Wear Clean Draws  (because there’s 5 million ways to kill a ceo)

it’s because of Teh Capitalism!

Petersen has a chapter called “Neurontin for Everything.” She details the case United States of America, ex rel David Franklin v Pfizer and Parke-Davis, Civil Action No 96-11651-PBS. Filed 1996, settled 2004. You can find material on this case at dida.library.ucsf.edu.

Unlike a lot of earlier cases, the company’s records were made public. In similar cases, the companies argued that documents contained trade secrets and had to be sealed. The courts have generally complied. Fortunately for us we get an inside look at the way a pharmaceutical company behaves, how it trains it’s supposed “medical” and “research” staff as sales representatives, and how it chooses to outright lie to doctors and consumers in order to make a buck.

The point here is not that this is one rogue company. The point is that this is how they all behave. And her other point? It’s how the majority of doctors behave. They are on the dole of the pharmaceutical companies. My doctor is. Your doctor is. You actually have to work hard to find a physician who doesn’t take some form of bribe. how to tell? Are the posters on the wall from a drug company? The tissue box? Are they cramming DrugTV at your in the waiting room? Toys. Is there drug marketing literature sitting around?

Yes? They are on the take. I agree with Petersen’s recommendation: I’d like a godamned list of all the events a doctor attends, how much cash she accepts, etc. etc. As she points out, there is a small percentage of physicians who aren’t on the take. You have to search them out.

anyway.

In Petersen’s chapter she details the all too common practices of pharmaceutical marketing which involve the following, which does not exhaust the list of their tactics:

1. In 2004, over 500,000 dinners, resort vacations, retreats, meetings, sporting events for physicians where other physicians are paid to speak to the wonders of drugs, with slideshows written by marketing firms. With the case mentioned above, these doctors had to sign NDAs.

2. The hiring of fleets of sales reps who are called Drs, since they are. The companies purposefully hire physicans and PHDs, traipse them around in front of the FDA and their customers (physicians) to lend an air of scientific objectivity and medical authority to their antics.

These Drs are hired to ostensibly answer physician’s concerns, b/c they speak “their language” and are acting as trusted colleagues who will candidly discuss the research as objective scientists. They, however, are trained like David Franklin (case above) to dodge the questions, to lie to physicians. (one firm’s training material is actually called Dodge Ball. The reps are trained to dodge questions and not give answers.)

3. Doctors who are studied for their prescription rates and then targeted by doctor/sales reps to reward them with cash money for doing so, and to then get them to prescribe more by detailing all the possible uses for the drugs they hadn’t considered.

4. Doctors who, aware of the largess of big pharma, make requests for grants, cash payments, gifts, lusher retreats, better meals, better celebrities at their golf and fishing tournies, and entertainment for their kids on pharm-sponsored junkets. That is, they are already aware they are being bought, so they demand even more.

5. Doctors who are paid to give their (and, thus, your) medical records to these companies.

6. Doctors who are recruited to be thought leaders to push the off label uses of drugs to other doctors at the events in 1.

7. doctors who attend these conferences and refuse to do so are sabotaged by plants in the audience, hired and scripted by marketing firms.

8. Doctors are recruited to author articles and editorials which are ghost written for them by marketing firms and published in respected journals. In just one example, Parke Davis paid 160,500 for 12 articles written by marketing firm, Medical Education Systems, Inc., to describe the drugs emerging uses for bipolar disorder, migraines, chronic pain, mental disorders, and behavioral problems.

9. Doctors who are precepted (shadowed) by the doctor/sales reps. In a voicemail revealed in the case above, after seeing a patient, doctor and shadowing sales rep would consult privately. The sales rep would tell the doctor what to do, includign telling the doctor to double the dose to twice the legal limit allowed by the FDA.

10. Pharmaceutical comapnies hire doctors to front research trials but which the marketing arm or company ultimately directs. With Ritalin LA, these drugs are tested with dubious techniques: in the first two weeks of the trial, every placebo responder was removed, as were all the kids who demonstrated no response. Then, they removed all the kids who had suffered from depression, suicidal ideation, anxiety, migraines, intense anger, hypomania. The rest of the trial was conducted on children who did respond and who did so without the side effects listed above.

Petersen does not claim that these are merely unethical people. Instead, she points to research to explain, first, that company executives “make decisions that hurt people or society…because their foremost responsibility … is to maximize profits for shareholders.” She goes on to describe the work of J. Scott Armstrong’s research which basically shows what we already know (e.g., cases like the Ford Pinto) only doing so with business students at Wharton who, in a role playing game, make decisions must as Pfizer and Upjohn (the case of the drug Panalba) and other company execs did.

But that only explains the behavior of company execs and maybe even the doctor/sales reps who, unlike David Franklin, didn’t blow the whistle after four months as an employee. Instead, they collected bonuses higher than their salaries based on the rates at which doctors in their territories prescribed the drugs they were pedaling.

So, why do doctors go along with this?

“Social scientists have found that gifts as small as a cup of coffee can change the behavior of the recipient in ways that he or she does not even realize. The friendly giving of a penlight or key chain imbues a person with a sense of indebtedness. Whether he or she is conscious of it or not, the recipient feels the need to return the favor. Most doctors believe a gift can’t sway their judgment, that they are somehow different from everyone else. Study after study has shown they are wrong.”

(from Katz et al., “All Gifts Large and Small,” The American Journal of Bioethics, Summer 2003.)