that YOU are the leader of your

healthcare team and they are simply a member of that team......

Keep a smile on your face, love in your heart and walk with the angels,

holding hands in the " chain of love " ......

Angel Huggzzz

or Angel

MESSAGE BOARD FOR HEPATITIS

http://www.dream-tool.net/tools/messages.mv?index+hepheimers

HepHeimers Hepatitis Hut

www.hepheimers.com

January 30, 2004

In a message dated 01/29/2004 11:54:44 PM Eastern Standard Time,

heis1am@... writes:

> I found this article offensive. I know my lyme doctor doesnt even have

> time to get a vacation, never mind one payed for by " kickbacks " . Most LLMD's

> work an immense amount of hours.

January 30, 2004

In a message dated 01/29/2004 11:54:44 PM Eastern Standard Time,

heis1am@... writes:

> I found this article offensive. I know my lyme doctor doesnt even have

> time to get a vacation, never mind one payed for by " kickbacks " . Most LLMD's

> work an immense amount of hours.

January 30, 2004

In a message dated 01/29/2004 11:54:44 PM Eastern Standard Time,

heis1am@... writes:

> I found this article offensive. I know my lyme doctor doesn't even have

> time to get a vacation, never mind one paid for by " kickbacks " . Most LLMD's

> work an immense amount of hours.

I agree with you ( & with Lorraine)...and I know for a fact that your

Dr. (who is also mine) does not receive " kickbacks " . I also work for him & am

thoroughly aware of what goes on in the office. He has never been afforded

trips or anything else that extravagant. A lunch is usually simplistic; eating

sandwiches or pizza in our waiting room while having the drug rep. explain

his/her product and/or a teleconference call which requires 30-60 minutes of

listening to someone drone on about the product. He is always anxious to learn

something new & doesn't pass up an opportunity to be made aware of a new product

or a new use for an old product. He also spends a lot of his own time doing

research & his own money attending workshops or other types of programs that

continue to expand his knowledge. And let's not forget the " heat " many of our

LLMDs have endured while trying to help patients when no other Dr. will.

I'm sure there is some basis of truth to " kickbacks " but the audience the

drug companies seek is not a Dr. in a solo practice.

The problem is the insurance companies & their imposed formularies, as

Lorraine stated. I know this firsthand as my own insurance just subscribed to

that

practice for the very first time. And I wasn't even told until after the

fact. Upon questioning my RX company (the one mandated by my insurance), I was

told there is no law stating that I had to be told! In my experience as working

for a Dr. and as a patient, it is the pharmaceutical companies & insurance

companies that have banded together & have definitely taken choices of treatment

& diagnostic testing out of the hands of the patient & especially of the Dr.

As Lorraine had stated, we can spend days trying to get tests approved or a

certain prescription approved (based solely on the Dr.'s opinion that is the

best medication for that patient). Often an appeal process then becomes

necessary. And I can tell you that original denials stem mainly from the fact

that

someone who knows absolutely nothing, is just reading the formulary set forth

by that prescription company, which in turn is controlled by the pharmaceutical

companies. This is a huge problem & one that patients need to be made aware

of...your rights & your Dr's rights have been infringed upon. How dare some

untrained person sitting at a computer be given the power to deny a patient a

necessary medication or a possible life-saving test?

Pharmacists are in on it too...substituting generic drugs for name brand

ones, even when " do not substitute " is checked off on the prescription & they

are

not even honest enough to tell the patient. We see it happen all the time & I

have had it happen to me but because of my knowledge from working in the

field I was fortunate enough to not get suckered into it.

Just beware & be your own advocate. The only influence the Dr. I work for

has, is his own knowledge & experience & what has successfully treated Lyme &

the various co-infections. But it is very upsetting & frustrating for him & for

us to know that he cannot always treat a patient as he deems necessary. And

very often the result is that his opinion doesn't count, but one of an

unqualified person does.

As said, if you don't feel your Dr. can be trusted, then maybe it is

time to look for a new one.

Deb

January 31, 2004

Angel

I agree 100% and wish I knew this yrs ago.

Re: [ ] Doctors do not receive " kickbacks "

Hello 1/29/04,

In reference to your comment:

è I found this article offensive. I know my lyme doctor

è doesnt even have time to get a vacation, never mind

è one payed for by " kickbacks " . Most LLMD's work an

è immense amount of hours. If you are concerned about

è your doctor getting kickbacks, maybe he or she is not

è the doctor for you. One has to be able to trust his or

è her doctor fully. If it is a LLMD, you can usually tell

è how passionate they are about lyme disease and their

è patients wellness. NanB

******Nan I believe most of us were offended to even think that " kickbacks "

go on in the medical communities, however they DO!! I can guarantee you that

when your doctor attends his continuing education (which is a license

requirement yearly) that he has received some form of compensation. When I

posted

these articles it was for the sole purpose of bringing awareness to those who

didn't know this happens daily in our medical communities......It isn't a

matter

of not trusting, it is an unfortunate " fact. " There is no doubt in my mind