Fraudulent Pfizer

ZYX

I suppose we all guess some drug companies lie and make false claims. Nice to know one has been found out

From the BBC:


US drugmaker Pfizer has agreed to pay $2.3bn (£1.4bn) in the largest healthcare fraud settlement in the history of the Department of Justice. It follows the firm being found to have illegally promoted four drugs as treatments for conditions different to those which regulators had approved.
A subsidiary of the firm pleaded guilty to misbranding drugs "with the intent to defraud or mislead".
US officials said Pfizer would have to enter a corporate integrity agreement.
It will be subject to additional public scrutiny by requiring it to make "detailed disclosures" on its website.
Pfizer's general counsel said: "We regret certain actions taken in the past, but are proud of the action we've taken to strengthen our internal controls."
Acting US attorney for the District of Massachusetts, Mike Loucks said that "the size and seriousness of this resolution, including the huge criminal fine, reflect the seriousness and scope of Pfizer's crimes".
The company faces a criminal fine of $1.195bn and a subsidiary company of Pfizer - Pharmacia & Upjohn - will forfeit $105m.
The remaining $1bn fine was levied to resolve the allegations under the civil False Claims Act.
Four drugs
The civil settlement also relates to allegations that Pfizer paid bribes and offered lavish hospitality to healthcare providers to encourage them them to prescribe four of the company's drugs. These were Bextra, an anti-inflammatory drug, Geodon, an anti-psychotic drug, Zyvox, an antibiotic and Lyrica, an epilepsy treatment.
The investigation was trigged by allegations made by six whistleblowers. They will receive $102m of the civil fines paid by Pfizer.
"Although these types of investigations are often long and complicated and require many resources to achieve positive results, the FBI will not be deterred from continuing to ensure that pharmaceutical companies conduct business in a lawful manner," said Kevin Perkins, FBI assistant director, Criminal Investigative Division.
The pharmaceutical firm said earlier this year that it would pay the fine "to put issues that diminish trust behind us".
Pfizer reported a 90% drop in profit to $268m in the fourth quarter of 2008, because of the $2.3bn legal settlement, indicating that the company was aware they would be paying this sum before the terms of the deal with the Department of Justice were announced.

ZYX

I didn't realise this but pfizer have history when it comes to fraud:

From May 2002

Pfizer has agreed to pay $49 million to settle charges that a subsidiary defrauded the Medicaid program by overcharging for the cholesterol-lowering drug Lipitor, the Justice Department said today.

From 2004.
In mid-May, Pfizer's (PFE) Warner-Lambert division pleaded guilty to illegally marketing a drug called Neurontin to treat ailments for which it was not approved. Pfizer, which did not own Warner-Lambert when the government said the wrongdoing happened, paid a $430 million fine to settle charges that included defrauding Medicaid.

tallaght01

Not in the least bit surprised to be honest. Pfizer probably isn;t that much of an exception, and didn't own the second company when the madness happened.

BUt drug companies are absolute parasites in a lot of cases. One thing I would say to med students is to learn how to read papers and interpret evidence at an early stage, as drug reps will try and convince you that black is white given half a chance.

Someone hinted on another thread that they are significantly restricted in Ireland now, which is a great thing if it's true. I don't think they should be allowed sponsor events, or visit doctors.

They usually act within the limits of the law, but that doesn't mean they act is acceptable.

Anyone know if there are new rules in Ireland about drug companies?

sam34

tallaght01 wrote: »

Someone hinted on another thread that they are significantly restricted in Ireland now, which is a great thing if it's true. I don't think they should be allowed sponsor events, or visit doctors.

Anyone know if there are new rules in Ireland about drug companies?

to the best of my knowledge (although im open to correction) there are no restrictions regarding them calling to docs or sponsoring events, as long as teh event has an educational component.

the days of them taking docs out just for boozy dinners etc are over.

they can still drop in the promotional pens, post-its etc

Dr Galen

the new rules come moreso from a European level afaik.

They can still call on doctors and leave promo stuff like pens etc but as Sam34 points out, no boozy dinners etc. There are very strict limits on what can and can't be done with medical people too. Drug companies can sponsor people to attend conferences etc or provide educational seminars, but the content has to be pretty strictly controlled as well. It's worth remembering though that there are lots of really good and properly run conferences that rely on money from medical companies to actually get put on. Without some of the pharma money some of this worthwhile stuff wouldn't happen. Anyone organising such an event though should have the balls to stand up to any company wishing to give them money, and say what is and isn't on. Conferences should not have their independance and/or integrity blown away just because they accepted a wedge of cash.

I'd echo totally what T01 says, in that medics should read whats given to them properly, critique and ask questions of any Rep for any product. If the data holds up then the Rep should have no issue answering the questions. In fact any company worth it's salt should highlight limitations of studies etc to the groups that they are talking to. I'd have much more respect for someone who said to me that the study wasn't perfect, here's the good and here's the bad, now go make your mind up.

tallaght01

I think it's a real shame that drug companies are encouraged to sponsor scientific conferences, which should be the cutting edge of basic science.

I'm spending next week at a conference. The drug companies are all over it. You know how it goes, they'll be everywhere. It's not just that they sponsor the thing, they really get free reign to push their stuff in a big way.

I don't do drug company stuff, but I can't just avoid conferences forever.

They're not sponsoring it for the good of their health.

I worry that bringing in rules allowing them to sponsor educational stuff just means that they can bring everyone to see a talk, and give them a huge dinner beforehand, or afterwards, does it not? I've been in the situation before, where they sponsored the dinner and not the talk. But I wanted to see the talk. So, I made my excuses and turned up after dinner, or left before it. BUt it's a pain in the arse.

I just wish they'd leave us alone :P

ZYX

Mystik Monkey wrote: »

I'd echo totally what T01 says, in that medics should read whats given to them properly, critique and ask questions of any Rep for any product. If the data holds up then the Rep should have no issue answering the questions. In fact any company worth it's salt should highlight limitations of studies etc to the groups that they are talking to. I'd have much more respect for someone who said to me that the study wasn't perfect, here's the good and here's the bad, now go make your mind up.

But why meet the rep at all? If you have read the papers properly why ask the rep. They are going to give you a biased answer. Their job is to sell their product. They will spin any research to promote their product. Asking them questions simply means you get an answer that you do not know whether to trust or not.

EDIT: just to add. Based on this fine for pfizer, not only do they spin the research, they may lie.

tallaght01

ZYX wrote: »

But why meet the rep at all? If you have read the papers properly why ask the rep. They are going to give you a biased answer. Their job is to sell their product. They will spin any research to promote their product. Asking them questions simply means you get an answer that you do not know whether to trust or not.

EDIT: just to add. Based on this fine for pfizer, not only do they spin the research, they may lie.

Agreed. I never see reps. I figure that's the only way to stop them coming. Once or twice, they've been let in, and they're standing there in front of me. I don't tell them to get lost. I just ask them for a copy of their paper (they always bring a paper, of variable quality) and then make my excuses.

But if people stop seeing them, and stop taking their stuff and stop going to their lunches then they might stop hassling us. But, in fairness, a lot of people quit like a bit of drug rep schmoozing, and that's an issue for them, as things currently stand.

A lot of people will just appreciate being spoiled. One of them used to come into a neonatal ICU where I worked to see the nurses. Now, our nurses weren't use to being schmoozed like that, as they tend to get ignored in all the wining and dining. So, this rep was selling stuff that nurses use, and nurse managers buy. And she brought in a big posh lunch for them, and called her sales talk an "educational symposium". So, they felt they were going to a lecture, and were given some nice stuff. IN reality, their employer should be putting on the odd catered lecture for them. But they never did. So, this made them feel the drug rep was one of the good guys. They all walked away carrying papers with stats they din't understand, but they read the conclusions. And the conclusions told them the product was great.

It's how people work, and the drug companies know it. I think there should be a ban on them visiting us at all. But I'ma drug company nazi. Though I have sold my soul by carrying out clinical trials, so I may just be over-compensating :LP

sam34

tallaght01 wrote: »

But, in fairness, a lot of people quit like a bit of drug rep schmoozing

well, sometimes they're reaaaaaaaaaaally hot;)

Dr Galen

ZYX wrote: »

But why meet the rep at all? If you have read the papers properly why ask the rep. They are going to give you a biased answer. Their job is to sell their product. They will spin any research to promote their product. Asking them questions simply means you get an answer that you do not know whether to trust or not.

EDIT: just to add. Based on this fine for pfizer, not only do they spin the research, they may lie.

i suppose I'm taking it on the basis that some doc's will meet the reps. So i say, if your going to do it, then make sure that you ask the questions of the data etc. and don't settle for the marketing bullcrap

as for the pfizer incidence, I couldn't agree more.

tallaght01

Mystik Monkey wrote: »

i suppose I'm taking it on the basis that some doc's will meet the reps. So i say, if your going to do it, then make sure that you ask the questions of the data etc. and don't settle for the marketing bullcrap

as for the pfizer incidence, I couldn't agree more.

Some of them are so pushy that they manage to even get into the offices of docs who don't want to see them :pac:

I've had them pop up in all kinds of places. So, in fairness to them, they know how to get themselves into places where they shouldn't be. Jack Bauer has nothing on some of these guys :P

Dr Galen

sam34 wrote: »

well, sometimes they're reaaaaaaaaaaally hot;)

i have one response to you T01 and it's what she said :pac:

sam34

tallaght01 wrote: »

Some of them are so pushy that they manage to even get into the offices of docs who don't want to see them :pac:

i share an office with the reg on the team.

a few weeks ago, i walked in (door was closed, but thats not unusual. we dont see patients in that office, so everyone just comes in as they please) and there was a rep there with the reg. ive known this particular rep a while and she is incredibly pushy, so i generally avoid her like the plague. when i walked in she said "sorry dr sam34, im just with your colleague here, could you give us a few minutes please" i was so taken aback that i actually just mumbled, apologised for being in MY OWN office and backed out!!! im really annoyed now that i effectively let her kick me out of my office. pushy in teh extreme!

anyone else think that was out of order?

allsaintssue

sam34 wrote: »

i share an office with the reg on the team.

a few weeks ago, i walked in (door was closed, but thats not unusual. we dont see patients in that office, so everyone just comes in as they please) and there was a rep there with the reg. ive known this particular rep a while and she is incredibly pushy, so i generally avoid her like the plague. when i walked in she said "sorry dr sam34, im just with your colleague here, could you give us a few minutes please" i was so taken aback that i actually just mumbled, apologised for being in MY OWN office and backed out!!! im really annoyed now that i effectively let her kick me out of my office. pushy in teh extreme!

anyone else think that was out of order?

Oh my God, that is totally out of order....what a bitch!:eek:

anotherlostie

First of all, sorry, but I still don't know how to multi-quote...

It's all very well giving out about the mean and nasty drug companies, but who do you expect to sponsor the health conferences if they don't? Would people be willing to the full whack? Probably not, and then the conferences might not be viable in Ireland.

It's like when people complain about drug companies making lots of money. Billions and billions of dollars are spent on R&D every year, as we all know, and it's a high risk game. I've seen countless drugs get to Phase 2 and fail, and hundreds of millions have been spent just to get to that stage. If we want to be truly altruistic about our medicine costs, why not get governments to fund the R&D and production/distribution?

And finally, I don't think a few pens or post its are really going to persuade anyone to change their prescribing habits, but undoubtedly different GP's get to 'like' certain variants of drug, and I'd wonder is that down to having a good relationship with a certain rep (or maybe they did read that good paper)!

JuliusCaesar

tallaght01 wrote: »

So, this rep was selling stuff that nurses use, and nurse managers buy. And she brought in a big posh lunch for them, and called her sales talk an "educational symposium". So, they felt they were going to a lecture, and were given some nice stuff. IN reality, their employer should be putting on the odd catered lecture for them. But they never did.

Necessity for CPD only recently recognised in nursing.

Education budgets slashed in HSE. InService Training slashed in HSE.

(Is there no 'bawling crying' emoticon?)

suspectpackage

This is why I a so disillusioned with my current degree I am doing. Say you are a pharmacy/chemistry/biotechnology student. You work hard at your degree and get top marks... what do you do now? Get a job in a company that produces drugs mostly likely. However, these companies are virtually all bent and only care about their balance sheet at the end of the year. They don't care about the people, just making money. I know people in my course who would have been thrilled to work for Pfizer (and probably some of them still will), but I just wouldn't be able to work for any of these companies. It wasn't a few thousand they got fined, not even a few million, it was over 1 BILLION!!

Vyse

suspectpackage wrote: »

However, these companies are virtually all bent and only care about their balance sheet at the end of the year. They don't care about the people, just making money.

Unfortunately that's business. I've worked in most of the major pharmaceutical companies and it's pretty much the same all round. In saying that they do make an effort to demonstrate that your work is having an effect on the lives of everyday people e.g. videos, testimonials etc. Being so disconnected from the patient however it has very little impact.

ZYX

anotherlostie wrote: »

It's all very well giving out about the mean and nasty drug companies, but who do you expect to sponsor the health conferences if they don't? Would people be willing to the full whack? Probably not, and then the conferences might not be viable in Ireland.

Well the HSE should be responsible for CPD of its workers. This does not have to be particularly expensive. It should be compulsory for all medical HSE employees to participate in CPD both as teachers and learners. All consultants I know for example give talks to various groups inside and outside their hospital for free. Th HSE owns huge amounts of property all over the country and really should be able to provide space for teaching. Finally there is no need to provide any refreshments. The actual cost to HSE would be tiny. We don't need drug company money.

RobFowl

ZYX wrote: »

Well the HSE should be responsible for CPD of its workers. This does not have to be particularly expensive. It should be compulsory for all medical HSE employees to participate in CPD both as teachers and learners. All consultants I know for example give talks to various groups inside and outside their hospital for free. Th HSE owns huge amounts of property all over the country and really should be able to provide space for teaching. Finally there is no need to provide any refreshments. The actual cost to HSE would be tiny. We don't need drug company money.

Agree totally but they are cutting what little they do provide instead........

tallaght01

And as much as they're nice to go to.....are conferences really essential? Most of the stuff gets published anyway. But if new legislation meant the death of conferences (which I doubt it would), then that isn't the end of the world.

ZYX

tallaght01 wrote: »

And as much as they're nice to go to.....are conferences really essential? Most of the stuff gets published anyway. But if new legislation meant the death of conferences (which I doubt it would), then that isn't the end of the world.

I suppose I am talking about smaller meetings rather than large international confrences. Although I think with some creative thinking these too can be held without drug company involvement.

ZYX

RobFowl wrote: »

Agree totally but they are cutting what little they do provide instead........

Still the costs we are talking about are the use of a computer for a few hours, perhaps some light and heat. It really would be tiny. The real expenses come from providing luxury hotel boardrooms, paying speakers and providing lavish entertainment. This is what the drug companies pay for and it really isn't necessary.

r3nu4l

anotherlostie wrote: »

First of all, sorry, but I still don't know how to multi-quote...

It's all very well giving out about the mean and nasty drug companies, but who do you expect to sponsor the health conferences if they don't? Would people be willing to the full whack? Probably not, and then the conferences might not be viable in Ireland.

It's like when people complain about drug companies making lots of money. Billions and billions of dollars are spent on R&D every year, as we all know, and it's a high risk game. I've seen countless drugs get to Phase 2 and fail, and hundreds of millions have been spent just to get to that stage. If we want to be truly altruistic about our medicine costs, why not get governments to fund the R&D and production/distribution?

And finally, I don't think a few pens or post its are really going to persuade anyone to change their prescribing habits, but undoubtedly different GP's get to 'like' certain variants of drug, and I'd wonder is that down to having a good relationship with a certain rep (or maybe they did read that good paper)!

Very good post!

It's all well and good claiming to be anti-drug companies but doctors would do very well to remember that without pharma and vaccine companies they wouldn't have many options when treating patients! Instead, they would be saying to a patient, yup, that's cancer alright, you'll be dead in a few months, sorry about that. Thanks to the pharma companies you can now say, well the chances are that if we give you drug X or Y you will live for at least another 5 years and may even live 20+ years.

So all this 'pharma is crap' rubbish is a bit stupid. There's a balance to be struck and as tallaght01 said, learning how to read a paper is vital!

I was at the ESC09 congress in Barcelona over the weekend and there was a fantastic Clinical trials session where results from a number of trials were presented by speakers associated with that trial and then immediately after were commented on by another speaker who had no ties to the trial or drug company sponsoring the trial. The commentators reminded the audience that trial X ot trial Y used an 'open-label' or had a 'narrowly selected patient population' etc. and discussed all trial and result limitations.

Incidentally, that session was sponsored by a drug company whose own clinical trial and product received a drubbing at the hands of the commentator but they were happy to sponsor it to show their openness and commitment to getting to the truth of clinical trials (I know this because I spoke directly with the company VP.

As for pharma not sponsoring congresses, well don't make me laugh, without the pharma sponsorship the congresses wouldn't exist. Guess what, ALL large congresses are run for profit. You wouldn't believe what can be sponsored at a congress! Delegate badges, badge lanyards, coffee bars, computer access points (pay for a screensaver or mouse mat at each computer), banners outside the congress centre or in the canteens etc. The congress organisers gouge the companies for as much as they can

Someone mentioned going to a sponsored dinner and complaining that the session wasn't sponsored. I can tell you that at a major congress the congress organisers decide what is and isn't sponsored. They are the ones who accept and reject sponsorship offers. Sometimes they won't allow a session to be sponsored because they don't want that session to be linked to any company. Perhaps the sponsoring company ONLY had that option of sponsoring the dinner? On other occasions, a company wants a presence at a congress but by the time they get their arse in gear and decide to sponsor it, the only options left are a congress bag insert, the delegate badge lanyard or a dinner. Sometimes the congress organisers decide that only the companies who buy the biggest exhibition booth spaces are allowed to sponsor sessions. It's all a game and the congress organisers are just as good at it as the pharma and device companies. Most of the delegates walking around the congress remain blissfully ignorant of all of this and think it's the pharma companies driving all the sponsorship :rolleyes:

However, More regulation is definitely needed! Thankfully we no longer have the case of first-class flights and 5-day accommodation in a 5-star hotel for a doc and his wife in an exotic location where he only has to attend a two-hour session in all that time, but things still need improvement. I know of at least one published major clinical trial paper where two of the named authors didn't even review the paper. :mad

On the other side of the coin I also know of a vaccine company who insist that if a paper is written by a medical writer that the named authors provide three reviews, participate in telecons with the medical writer and that the vaccine company themselves DO NOT have any involvement in the publication. That's a company with ethics.

Finally, yes there's a lot of crap out there and reps are pushy but remember that for every product that makes 'billions', that company has probably already spent billions on developing products that for one reason or another never made it to approval. Without pharma companies medicine would be in a svery sad state so take time before declaring yourself rabidly anti-pharma. Despise the underhanded sales tactics for sure but don't despise pharma because without their drugs most doctors would still be knocking people out with whiskey so they could use a saw to cut off the patients arm just because he got an infection that turned gangrenous

ZYX

r3nu4l wrote: »

Very good post!

It's all well and good claiming to be anti-drug companies but doctors would do very well to remember that without pharma and vaccine companies they wouldn't have many options when treating patients! Instead, they would be saying to a patient, yup, that's cancer alright, you'll be dead in a few months, sorry about that. Thanks to the pharma companies you can now say, well the chances are that if we give you drug X or Y you will live for at least another 5 years and may even live 20+ years.

So all this 'pharma is crap' rubbish is a bit stupid. There's a balance to be struck and as tallaght01 said, learning how to read a paper is vital!

No one is saying pharma is crap. Drug companies are allowed make profits even huge profits. They are not allowed lie which is what this thread is about.

Also we have to accept that drug companies will mislead people after all most companies do this with creative advertising

The big point is medical professionals and drug companies should be seperated. Doctors should make decisions based on best clinical evidence not on some spin from a drug company.

ZYX

r3nu4l wrote: »

Incidentally, that session was sponsored by a drug company whose own clinical trial and product received a drubbing at the hands of the commentator but they were happy to sponsor it to show their openness and commitment to getting to the truth of clinical trials (I know this because I spoke directly with the company VP.

That is simply spin he was giving you. It shows how well he did it that not only did you believe it but go online praising him. They were there to promote their product simple as that. Did he admit his product wasn't as good as his competitors? Did he advise people to use his competitors products instead of his? Of course he didn't. At least we aren't at the situation yet, where drug companies get to hear the talks beforehand and decide whether or not to sponsor the event based on whether they approve of it or not.

tallaght01

The thing is, r3nu8l, you're getting "anti-drug company" and "anti-drug companies trying to influence prescribing" mixed up.

Anyone who is against the concept of drugs companies is mental, pure and simple, and has no place being given the responsibility of treating patients.

But the behaviour of drug companies, to a large extent, is frankly repulsive.

They lie to us constantly. They suggest, in a subtle way, that their drugs work for indications that thy're not licensed for. These are really abhorent practices.

Those of us who don't think they should be involved in sponsoring conferences are not going to bring down the world of academia. They make profit because they can. But the bodies who run them, or the type I go to, are there for the advancement of the specialty. The annual conference might put some money in their coffers, but they're not making profit for individuals to cream off. But like I said before, pushing pharma companies further back would allow for other ways of raising money. I would support a ban on them being involved in medical education in any way. They are there for one reason and one reason only, and that is to influence prescribing. They wouldn't be there otherwise.

The only thing that should influence prescribing is the clinical picture and the evidence. It should be enough to be given a paper and be allowed to read it. The very fact that they turn up to conferences etc means they're up to something :P

r3nu4l

tallaght01 wrote: »

The thing is, r3nu84l, you're getting "anti-drug company" and "anti-drug companies trying to influence prescribing" mixed up.

FYP

Anyone who is against the concept of drugs companies is mental, pure and simple, and has no place being given the responsibility of treating patients.

Whew, glad you clarified that, I was beginning to wonder!

But the behaviour of drug companies, to a large extent, is frankly repulsive.

They lie to us constantly. They suggest, in a subtle way, that their drugs work for indications that thy're not licensed for. These are really abhorent practices.

Yes, companies lie, indeed in a previous job I notified the FDA about certain results being provided by one of the largest pharmaceutical companies in the world where they said that a certain side-effect was deemed 'unrelated to the study drug by the clinical investigator'. I had access to the raw data and it clearly showed that the adverse event in question was very likely (P < 0.001) related to the drug. Six months later the FDA issued a warning about the drug because this particular side effect was one at which those with the disease were already at risk of, never mind being placed on a drug that promoted that risk further! I'm no stranger to pharma lies.

Those of us who don't think they should be involved in sponsoring conferences are not going to bring down the world of academia. They make profit because they can. But the bodies who run them, or the type I go to, are there for the advancement of the specialty. The annual conference might put some money in their coffers, but they're not making profit for individuals to cream off.

In all fairness tallaght01, that's naive in the extreme. Take the annual meeting of the EAPCI (EuroPCR), it's run by a company called Europa-organisation, who are a HUGE company that organise and run over 50 congresses every year. EAPCI is a body dedicated to the advancement of the specialty but they outsource the congress organisation. Most of the largest congresses in the world are outsourced by the academic bodies whose name is on them, you may never realise that, even if you attend the congress every year but quite often they are. Only this year a doc who has been attending the same congress for 15 years told me that this year was the first time he realised that his academic body outsourced the congress, he always believed that the 100 or so docs on the various body panels organised the congress between them in their spare time

But like I said before, pushing pharma companies further back would allow for other ways of raising money. I would support a ban on them being involved in medical education in any way. They are there for one reason and one reason only, and that is to influence prescribing. They wouldn't be there otherwise.

Absolutely agreed with you on that one. However, please tell me what other feasible methods there are to run medical education and congresses? Do you think the taxpayer should pay for it? I don't! I think the doctors themselves should pay for it and pharma should be excluded if that's feasible.

The only thing that should influence prescribing is the clinical picture and the evidence. It should be enough to be given a paper and be allowed to read it. The very fact that they turn up to conferences etc means they're up to something :P

I agree with you completely however, once again, I'm always surprised at how many doctors are ridiculously under educated when it comes to dissecting papers. It's shocking! We all know that there are certain papers that are based on well designed trials but there are many papers out there with very impressive looking results but once you dig into the trial design you begin to see the glaring bias. Many doctors just don't have the time/the will to do this and accept academic papers at face value. That pisses me off.

What also annoys me is the fact that there are many journals out there whose editorial boards are less than scrupulous themselves. Here we have many of the top people in their fields reviewing a 'suspect' paper and accepting it for their journal...why? Reprints! Most pharma companies order tens of thousands of reprints of their study manuscripts when they are published, this makes huge money for the journal, hence every so often a journal will accept a paper that is clearly not very good but gives it a stamp of credibility by publishing it. :mad:

Finally, as for the lies told...well I could (but won't, I value my job) tell you some stories that would make your hair stand on end, stories that paint both the pharma and medical communities in a very bad light! However, it's always easy to blame big bad pharma but not the lifesaving docs, even if they are just as complicit.

r3nu4l

ZYX wrote: »

That is simply spin he was giving you. It shows how well he did it that not only did you believe it but go online praising him.

No trust me, I know this guy very well, he's a cynical, manipulative and ruthless so and so but he actually does really care. He also has no reason to lie to me because of our business relationship. Lying to me about his intentions means I can't help make those intentions happen and that's bad for his business and he really is all about the money. You can be a huge pro-pharma person and still want to change things. He's an enigma in the industry for sure!

They were there to promote their product simple as that.

Of course they were!

Did he admit his product wasn't as good as his competitors? Did he advise people to use his competitors products instead of his? Of course he didn't.

Oh dear, answering a question in the engative without even waiting for my answer! Actually, yes, he did. His company produce an angiotensin receptor blocker, they put it up against an ACE inhibitor hoping it would show non-inferiority...it didn't. They published that result and were praised for their candid admission. In the commentary on the trial, the commentator also praised the big-name journal that accepted the study for publication remarking that 'it takes guts for a journal to publish the results of a failed trial'. So yes, they admitted the product wasn't as good and yes, they said that in that particular indication, the other product should be used!

At least we aren't at the situation yet, where drug companies get to hear the talks beforehand and decide whether or not to sponsor the event based on whether they approve of it or not.

Erm, we very much are in that position, shows what you know matey
I myself have produced the slide sets to be presented for sessions sponsored by companies, we get the trial investigators in, give them a briefing on what needs to be said and they give the talk. This is normal practice! Those slide sets are reviewed by the clinical, marketing, regulatory and legal teams of the pharma company before being approved for presentation. The speakers have to include a slide disclosing their relationship with ALL companies in the field, including any trials, advisory boards or honoraria they have participated in or received.


Now, here's something you may not know. It can take MONTHS for a pharma company to approve the content of a single 4-page product information piece. Just four pages can cause huge conflict in a company. If the piece is deemed 'medical' the medical teams then will refuse to allow most marketing messages to be placed into it. This of course makes the marketing team unhappy and eventually by force of will an agreement is reached on the level of marketing allowed (usually extrememly little). If it's a marketing piece then the marketeers use all their favourite buzzwords and then it's passed to medical who usually say 'WTF? You can't say that!! Remove this sentence, remove that comment' etc...

Once that's agreed, the regulatory team review and they usually say things like 'we're not approved to talk about this in that context as we don't have that indication'.

Finally, when everyone is happy, legal review it and then it's usually stripped clean. Finally it reaches the audience it was intended for. What the sales people say is usually very controlled by the company but once again, I believe that the regulation at the sales end just is not tight enough at all. The information should simply be presented by pharma companies to either congresses, academic bodies or hospitals for independent review. Those bodies should then make independent recommendations based on their review. Even that is up for manipulation though

It's a tough call and I'm not denying the lies that are told, I acknowledge them but it's not nearly as simple as some people here are making it out to be and it's very naive to think that it is.

tallaght01

I don't think I'm being naive. Certainly none of the societies I'm a member of have members creaming off profits from conferences, which was my point. Whether or not they outsource conference organisation is one thing, but it's not the same thing.

But, like I said, conferences are fine. But less conferences wouldn't significantly reduce the quality of medical education. And CPD definitely should be funded by the taxpayer, via the local health service.

As YXZ, or ZXY (or whatever he's called :P ) said, if the HSE took an active role in CPD, there would be no real need for conferences. We have in-house ALS, infection control teaching etc, why not evidence based medicine gatherings?

I don't see what a conference offers, over and above what a journal offers. They often coincide with meetings, but there's teleconferencing nowadays.

But if we stopped pharma companies getting involved, then some would die off, some would innovate, and some would run at a lower price. The conference I'm going to next week doesn't have a single pharma company as a major sponsor. So, it can be done.

Bear in mind that patients ultimately pay for all this guff, with increased drug prices.

You can blame docs along with big pharma if you like, but you can throw in all kind of other people along with that, too. The reality is, however, that the pharma company exists to make money for it's shareholders, whereas the medical profession exists to help patients. The two are just not compatible.

Better ability to examine evidence would be useful. But, having said that, it's really only the junior docs (who are neglected in terms of CPD) who struggle with interpreting some papers. For that reason, many, if not most, departments now produce their own guidelines for junior docs about what they should and should not prescribe for various conditions. These are written up by the consultants, and prescribing groups locally. It doesn't remove the problem, but it goes a long way towards dealing with it.

But I think we can all co-exist peacefully. I just made the choice a while ago not to interact with them. And I have to say, while I was dubious about it initially, it just makes life so much straight forward, and I can see why so many docs have gone down that route.

r3nu4l

Hee hee, believe me I throw myself and all the companies in the same industry as me into the mix of the problem too. I'm not just blaming pharma and doctors for this mess.

Continual medical education or congresses should NOT be funded by the taxpayer IMO. If I want to continue my education I have to pay for that myself and I don't expect the taxpayer to pay for that! (This however, is another argument I'lll grant you that )

There is definitely room for improvement in congress organisation and I'd love to see a large, successful congress organised without pharma input.

However, you say that the people at the top of your society don't get money from these congresses. Let me ask you something. Do these guys give a lot of presentations at these congresses? Are they sponsored presentations? If so then I am 99% certain that their flights to the congress, accommodation during the congress and some meals are paid for. Not only that but they receive up to GBP £1000 for each of those presentations.

The top names in every field, tend to be the top names in most specialist societies and coincidentally, the ones that the pharma companies really tie in with because they are the 'key opinion leaders' (KOLs). These guys get paid to put their names on papers, participate in advisory boards, present at congresses and generally be 'champions' for a drug. Some top-tier KOLs are great, they NEVER abandon their principles and are absolutely a pain in the ass for the pharma companies to deal with but they do deal with them because these guys have huge influence.

However, some other top-tier KOLs will basically say whatever they are asked to say and indeed I was disgusted to have a top-tier paediatric KOL from Guy's Hospital, who when I asked for his opinion once asked me 'well you are the one paying us...so what do you want us to say?'. :mad: He totally missed the point and didn't get that we wanted his honest opinion, not what he thought we wanted to hear!

The only concern I have about tighter regulation is that ironically, it will encourage some pharma companies to find 'other methods' to promote their drugs (by that I don't mean horses heads in beds!).

In the UK, NICE are responsible for ensuring clinical and cost-effectiveness of a drug programme. For this reason it doesn't matter what a sales rep tells a doc about the latest ACE-inhibitor, the docs hands are tied by the fact that NICE have instructed the NHS trusts to only use generic ACE inhibitors unless there is a specific validated reason for going with a branded product.

However, pharma companies took note when a British woman was refused Herceptin because it was 'not cost-effective' for breast cancer treatment. The woman got lots of coverage in the paper because she sold her house to pay for herceptin. There were loads of stories about how she was being made 'homeless' by the evil people at NICE. So eventually public pressure became so great that NICE relented and herceptin is now approved...

Why would pharma take note of that I wonder? It's another way to get a drug approved. Forget about the docs, create a campaign that shocks and outrages the public and they will put on the pressure. Of course, the drug does have to be good already but if cost is the only issue then public perception can force a change. That's bad IMO because it's a potential new avenue to force approvals through! Of course, pharma is not allowed (thankfully) to appeal directly to the public but that's not going to stop a covert campaign now is it?

So, to sum up. Yes, pharma tells lies but then again so do most big companies...just look how many are claiming 'green' credentials these days :roleyes: More regulation is needed. That's a given. But don't go assuming that it's all the fault of pharma, the medical community has encouraged pharma participation in their work and indeed at most congresses I've been at this year (large and small) the overwhelming opinion has been that medicine needs to engage with pharma MORE, not less to change the current status quo. The last advisory board I was at was interesting in that a top-tier KOL said 'We need you to ENGAGE WITH us more and TALK AT us less, then we can make things happen'. Another KOL said 'Let us tell YOU what we NEED, not have YOU tell us what you THINK we need'.

The company I was working with at the time were excited by this as believe it or not, they would much rather spend less money on sales reps, sales reps cars and literature for sales reps, if they thought they could get the same amount of sales in a different way.

tallaght01

Doctors have always taken freebies from drug companies, and will continue to do so until the practice is legislated out of existence. But these doctors are, quite rightly, thought of as being the pariahs of medical care. They may be at the top of their game, but I (and plenty of docs) won't even read a paper that has been sponsored by a drug company. I won't be going to the evening plenaries that are sponsored by the drug companies at my conference next week, as I won't believe anything that's said.

The area I work in, and go to conferences in, is one where people have generally chosen a lower salary than their peers, so they don't tend to be easily bought. certainly no-one locally here where I work sees drug reps, or takes money from them. Key opinion leaders sometimes do. That's just another reason to keep medics and drug companies apart.

It's also another reason why CPD should be funded by the taxpayer. Yours shouldn't because you work for a private company, where your shareholders see the benefits. the only people who benefit from me being up to speed on the latest developments are the public. In fact, with the money my local health authority is spending on sending me to a 5 day conference, they could have put on something small locally. With the money they've sent on sending a group of us, they could have put on something decent. We get lots of our training done locally, so no sure why our CPD shouldn't be covered. It seems bizarre that our doctors and nurses shouldn't be educated by the state.

I think interacting more with pharma companies is a bad move. Nothing will change the fact that their aim to make money and to make us prescribe their product, whether or not that is the right treatment or not. That's a really amazing thing to be able to say about other human beings, when you think about it. One reason I don't miss talking to drug reps is because I used to sit there with absolute contempt for them at times. When they were telling me how good their drug was, when it was simply untrue, I used to wonder how they sleep at night. I still do.

But I think they should be kept at arms length. There's simply no need for them to have any interaction with us. I do some work for a clinical trials group who do research for pharma companies, and I don't interact with the company reps in that environment, so there's sure as hell no need to interact with them in a hospital/GP environment. There is simply nothing that can't be conveyed to us by a paper in a journal. That to me is the bottom line. There is just no need for us to work closer with them. If they cared about anything other than the bottom line I'd be willing to engage them, but they don't.

I just do't see what harm would come of strict legislation stopping the interaction.

But I think docs have to so their part. Everytime I move jobs I set up a journal club if there isn't already one. I can direct medical students towards organisations like "no free lunch" in the UK, and the American Medical Students Association equivalent.

I will admit it's a pain in the ass eating my scabby out of date home made sambos at meetings that are catered by drug companies. But in this day and age, this kind of thing really shouldn't be going on. But I htink phama companies are too powerful at this stage, and I think legislation is the only answer.