Reprinted with the kind permission of Dr. Mercola, January 8, 2014
By Dr. Mercola
It is entirely legal for drug companies to pay medical professionals to promote their products, and this practice is widespread in the drug industry.
After all, as the New York Times reported, "doctors are most likely to value the advice of trusted peers,"1 which is why drug companies are known to invest heavily in paying physicians to speak about their products to other physicians (often at medical conferences).
The conflict of interest within this practice is obvious, which is why the drug industry often keeps quiet on their actual payments, as do the medical professionals involved. Now, in a first for any major drug company, British drug maker GlaxoSmithKline has announced that it is putting an end to this and other dubious business practices.
Glaxo to Stop Paying Doctors for Drug Promotion
Last month, Glaxo's chief executive Andrew Witty announced the company would no longer pay health care professionals to promote its products or the diseases they treat to "audiences who can prescribe or influence prescribing." Also set to be discontinued is the practice of paying for doctors to attend medical conferences (a practice that is already banned in the US but is still allowed in other countries).
Glaxo also plans to stop compensating its sales representatives based on the number of prescriptions that doctors write, instead saying that they will base their pay on technical knowledge, quality of service they provide and other factors.
This move was actually required as part of a corporate integrity agreement Glaxo made with the US Justice Department in 2011, but it only applies to the US. Glaxo now plans to extend the policy globally.
The new plan, which is expected to take effect worldwide by 2016, is said to be the culmination of a yearlong effort "to try and make sure we stay in step with how the world is changing," according to Witty.2 But some believe it may simply be "a desperate attempt to deflect attention from recent scandals"3 that have plagued the drug giant…
Glaxo Paid the Largest Health Fraud Settlement in US History
In 2012, GlaxoSmithKline (GSK) plead guilty in the largest health fraud settlement in US history. The company was fined $3 billion to resolve criminal and civil liability charges related to illegal drug marketing and withholding information about health hazards associated with its diabetes drug Avandia and others, including Paxil and Wellbutrin. According to the US Justice Department,4 GlaxoSmithKline:
1. Unlawfully marketed the antidepressant Paxil to children and adolescents.
The drug is FDA approved for the treatment of depression in adults only. The complaint details how GSK manipulated the findings of one of these studies to reach the false conclusion that Paxil was effective against depression in adolescents.
A GSK employee also recommended revising a section of the study relating to side effects, removing the finding that serious side effects like worsening depression and hostility (suffered by 11 children in the study) were considered related to the treatment, and replacing it with a statement that headache (suffered by one participant) was the only side effect considered to be treatment-related.
The complaint calls the study, published in July 2001 in The Journal of American Academy of Child and Adolescent Psychiatry, "false and misleading." This fraudulent and misleading study was subsequently used by GSK to illegally promote Paxil for children and teens...
2. Unlawfully marketed the antidepressant Wellbutrin for weight loss and sexual dysfunction.
In a NPR radio interview,5 Carmen Ortiz, U.S. Attorney for the District of Massachusetts, stated that "GSK hired a public relations firm to create a buzz about getting skinny and how you could have more sex simply by using this drug... using every imaginable form of high-priced entertainment, from Hawaiian vacations to paying doctors millions of dollars to go on speaking tours, to a European pheasant hunt, to tickets for Madonna concerts."
One of the most high-profile accounts involved television celebrity Dr. Drew, who reportedly received $275,000 from GSK to promote Wellbutrin to treat sexual dysfunction associated with depression even though it hasn't been proven effective for this purpose.
3. From 2001 through September 2007, failed to report safety data relating to clinical experience and other information as required by law to the FDA for the diabetes drug Avandia.
As previously reported, Avandia has been found to be profoundly dangerous—a fact hidden by GSK for over 10 years, as they knew it would adversely affect sales.6 This was revealed in a Senate Finance Committee report, released by Max Baucus and Charles E. Grassley in February 2010. The report also asked why the FDA allowed a clinical trial of Avandia to continue even after the agency estimated the drug had caused an estimated 83,000 heart attacks between 1999 and 2007.
GlaxoSmithKline Is Embroiled in Alleged Kickback Allegations in China
In 2012, China's pharmaceutical market grew by 20 percent, a hefty increase now believed to be at least partly the result of years' worth of bribery and scandal. GlaxoSmithKline, in particular, has faced above-average growth in the region, with its stock outperforming its competitor's nearly 2 to 1 in 2012.
The company's super growth appears to be backed by illegal marketing strategies, which actually encourage bribery. Allegations have been made, in fact, that GSK paid kickbacks to doctors, hospitals, and government officials, using travel agencies as middlemen to carry out the illegal acts. Doctors and government officials reportedly received perks such as travel, cash and even sexual favors that, when combined, amounted to nearly $5 billion, according to some reports.
Four Chinese GSK executives have been detained and accused of bribe collaboration so far in the six-month long investigation. British national Mark Reilly, GSK's head of Chinese operations, reportedly left China in June 2013. Like most other drug companies,
GSK is no stranger to criminal allegations and convictions. So their recent announcement that they are ending two of the most controversial practices common to the drug industry does raise some eyebrows. Is this leopard really changing its spots… or are other motives at play?
Obviously, with their reputation increasingly tarnished by their 2012 $3-billion settlement and the ongoing bribery investigation in China, they could use all the positive PR they can get. As reported by Forbes, GSK may be simply doing some damage control, betting that what they lose in doctor drug promotions they'll regain by bolstering their ailing reputation.
"…studies have shown that a company's value as measured by market capitalization increases when its reputation is enhanced and that non-financial indicia of reputation are critically important tools that support the ability to charge premium prices and ensure access to capital markets. So it's not a bad thing, or even necessarily financially disadvantageous, for executives to think broadly about societal benefit when managing corporations…"7
Huge Fines Are Not Enough to Deter Drug Companies from Breaking the Law
After GSK paid its "dues" in the form of a $3-billion settlement and has followed through with its corporate integrity agreement to stop compensating its sales force based on doctors' numbers of written prescriptions, it might appear that they are now changing their tune, straightening up and flying right.
But as a new observation piece published in the British Medical Journal8 points out, even with escalating criminal and civil penalties, international drug companies are not being deterred from breaking the law. Even after paying enormous fines and being monitored under mandated corporate integrity agreements, many drug companies go on to commit additional criminal acts. The review goes so far as to state that "commission of such criminal and civil violations has become part of their business models."
"Are criminal and civil penalties of hundreds of millions of dollars an important deterrent to law breaking by international drug companies? Further, would external monitoring in the form of US government mandated corporate integrity agreements (CIA) to prevent recurrences of such illegal activities, lasting five years after being signed, be an additional deterrent? Yes in both cases, but only if the size of the penalties outweighed the companies' gains while violating the laws and only if enforcement of the CIAs were effective.
Unfortunately, neither is the case. This evaluation is based on the recent, sharp escalation in the frequency with which many giant multinational drug companies repeatedly engage in illegal criminal and civil activity after previously paying enormous fines and despite monitoring under CIAs. It seems that for some companies, commission of such criminal and civil violations has become part of their business models."
Are You Wondering What Your Doctor Has Been Paid?
Beginning in 2014, you will be able to determine if a health care provider you trust is actually on the drug industry's payroll, thanks to a new federal law that entails the following:
Drug and medical device companies will be required to report and disclose all payments (including stock options, research grants, knickknacks, consulting fees, travel expenses, and more) to physicians. Unfortunately, payments to nurses, physician assistants, and other medical professionals will not have to be disclosed
The information will be displayed in an online government database that you will be able to search
In the meantime, you can search ProPublica's database to see the disclosed payments made to physicians in your state. Many of the most prestigious universities, including Harvard, are now banning their staff from receiving money from drug companies for speaking, and this new disclosure requirement will hopefully push more institutions in that direction.
Breaking the drug industry's stranglehold on the conventional medical industry will not be easy -- after all, the drug industry spends nearly twice as much on promotion9 as it does on research and development -- but the tide is beginning to turn. Increasing numbers of people are now waking up to these harsh realities, and you, being among those who are informed, can help share this knowledge with others. More than 1.5 million people receive this newsletter, and together, we can make a huge difference.
The ultimate goal is to have a critical mass of people refuse the unnecessarily dangerous and counterproductive solutions currently offered by conventional medicine, as this will be the powerful stimulus to generate authentic change. You can also act now, on a personal level, by making the necessary lifestyle changes that will allow you to take control of your health, instead of leaving it in the hands of the drug industry.
1. NYTimes.com December 16, 2013
2. NYTimes.com December 16, 2013
3. Forbes December 23, 2013
4. US District Court, US v. GlaxoSmithKline
5. NPR July 9, 2012
6. Associated Press February 20, 2010
7. Forbes December 23, 2013
8. BMJ 2013;347:f7507
9. PLoS Med. 2008 Jan 3;5(1):e1.
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