Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?
As commercial interests gain an increasing role in determining our “medical knowledge,” it is important to understand that the fundamental reason that companies help create and distribute this information is to promote their products and improve their corporate bottom lines. Our health is relegated to, at best, a secondary consideration. We need to question whether doctors should be given financial incentives to follow clinical practice guidelines, as some now are, when those guidelines may be based on incomplete or biased research...
The commercial take-over of our medical knowledge is, at its core, not a scientific problem but a political one.
When Shahram Ahari went to work at pharmaceutical giant Eli Lilly straight out of college in New Jersey, he was hired to do a job that few people know exists. Even the job title would be a mystery to most people. Ahari was going to be a "detailer".
His job was to schmooze with doctors in order to get them to prescribe Lilly's drugs. He was really a salesman, but he was also much more. His tools included everything from free drugs to offers of lucrative speaking engagements, even trips. He'd bring medical residents pizza for lunch or invite a doctor to dinner at an exclusive restaurant. He’d do anything to improve sales in his New York City district, which meant a bigger bonus.
The first hint of the strange world Ahari had entered came when he was brought to Indianapolis for Lilly's intensive, six-week boot camp for detailers. There, he met his fellow trainees. They were hundreds of fellow college grads, mostly in their mid-20s, perhaps two-thirds of them women, the vast majority beautiful.
"They were 200 or 300 of the most attractive people I had ever seen," he said in a phone interview. "The physical appeal was only part of it. They were vivacious, well-coiffured, well-dressed, engaging people."
For 14 years, British Columbia's Ministry of Health has relied on UBC's Therapeutics Initiative to assess the cost-effectiveness of prescription drugs, and to advise it on which drugs to include on the formulary of drugs covered by the publicly-supported program, Pharmacare. The assessments are based on the best scientific evidence, and completely independent of industry influence. Probably as a consequence, drug costs in B.C. are the lowest in Canada, and the province's skepticism about industry claims has protected residents from dangerous drugs that were more widely used elsewhere. For example, B.C. restricted the use of Vioxx, the arthritis drug that was pulled from the market because it increased the risk of heart attacks, and reportedly prevented some 500 deaths by doing so.
Now, B.C. is replacing this rigorous, evidence-based system with one likely to be dominated by the pharmaceutical industry, despite the industry's obvious interest in getting more brand-name drugs on the formulary, and doing it faster.
Perhaps the most egregious case exposed so far by Senator Grassley is that of Dr. Charles B. Nemeroff, chair of Emory University's department of psychiatry and, along with [Dr. Alan] Schatzberg, coeditor of the influential Textbook of Psychopharmacology. Nemeroff was the principal investigator on a five-year $3.95 million National Institute of Mental Health grant--of which $1.35 million went to Emory for overhead--to study several drugs made by GlaxoSmithKline. To comply with university and government regulations, he was required to disclose to Emory income from GlaxoSmithKline, and Emory was required to report amounts over $10,000 per year to the National Institutes of Health, along with assurances that the conflict of interest would be managed or eliminated.
But according to Senator Grassley, who compared Emory's records with those from the company, Nemeroff failed to disclose approximately $500,000 he received from GlaxoSmithKline for giving dozens of talks promoting the company’s drugs. In June 2004, a year into the grant, Emory conducted its own investigation of Nemeroff's activities, and found multiple violations of its policies. Nemeroff responded by assuring Emory in a memorandum, "In view of the NIMH/Emory/GSK grant, I shall limit my consulting to GSK to under $10,000/year and I have informed GSK of this policy." Yet that same year, he received $171,031 from the company, while he reported to Emory just $9,999--a dollar shy of the $10,000 threshold for reporting to the National Institutes of Health.
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