Cash, sexual favors and drugs

money-pillsCash, sexual favors and drugs. We’re not talking about a dope house.

Some people (and companies) never learn:

…last week, UK pharma firm GlaxoSmithKline admitted that Chinese doctors were bribed by its execs with cash and sexual favours in return for prescribing the company’s drugs. That coincided with rival AstraZeneca having its Shanghai office raided by police – all of which is jolly inconvenient, as Astra faces the City this week to unveil its interim results.

Some investors ponder whether bribery is a wider problem than has yet emerged, and if Chinese authorities are deliberately targeting foreign firms.

Maybe, but critics of the UK companies also point to GSK’s $3bn fine last year for bribing US doctors, plus Astra’s indictment in Serbia on similar charges, as well as an admission in its annual report about “investigating indications of inappropriate conduct in certain countries, including China”.

Why is this relevant here?

Well, last year GSK, among other things, admitted to illegally marketing Wellbutrin as an addiction treatment. They are a current partner with NIDA on developing a nicotine vaccine.

As for AstraZeneca, they are a new partner with NIDA on developing new addiction treatment medications.

In a related post, Alan Frances argues that congress needs to fix the U. S. mental health system.

On Pharma:

Third, Big Pharma needs to be tamed — just as twenty years ago, Congress tamed Big Tobacco. Drug company marketing consists of nothing more than misleading disease mongering — selling diagnoses to peddle pills to people who don’t need them. If it has the political will to take the following steps, Congress can easily end Pharma’s hijacking of medical care. No more direct-to-consumer advertising of drugs — a privilege Pharma enjoys only in the US. No more misleading marketing to doctors cloaked in the sheep’s clothing of ‘education’. No more financial contributions turning consumer advocacy groups into extenders of company lobbying. No more ‘research’ guided by the marketing efforts to enhance patent life and stretch indications, rather than aiming for real breakthroughs. No more ghost written papers by thought leaders who mouth party line. No more monopoly pricing power because government is prohibited from bargaining. And no more revolving door politicians drifting back and forth from government to cushy Pharma jobs.

On overdoses:

Seventh, Congress should attend to the catastrophe that more people now die from overdoses of prescription than street drugs. High flying prescribers need to be brought to ground with strict monitoring, professional discipline, and public shaming. And real-time computerized control could contain loose drug dispensing. If Visa can put an advance stop on a suspicious $100 purchase, we can develop a proactive check that a prescription makes sense before filling it. Cooperative FDA and DEA scrutiny of drug company marketing practices and distribution methods would reduce the current free availability of lethal narcotics. We are fighting a drug war against the cartels that we cannot possibly win and haven’t yet begun a war against the inappropriate use of prescription drugs that we could not possibly lose.

Also a couple of points on Pharma’s diagnostic fuel.

On the DSM:

First, the diagnostic system in psychiatry is broken and can’t be fixed internally by the American Psychiatric Association — which currently holds the monopoly. DSM-5 has fanned the flames of diagnostic inflation with definitions that turn everyday life problems into mental disorder — harming the misidentified ‘patients’ and costing the economy billions of dollars. Psychiatric diagnosis has become too important (in decisions determining workman’s comp, disability, VA benefits, school services, custody, criminal responsibility, preventive detention, and the ability to adopt a child, fly a plane, or buy a gun) to be left to one small professional association

Psychiatric diagnosis is too much a part of public policy to be left exclusively in the hands of the psychiatrists. Experts in psychiatry have no expertise in how their diagnostic decisions will affect public health, public welfare, the allocation of resources, and the health of the economy. Congress should set up an agency to ensure much more careful vetting of risks and benefits.

On inflated prevelance estimates:

Sixth, Congress should investigate the CDC’s fatally flawed method for determining rates of mental disorder. CDC has a systematic bias toward over-estimating the disorder rates in the healthy and ignoring the needs of the really sick. Its data gathering relies on telephone contacts conducted by lay interviewers who cannot possibly distinguish clinically significant mental disorder from everyday symptoms that are part of the human condition. The wild instability and elasticity of the reported prevalences is proof positive they should be discounted; not taken as credible indication our society is getting sicker. Epidemiological attention should focus instead on the extent and correlates of the more severe mental disorders currently being neglected.

GlaxoSmithKline’s corruption

GlaxoSmithKline
(Photo credit: Ian Wilson)

The details are simultaneously exactly what you’d expect and shocking.

And some people wonder why we’re reluctant to embrace the latest and greatest pharmacological fad. Keep all of this in mind next time someone suggests that medicalizing addiction treatment will improve professionalism, ethics and reliance on scientific evidence.

Sham advisory boards:

Glaxo also used sham advisory boards and speakers at lavish resorts to promote depression drug Wellbutrin as an option for weight loss and a remedy for sexual dysfunction and substance addiction, according to the government. Customers were urged to use higher-than-approved dosages, the government said.

Phony continuing education programs:

GSK paid millions to doctors to promote the drug off-label during meetings sometimes held at swanky resorts, the government said. The company relied on pharmaceutical sales reps, “sham advisory boards,” and continuing medical education programs that appeared independent but were not.

Misleading doctors:

The company went to extreme lengths to promote the drugs, such as distributing a misleading medical journal article and providing doctors with meals and spa treatments that amounted to illegal kickbacks, prosecutors said.

Bribing doctors:

“GSK’s sales force bribed physicians to prescribe GSK products 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 to Madonna concerts, and this is just to name a few,” said Carmin M. Ortiz, U.S.attorney in Massachusetts.

Widespread:

Crimes and civil violations like those in the GlaxoSmithKline case have been widespread in the pharmaceutical industry and have produced a series of case with hefty fines. One reason some have said the industry regards the fines as simply a cost of doing business is because aggressively promoting drugs to doctors for uses not officially approved — including inducing other doctors to praise the drugs to colleagues at meetings — has quickly turned numerous drugs from mediocre sellers into blockbusters, with more than $1 billion in annual sales.

Stories have noted that Pfizer agreed to a $2.3 billion settlement in 2009. Also, Johnson & Johnson settled with Arkansas for $1.2 billion for several violations, including:

…for not disclosing the risks of the antipsychotic Risperdal.

Withholding data on Paxil:

GSK allegedly participated in the publishing of medical journal articles that stated paroxetine was effective in patients under 18, when, in fact, the data showed that the opposite was true. At the same time, the company withheld study data in from two other studies in which Paxil also failed to demonstrate efficacy in treating depression in patients under 18, according to a press release from the Justice Department.

Kept safety issues secret:

…the company kept secret data on raised cardiovascular effects.