Sunday, June 24, 2012

Who’s Paying Your Doctor?

Prior to being diagnosed with cancer, I did not have much interaction with doctors or the medical establishment.  I knew that the pharmaceutical industry paid doctors to prescribe drugs - with resulting conflicts of interest.  Since I was not taking any drugs, this did not really matter to me. 

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.  MultimediaIn 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.