Drug companies do
indeed pay millions of dollars a year to physicians for speaking and consulting.
A series of “whistleblower”
lawsuits brought by former employees of those companies allege those payments
often were used for illegal purposes — financially rewarding doctors for
prescribing their brand-name medications. In several instances, the ex-employees say, the
physicians were encouraged to push “off-label” uses of the drugs — those not approved
by the U.S. regulators. This marketing tactic is banned by federal law.
After being
diagnosed with cancer, but before I went to MSKCC to see a specialist, I looked
into Sandostatin, the drug that Dr. L had recommended. I did not have to look
too far. It had shown up on the front page of the Wall Street Journal
and New York Times. As a
financial services employee, these are my regular reading materials. On September 30, 2010, Novartis, the maker of
Sandostatin, settled a whistleblower lawsuit filed by the Department of Justice
regarding the payment of illegal kickbacks
to health care professionals through mechanisms such as speaker programs,
advisory boards, entertainment, travel and meals. These were inducements to
prescribe Trileptal, as well as Diovan, Zelnorm, Sandostatin, Exforge and Tekturna.
Novartis paid $422 million as a civil penalty without admitting any
guilt. As a result of this settlement, Novartis
had to disclose payments to any doctor or medical institution receiving any compensation
from the company on a quarterly basis.
The link to payments is at:
On November 2, 2010, I had my
first appointment with Dr. Jekyll at MSKCC.
He wanted me to start Sandostatin immediately. The following week he cited the PROMID study
as a rationale for this treatment plan.
The PROMID study, funded by Novartis, found that patients taking a 30 mg
monthly dose of Sandostatin had a median time to progression of 14 months
longer than those on placebo. Dr.
Jekyll acknowledged the conflict of interest inherent in this study and said
that there have been no independent studies to confirm these results.
I subsequently found a bio of
Dr. Jekyll on a website where he had to disclose his conflicts of interest and it is below:
“Disclosure:
Dr. Jekyll has disclosed that he has financial interests, arrangements, or affiliations
with the manufacturer of products or devices to be discussed in this activity
or who may financially support the activity: Consultant: Alchemia
Limited; Bayer HealthCare; Delcath Systems; Genentech, Inc.; ImClone Systems
Incorporated; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation;
Pfizer Inc.; Roche Laboratories, Inc.; YM BioScience Inc. Grant/Research
Support: Amgen Inc.; Bayer HealthCare; Bristol-Myers Squibb Company;
Genentech, Inc.; ImClone Systems Incorporated; Merck & Co., Inc.; Pfizer
Inc.; Roche Laboratories, Inc.; Taiho Pharmaceuticals Co., Ltd.”
No
wonder he had no interest in treating patients!
My
intent with this post is just to inform others that doctors may have conflicts
of interest. They can be influenced by outsiders who are paying them to do
things which may not be in the best interest of their patients. Knowing all this information, I continued
with the treatment plan of Sandostatin LAR and am still getting monthly
injections of this drug. In a recent
article by Dr. K.E. Oberg from
University Hospital in Uppsala, Sweden titled “The Management of Neuroendocrine
Tumors: Current and Future Therapy
Options”, the author states the following: “There has been a dramatic
improvement in survival of patients with NETS diagnosed between 1988
and 2004 compared with those diagnosed earlier, based on data from the SEER
database. Coincidentally, this survival
improvement in the past 20 years corresponds with the introduction of Octreotide
(Sandodatin) in 1987. Historically, the
5 year survival rate was 18%, but it has improved to 67% in patients who have
received Somatostatin analogs.”
There
have been quite a few whistleblower lawsuits over the past few years. There
is also another website that one can check to see if your doctor is receiving
payments from any drug company. Propublica,
an independent not for profit news room, has compiled a list of doctors
receiving payments from those drug companies which were forced to disclose this
information as a condition of settlement of these lawsuits. Unfortunately, this list only covers about
40% of the drugs prescribed in the US. There are plenty of other doctors taking
funds from big Pharma that are not on this list. The link below from Propublica will inform you
if your doctor is receiving money from the pharmaceutical companies involved in
these lawsuits:
I
think that the reason that Americans take so many drugs is because the drug
companies have promoted their products aggressively through the medical
community. In the USA, we have higher
mortality and take more drugs than others in the developed world. Yet, these
other nations have a substantially longer life span. I believe this is due to these
payments and incentives for doctors in the US to prescribe
drugs. I would like the system to be
more transparent. I would like to know what percentage of my doctor’s income
is coming from patient and insurance reimbursements compared with income from
“speaking engagements and other work” from pharmaceutical companies. Doctors can and do take offense from this
line of questioning and are not very transparent about this even if asked. I don’t expect this to change very soon but
it is an important issue from a patient perspective.
