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There’s been a lot of news from the Pharma realm these last few weeks. As you all know, I make a point of passing this kind of thing along…. Given the massive role pharmaceutical drugs play in our society’s conventional health care, I like to keep on top of the developments. Speaking of “massive,” first there’s news from the National Center for Health Statistics, which released a report [3] measuring trends in prescription drug use and cost in the last decade. Between 1999 and 2008, prescription drug use rose in all age categories, as did the number of people taking multiple prescriptions. Approximately 88% of people over the age of 60 take one or more prescription medications on a regular basis. A whopping 66% use five or more prescriptions. Not surprisingly, cholesterol-lowering medications topped the list for this age group. In those 20-59, the most popular prescription was antidepressants. In children, 22% take a prescription drug, most commonly asthma medication. In the teenage category, the number jumps to 30%, with ADD/ADHD related meds first on the list. Not surprisingly, what we shelled out for Pharma products soared as well. Already taking inflation into account, Americans in 2008 spent more than twice ($234 billion) what they did in 1999 ($106.4 billion). Against this backdrop, we also learned that two popular prescription drugs were shown to actually cause the very problems [4] they prescribed to prevent. Telling stories and statistics, I’d say. What’s more sobering, however, are a number of recent publications that illuminate the cultural and financial underbelly of the pharmaceutical industry as a whole. I think you’ll find it thought-provoking.
For those of you who have joined us recently, let me mention a few things first. I’m not against medication [5]. In fact, I wholeheartedly support it when it genuinely and distinctively serves the critical health of an individual. I love living Primally [6], but I’m firmly planted in the modern age and appreciate its myriad of benefits. A number of us (and our loved ones), I know, wouldn’t be here without the help of medication at some point. When I refer to Big Pharma, I’m not referring to that worthy aim. I’m addressing instead the machinery that’s been built up around what should be a straightforward, transparent medical enterprise – a machinery that too often exploits and subverts the essential therapeutic purpose essential medication should serve. I’ve written before about underreported issues like manipulated statistics [7], off-label marketing [8], questionable research standards [9], and the FDA’s minimal reach [10]. It’s not about mass conspiracy. These are simply the facts. I, for one, believe knowledge is power. You as a reader can choose what to do with it.
That’s why I appreciated a recent article in The Chronicle of Higher Education [11] that a friend in the academe sent me a few weeks ago. Author Carl Elliott takes on “The Secret Lives of Big Pharma’s ‘Thought Leaders’” by revealing the staffing strategies pharmaceutical companies employ. The article focuses especially on the “key opinion leaders” (KOL’s), who Elliott describes as “a combination of celebrity spokesperson, neighborhood gossip and the popular kid in high school.” Within their academic circles, Elliott says, these big name researchers and practitioners have the professional clout to create inroads for the Pharma companies with their medical colleagues. Although the Pharma companies paint the KOLs role as “education,” their more strategic job is infiltration.
Reeling in these types of figureheads promises a unique and efficient means for reaching their medical field colleagues. All in all, pharmaceutical companies spend approximately one-third of their marketing budgets on this KOL program. The industry, Elliott explains, lures big name physicians with big money (sometimes much more than they earn from their medical practice or research) and with the enhanced sense of status that Pharma offers (complete with badges – no, seriously). The KOLs conduct industry sponsored studies, but their primary purpose is to create buzz within the medical field through their personal contacts and their mostly industry-written presentations. (Stray from the slides, dear doctor, and you’ll likely end up de-badged at the close of the conference.) KOLs also play a unique role in Pharma’s skirting of off-label marketing laws. Pharmaceutical companies manipulate the employment status of KOL physicians to allow KOL representatives the legal loophole of promoting off-label uses of the company’s drugs [8].
There has been public push back, however. As Elliott’s article notes, last year’s health care reform legislation included the “Physician Payments Sunshine Act,” a provision that legally compels pharmaceutical and medical device companies to regularly divulge to the Dept. of Health and Human Services all of their financial dealings with physicians and hospitals. It’s a start, but a more efficient means of controlling industry’s reach would be for universities and teaching hospitals to crack down on these Pharma ties. That move, Elliott explains, is unlikely given the number of academic physicians and administrators embroiled in corporate associations. Enlightening examples? As Elliott explains, University of Michigan’s president sits on the board of Johnson & Johnson. The president of Brown was a board member of Pfizer. So much for academic neutrality.
Other reports out this week, however, add another more disturbing layer to this picture. A public interest group, ProPublica, in partnership with Consumer Reports and National Public Radio have compiled and released a series of reports assessing the pharmaceutical companies’ payouts to doctors and the public’s discomfort with their physicians’ industry ties [12].
Although the industry’s financial dealings are still private material, lawsuits aimed at Pharma’s marketing have required many of the larger companies to disclose much of their payout information. Although the details are scattered in public websites and documents, ProPublica compiled the information from these various resources. The result? A list of 17,000 doctors and $257 million dollars in payout [13]. Additionally, the organization found that hundreds of physicians on the Pharma payroll lacked board certifications in their claimed fields [14] or had been sanctioned by state medical boards for unprofessional (and in some cases heinous) behavior.
ProPublica’s site [13] allows you to view top Pharma payouts and even check whether your doctor is on the payroll of one of the listed drug companies. The researchers acknowledge that their report represents only a partial tabulation. When the Sunshine Act goes into effect, we’ll get to see the full financial picture. In the words of a Coen brothers thought leader, “New s— has come to light.” Indeed.
Thoughts? What do you make of the emerging depictions and statistics? I’ll look forward to reading your comments. Thanks for reading, everybody. Have a great day.
