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| A la carte meals, conference expenses etc are part of the 'inducement culture' of Big Pharma. |
Drug
companies pay doctors £40m for travel and expenses
Fri, 04/05/2013 - 15:29 EDT - The Guardian
Total
spend on consultancy fees and junkets by 35 suppliers revealed by trade body in
move to greater transparencyDrug companies are paying an estimated £40m a year
to British doctors in service fees, flights, hotel and other travel expenses,
according to the trade body that represents pharmaceutical companies.The
Association of the British Pharmaceutical Industry (ABPI) said that most of the
44 biggest companies had now revealed how much they paid doctors to help market
their drugs. Its aggregated total of £40m is based on 35 suppliers who have
shared precise information with the body and estimates for the rest.The largest
British group, GlaxoSmithKline, spent £1.9m on fees for advice and consultancy
on 1,517 UK-based doctors, an average of £1,252 each. It also sponsored 1,022
doctors and other healthcare professionals to attend scientific conferences and
meetings, at a total cost of £887,294 – an average of £868 per trip.Doctors
have always denied that taking drug company money influences their judgement in
any way about a medicine, but suspicions have lingered.Doctors sometimes ask
for sponsorship to go to international meetings, which they argue they need to
attend to keep up with developments in their field. Their hospitals cannot afford
to pay their flights and hotel bills, they say.Thousands of doctors have their
flights, registration fees and hotels paid for when they attend major
international conferences on cancer or cardiology. They are transported to top
restaurants by their sponsoring company and socialise with its staff. Many of
the speakers who take to the platform to talk about the benefits of new
medicines are senior doctors who are earning a consultancy fee from a
pharmaceutical firm.AstraZeneca, the other major British company, separates out
the payments from its UK office and those from its "global teams and
international affiliates". The UK office paid £671,400 in fees to 903
doctors plus £30,200 for their travel and hotel bills. Some doctors carried out
more than one engagement. Their average earnings including expenses came to
£776.96.But those who were paid by the global teams did far better. A total of
£563,000 including expenses was paid out to 93 individuals, giving an average
of £6,053.76. However, the 93 people were involved in 304 activities, which
gave them an average fee, including expenses, of £1,851.97.Unlike AstraZeneca,
GSK said it had added in payments from its offices abroad, because many of the
doctors who receive payment for advice and consultation are global
experts.AstraZeneca, however, did not sponsor any doctors to go to conferences
in 2012, a major departure for a pharmaceutical company, because the bad
publicity surrounding drug company junkets made it rethink its policy.In 2005,
the Commons health select committee warned in a report that the industry's
sponsorship of doctors and other medical staff had drug promotion as its motive
and could lead to the unsafe prescribing of drugs such as Vioxx, the arthritis
drug which was found to cause heart attacks.AstraZeneca only supports "a
limited number of doctors to attend international conferences in connection
with contracted services", it said, which means they would earn fees for
speaking rather than being sponsored to listen.It said it was not offering lavish
expenses. "We have embedded robust controls in our process for supporting
travel and accommodation to ensure that it is only provided in a lawful manner
that is consistent with our commitment to integrity," AstraZeneca
said.Andrew Powrie-Smith, director of the ABPI, said he did not think having to
publish what the pharmaceutical industry spent on doctors would tend to make
most companies less generous.Powrie-Smith said: "Industry in the UK is
proud of its collaboration with health professionals. A fifth of the top 100
medicines in the UK have come from this collaboration. But there is increasing
demand for transparency in the relationship. I don't see that it will have a
particularly negative impact over their willingness to support medical
education."At the moment, drug companies are only required to publish
their total outlay on doctors. By 2016, however, the European trade body is
expecting them to publish the names of the individual doctors they pay. If this
happens, the industry will have moved further and faster than the NHS on
transparency. All hospital trusts are supposed to keep a register of payments
to their staff in case of conflicts of interest, but not all are complete and
they are not always available to the public.The ABPI agreed in 2010 that all
companies would publish their total payments to healthcare professionals.
Sarah
Boseleyguardian.co.uk
© 2013 Guardian News and Media Limited
GlaxoSmithKline
fined $3bn after bribing doctors to increase drugs sales
Sales
reps in the US encouraged to mis-sell antidepressants Paxil and Wellbutrin.
- Simon Neville
- The Guardian, Tuesday 3 July 2012 17.19 BST
GlaxoSmithKline has admitted to corporate
misconduct in the US. Photograph: Toby Melville/Reuters
The
pharmaceutical group GlaxoSmithKline
has been fined $3bn (£1.9bn) after admitting bribing doctors and encouraging
the prescription of unsuitable antidepressants to children. Glaxo is also
expected to admit failing to report safety problems with the diabetes drug
Avandia in a district court in Boston on Thursday.
The
company encouraged sales reps in the US to mis-sell three drugs to doctors and
lavished hospitality and kickbacks on those who agreed to write extra
prescriptions, including trips to resorts in Bermuda, Jamaica and California.
The
company admitted corporate misconduct over the antidepressants Paxil and
Wellbutrin and asthma drug Advair.
Psychiatrists
and their partners were flown to five-star hotels, on all-expenses-paid trips
where speakers, paid up to $2,500 to attend, gave presentations on the drugs.
They could enjoy diving, golf, fishing and other extra activities arranged by
the company.
GSK
also paid for articles on its drugs to appear in medical journals and
"independent" doctors were hired by the company to promote the
treatments, according to court documents.
Paxil
– which was only approved for adults – was promoted as suitable for children
and teenagers by the company despite trials that showed it was ineffective,
according to prosecutors.
Children
and teenagers are only treated with antidepressants in exceptional
circumstances due to an increased risk of suicide.
GSK
held eight lavish three-day events in 2000 and 2001 at hotels in Puerto Rico,
Hawaii and Palm Springs, California, to promote the drug to doctors for
unapproved use.
Those
who attended were given $750, free board and lodging and access to activities
including snorkelling, golf, deep-sea fishing, rafting, glass-bottomed boat
rides, hot-air balloon rides and, on one trip, a tour of the Bacardi rum
distillery, all paid for by GSK.
Air
fares were also covered for doctors and spouses, in most cases, and speakers at
the event were paid $2,500 each.
Before
one event, the compere said: "We have a wonderful and unforgettable night
planned. Without giving it all away, I can tell you – you'll be experiencing a
taste of luxury."
Not
everyone was impressed, though. One psychiatrist complained: "The style of
the conference would have been suitable for a convention of cosmetics sales
reps; this is supposed to be a scientific meeting. To me, the music, lights,
videos, emcees are offputting and a distraction, even demeaning."
GSK
also published an article in a medical journal that mis-stated the drug's
safety for children, despite the journal asking several times to change the
wording.
Copies
of the misleading article were given to sales representatives to pass on to
doctors in the hope that it would secure more business. Tickets to sports
matches were exchanged for discussions about Paxil, with one doctor writing:
"Dinner and a Yankee game with family. Talked about Paxil studies in
children."
Despite
knowing that three trials had failed to prove its effectiveness on children,
Glaxo published a report entitled "Positioning Paxil in the adolescent
depression market – getting a headstart".
The
second drug to be mis-sold was Wellbutrin – another antidepressant aimed only
at adults.
The
prosecution said the company paid $275,000 to Dr Drew Pinsky, who hosted a
popular radio show, to promote the drug on his programme, in particular for
unapproved uses – GSK claimed it could treat weight gain, sexual dysfunction,
ADHD and bulimia.
Pinsky,
who had not declared his GSK income to listeners, said Wellbutrin could give
women 60 orgasms a night. A study of 25 people using the drug for eight weeks
was pushed by a PR firm hired by GSK, generating headlines including
"Bigger than Viagra? It sounds too good to be true: a drug to help you
stop smoking, stay happy and lose weight" and "Now That is a Wonder
Drug".
When
a GSK-funded doctor refused to remove safety concerns about the drug from an
article he was writing, GSK removed his funding.
The
investigation also found that sales representatives set up "Operation
Hustle" to promote the drug to doctors, including trips to Jamaica,
Bermuda and one talk coinciding with the annual Boston Tall Ships flotilla.
Speakers were paid up to $2,500 for a one-hour presentation – up to three times
a day – earning far more than they did working in their surgeries.
One
speaker, Dr James Pradko, was paid nearly $1.5m by GSK over three years to
speak about the drug. He also produced a DVD funded by the company, which was
claimed to be independent. It was shown more than 900 times to doctors.
The
hope was that doctors would be persuaded to prescribe the drug to patients over
its rivals.
The
last drug under scrutiny was Advair, GSK's bestselling asthma treatment.
The
drug was launched to sales representatives in Las Vegas using images of slot
machines, emphasising the bonuses they could make through sales. At the event,
the then chief executive, Jean-Pierre Garnier, said: "What is the number
one reason why you should love to be a GSK sales rep? Advair's bonus plan.
Yeah!"
The
company pushed the drug as the ultimate answer for tackling asthma, saying it
should be the drug of choice for treating all cases. However, it had been
approved only for treating severe cases, as other drugs were more suitable for
mild asthma. GSK published material calling mild asthma a "myth" in
an attempt to boost sales, according to the prosecution.
About
$600,000 a year was given to district sales representatives for entertainment,
including regular golf lessons, Nascar racing days, fishing trips, and baseball
and basketball tickets.
US
attorney Carmin Ortiz said: "The sales force bribed physicians to
prescribe GSK products using every imaginable form of high-priced
entertainment, from Hawaiian vacations [and] paying doctors millions of dollars
to go on speaking tours, to tickets to Madonna concerts."
GSK
chief executive Andrew Witty said: "Whilst these [matters] originate in a
different era for the company, they cannot and will not be ignored. On behalf
of GlaxoSmithKline I want to express our regret and reiterate that we have
learnt from the mistakes that were made."
Despite
the large fine, $3bn is far less than the profits made from the drugs. Avandia
has made $10.4bn in sales, Paxil took $11.6bn, and Wellbutrin sales were $5.9bn
during the years covered by the settlement, according to IMS Health.
·
·
The inadequacies of relying solely on market forces
for our drugs are clearer than ever. This scandal should prompt a rethink
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