Chemotherapy Kickbacks and Drug Industry Manipulation
Your oncologist is not likely working in YOUR best interest
I got onto this topic when Ilene and I met a farmer from the midwest. He told us of a conversation he had with a neighbor, a pharmaceutical sales representative for Lipitor. Her job was to go to each physician in her territory and review their prescription records. She implemented the "Lipitor program", in which the physician received $100.00 for every 6 or so prescriptions written for Lipitor! No wonder so many physicians prescribe Lipitor and its sales were $12.9 Billion in 2006 and growing 6.4 percent a year. And given that Lipitor is so profitable, it is unlikely that the medical establishment will refrain from prescribing Lipitor despite its ability to wipe out memory and cause other health issues. The Lipitor rebate system upset and intrigued me. Here is a look at some ways drug companies manipulate physicians. I had heard the money was even bigger in the chemotherapy field.
The Danger In Drug Kickbacks. (if the link vanishes, click here). This May 2007 article from the NY Times shows just how much money still exists in rebates and kickbacks for cancer doctors.
"...(for)...high-volume providers the profits can be substantial. One group of six cancer doctors in the Pacific Northwest earned a profit of about $1.8 million last year thanks to rebates from Amgen, while a large chain of dialysis centers gets an estimated 25 percent of its revenue, and a higher percentage of its profits, from the anemia drugs. It seems likely that these financial incentives have led to wider use and the prescribing of higher doses than medically desirable. "
Incentives Limit Any Savings in Treating Cancer (if the link vanishes, click here) Highlights:
"In general, oncologists make money by providing chemotherapy, even when it has little chance of success."
“Five years ago, many physicians were earning over $1 million per year on drug sales alone”
"Doctors who buy large quantities of medicine can still get big rebates from drug companies, so they can continue to make money on prescriptions — even if it is not at the levels of the past.
"Some physicians say that cancer doctors responded to Medicare’s change by performing additional treatments that got them the best reimbursements, whether or not the treatments benefited patients."
“People go where the money is, and you’d like to believe it’s different in medicine, but it’s really no different in medicine,” Dr. Geller said. “When you start thinking of oncology as a business, then all these decisions make sense.”
Exposing the links between doctors and Big Pharma New Scientist, 25 February 2009
A New England Journal of Medicine article, "Financial Conflicts of Interest in Physicians' Relationships with the Pharmaceutical Industry — Self-Regulation in the Shadow of Federal Prosecution" October 2004, discusses the inappropriate relationship between physicians and drug companies.
Health Industry Practices That Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers JAMA, 2006 discusses the issue and proposes that action be taken. Do not count on "Action". The money is too big and the problem has been around forever. You cannot expect doctors to voluntarily cut their incomes in half.
Is Your Endocrinologist "Under the Influence?", by Mary Shomon is a nice review of this article and adds some great additional material. Interesting too was the look at the special interest ties of a doctor who was openly critical of her blog.
Who's Buying Lunch: Are Gifts to Surgeons from Industry Bad for Patients? 2005, Thoracic Surgery Clinics.
Prescribing Under the Influence
Following the Script: How Drug Reps Make Friends and Influence Doctors is a testimony by a former drug company rep and gives an inside look at how drug company salesmen are supposed to wine and dine doctors.
"While it's the doctors' job to treat patients and not to justify their actions, it's my job to constantly sway the doctors. It's a job I'm paid and trained to do. Doctors are neither trained nor paid to negotiate. Most of the time they don't even realize that's what they're doing"
" Pharmaceutical companies spend billions of dollars annually to ensure that physicians most susceptible to marketing prescribe the most expensive, most promoted drugs to the most people possible. The foundation of this influence is a sales force of 100,000 drug reps that provides rationed doses of samples, gifts, services, and flattery to a subset of physicians" (full pdf version)
Getting Doctors to Say Yes to Drugs: The Cost and Quality Impact of Drug Company Marketing to Physicians (Full PDF)
The top-spending firms currently pour more than $1 billion each into their sales forces every year." The "detail force' of the drug companies gets a return-on-investment of over 10:1 when talking directly to physicians.
YouTube Video http://www.youtube.com/watch?v=nj0LZZzrcrs by Shahram Ahari, the former drug company representative.
Gwen Olsen YouTube video, a former drug company rep tells a tale of the hiding of serious side effects from doctors and the public. She also discusses the high level of training the drug reps get to control and guide doctors.
John Ringen YouTube Video. John was a former (35 years) pharmaceutical executive and discusses a book about his often criminal actions within the industry. It's all about "money, money, money".
Adriane Fugh-Berman YouTube Video on some tactics that drug company reps use to sell drugs to doctors.
A national survey of physician-industry relationships. 2007, New England Journal of Medicine. "RESULTS: Most physicians (94%) reported some type of relationship with the pharmaceutical industry".Physician ties to drug industry stronger than ever is a nice summary of this article.
"The influence that the pharmaceutical companies, the for-profits, are having on every aspect of medicine ... is so blatant now you'd have to be deaf, blind and dumb not to see it,"
Nationally distributed news article, 11 September 2008, "Medical schools, journals fight industry influence"
Conflict of interest between the drug companies and physicians is as prevalent as ever. You need to know that your doctor might not be acting with you only in mind. Most doctors rely on drug company reps for information and many doctors are swayed by lucrative incentives. A doctor can add hundreds of thousands of dollars to his yearly income by prescribing expensive, useless and harmful chemotherapies, surgeries and scans. It is in HIS interest to do this. Do not assume your doctor is acting only in your interest. There are many great physicians out there. You need to do some searching to find one. If you do find a physician that is willing to help you with DCA, please let us know so we may share that information with others.