If you think bankers are corrupt, be sure you give doctors their due. On Feb. 9, the pharmaceutical company Pfizer announced it would disclose the payments it makes to doctors to promote its drugs. Unfortunately, Pfizer is like a husband who confesses to infidelity right after he's been caught in bed with another woman.
In the last year, investigations by Iowa Sen. Chuck Grassley, the senior Republican on the Senate Finance Committee, have turned up breathtaking cases of corruption among doctors and pharmaceutical companies. Universities typically require doctors to disclose income from drug companies to insure that conflicts of interest don't undermine medical research. However, there is no legal penalty for lying, and the system relies on doctors to act in good faith. As Sen. Grassley has discovered, asking doctors to act in good faith regarding pharmaceutical payments works about as well as trusting a kindergartner with a jar full of chocolate chip cookies. The doctors have been lying. A lot.
Consider Charles B. Nemeroff, the doctor who directed Emory University's department of psychiatry. He was the lead researcher on a five-year, $4 million grant to study drugs made by GlaxoSmithKline. In 2004, Emory reviewed Nemeroff's management of the study and asked him to affirm that he was adhering to university disclosure policies. Nemeroff assured Emory that he would limit his work for Glaxo while he was researching the company's drugs. He later reported $9,999 of consulting income, or $1 beneath the disclosure threshold set by the National Institutes of Health.
How much was Nemeroff really making? By pressuring pharmaceutical companies to release payment records, Sen. Grassley discovered that Glaxo actually paid Nemeroff a stunning $171,031 in 2004. Over the course of several years, Nemeroff failed to disclose more than $500,000 in income from Glaxo alone. In December, Emory announced it was stripping Nemeroff of his chairmanship.
The most egregious example may be Joseph Biederman, professor of psychiatry at Harvard Medical School. Biederman was hugely successful in convincing psychiatrists that they were under-diagnosing bipolar disorder in children. Thanks in large part to his efforts, children as young as 2 years old have been diagnosed with bipolar disorder and treated with atypical antipsychotic drugs such as Risperdal. In exchange for his efforts, pharmaceutical companies paid Biederman $1.6 million in consulting and speaking fees, most of which he failed to disclose.
The pharmaceutical companies claim that the payments are legitimate compensation for "educational" speeches the doctors make, but it's hard to see them as anything but bribes. Certainly, the doctors knew they had something to hide. At the same time that Biederman was collecting his payments, there was a 40-fold increase in the diagnosis of bipolar disorder in children, from 20,000 to 800,000 children. Nearly all of those children are treated with drugs, typically atypical antipsychotics. These drugs were developed to treat conditions such as schizophrenia, but there are only so many schizophrenics in the world. Risperdal alone had sales of $2.5 billion in 2007, and sales of all atypical antipsychotics are about $12 billion a year.
Undoubtedly, these drugs do help many patients, but the tidal wave of prescriptions for children is deeply troubling. The drugs have serious side effects, including precipitous weight gain. In November, a review panel for the Food and Drug Administration unanimously rejected the agency's proposals for monitoring Risperdal and Zyprexa, another antipsychotic. The panel expressed misgivings about the lack of safety studies on the use of these drugs in children and was particularly bothered that the drugs are increasingly prescribed as treatment for relatively mild conditions like attention deficit disorder.
It seems that pharmaceutical companies will do whatever is necessary to boost sales of their drugs. A survey of pharmaceutical research in the "New England Journal of Medicine" found that drug companies published 37 of 38 positive studies, but only 3 of 36 negative studies. In December, Sen. Grassley published internal documents from the drug company Wyeth showing that it had secretly paid ghost writers to publish positive journal articles on the company's drugs. In January, Pfizer announced it was buying Wyeth for $68 billion.
Drug companies spend an astonishing amount of money to promote their products to doctors. A January study in "PLoS Medicine" found that the industry spent $61,000 per doctor in 2004, the latest year for which data was available. The number of promotional meetings has increased dramatically, jumping from 120,000 in 1998 to 371,000 in 2004. Those costs are passed on to American consumers in drug prices that run 30 to 40 percent higher than prices in Canada. The drug companies spend twice as much on promotion as on research.
What is to be done? At minimum, Congress should pass Sen. Grassley's Physician Payments Sunshine Act of 2009. It would require drug companies to report all payments to doctors over $100. Failure to do so would be punished by fines of up to $1 million.
More broadly, we must give serious thought to whether our system can sustain a staggering $60 billion in pharmaceutical promotion every year. Among developed countries, only New Zealand and the United States allow widespread marketing of prescription drugs.
Today, we trust doctors and drug companies to act in the public interest even as the rewards for dishonesty are immense. As the Obama administration takes up health-care reform, we must ask ourselves: Do the drug companies deserve our trust?
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