Thursday, May 10, 2007

How to buy a physician - first find someone who agrees with you

I dug this post out of the archives of unpublished posts. I wrote it in 3/07, but the NYT has followed up with a 2nd article today. So I've put them together.
In the old days, when you wanted to buy a Senator you slipped them a bag full of money. That still happens I'm sure, but we're more sophisticated now. If Philip Morris wants to buy a Senator, they find who agrees with them (preferably someone stupid, but a smart libertarian will do) and they fund their political career. Chances are they'll still be an idiot even if they're elected, and Philip Morris will have purchased a senator.

Not surprisingly, physicians are just as easy to purchase as Senators -- and cheaper. They're equally likely to deny that they've been bought. This is not new, but now, thanks to my home state, we have numbers (emphases mine). Much of this money will come from small CME programs sponsored by drug companies rather than direct payments. I've done those CME programs, though I probably wasn't speaking about meds. So the money trail is probably less precise than the NYT article implies ...
Doctors’ Ties to Drug Makers Are Put on Close View - New York Times
The New York Times
March 21, 2007

... payments ... appear in an unusual set of records. They come from Minnesota, the first of a handful of states to pass a law requiring drug makers to disclose payments to doctors. The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products.

The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million [jf: over 8 years] Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.

Doctors receive money typically in return for delivering lectures about drugs to other doctors. Some of the doctors receiving the most money sit on committees that prepare guidelines instructing doctors nationwide about when to use medicines. Dr. Collins, who received more money than anyone else in the state, is among a limited number whose payments financed research.

In dozens of interviews, most doctors said that these payments had no effect on their care of patients...

...There is nothing illegal about doctors’ accepting money for marketing talks, and professional organizations have largely ignored the issue.

But research shows that doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs — whether or not they are in the best interests of patients.

“When honest human beings have a vested stake in seeing the world in a particular way, they’re incapable of objectivity and independence,” said Max H. Bazerman, a professor at Harvard Business School. “A doctor who represents a pharmaceutical company will tend to see the data in a slightly more positive light and as a result will overprescribe that company’s drugs.”

In an e-mail message, Dr. Collins said he personally received in 2004 less than $10,000 from Amgen for educational presentations. “The contract amount of $1.9 million from Amgen was paid to the Minneapolis Medical Research Foundation (MMRF) for the research contract, on which I am the designated senior researcher,” Dr. Collins wrote. He wrote that he did not work for or serve on the board of directors of the foundation. Dr. Collins discloses on his Web site and research papers that he is a consultant to Amgen, among other companies.

Dan Whelan, an Amgen spokesman, said the company paid the Minneapolis Medical Research Foundation “to conduct sophisticated research and data analyses that have enhanced the understanding of health care delivery” for kidney patients.

But Dr. Daniel Coyne, a kidney specialist at Washington University, said he was troubled by the payments.

“Amgen’s funding for Dr. Collins’s MMRF is another huge financial connection to individuals at the National Kidney Foundation,” Dr. Coyne said. “The foundation’s recent pro-industry anemia guidelines — and the revisions due next month — have to be viewed with great skepticism.”

... More than 250 Minnesota psychiatrists together earned $6.7 million in drug company money — more than any other specialty. Seven of the last eight presidents of the Minnesota Psychiatric Society have served as consultants to drug makers, according to the Times examination.

After psychiatrists, doctors who specialized in internal medicine garnered the most money, followed by cardiologists, endocrinologists and neurologists...

... In addition to Minnesota, legislators in Vermont, Maine, West Virginia, California and the District of Columbia have passed laws requiring some level of disclosure of drug company marketing efforts. In Vermont, the state has collected three years of data on payments to doctors, but drug makers are allowed to keep the records private by declaring them trade secrets....

...Dr. George Realmuto, a psychiatrist from the University of Minnesota, said most of the marketing associated with his lectures was packaged around his talks.

“It’s at a wonderful restaurant, the atmosphere is very conducive to a positive attitude toward the drug, and everyone is having a good time,” said Dr. Realmuto, who compared the experience to that of buying a car in a glitzy showroom. He earned at least $20,000 between 2002 and 2004 from drug makers.

... Jamie Reidy, a drug sales representative for Pfizer Inc. and Eli Lilly & Company who was fired in 2005 after writing a humorous book about his experiences, said drug makers seduced doctors with escalating financial inducements that often start with paid trips to learn about a drug.

... “You’re making him money in several ways,” said Gene Carbona, who left Merck as a regional sales manager in 2001. “You’re paying him for the talk. You’re increasing his referral base so he’s getting more patients. And you’re helping to develop his name. The hope in all this is that a silent quid quo pro is created. I’ve done so much for you, the only thing I need from you is that you write more of my products.”

...The number of drug marketing presentations delivered by doctors across the United States rose nearly threefold between 1998 and 2006, according to Verispan, a company that tracks drug marketing efforts.

In some cases, consulting doctors are so well recognized that they offer drug makers far more than the chance to influence their own prescriptions. For drug makers, among the most prized consultants are those who write guidelines instructing their peers about how to use drugs...
A prior (harshly titled) post of mine has links to an article that details just how an individual is, slowly, corrupted. The great disappointment for me is how completely the drug companies have infiltrated the standards groups.

The NYT followed up in 5/07 with another article using the same data source, this time focusing on pyschiatrists and their prescription patterns:

... A New York Times analysis of records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors, provides rare documentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children.

From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.

Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money...

... Ten years ago, Dr. Realmuto helped conduct a study of Concerta, an attention deficit hyperactivity disorder drug marketed by Johnson & Johnson, which also makes Risperdal. When Concerta was approved, the company hired him to lecture about it.

He said he gives marketing lectures for several reasons.

“To the extent that a drug is useful, I want to be seen as a leader in my specialty and that I was involved in a scientific study,” he said.

The money is nice, too, he said. Dr. Realmuto’s university salary is $196,310.

“Academics don’t get paid very much,” he said. “If I was an entertainer, I think I would certainly do a lot better.”...

I wonder if Dr. Realmuto has any idea how bad that sounds? There is, finally, one hero in the entire series ...
Other psychiatrists renewed Anya’s prescriptions for Risperdal until Ms. Bailey took Anya last year to the Mayo Clinic, where a doctor insisted that Ms. Bailey stop the drug. Unlike most universities and hospitals, the Mayo Clinic restricts doctors from giving drug marketing lectures...
Praise be to the Mayo.

Great series NYT, but lord its bad news for physicians. Psychiatrists, in particular, are supposed to know a bit about how the mind works. Be ashamed, be very ashamed.

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