Drug firms turn to private doctors for promotion
Filed under: Conflicts of interest, Hot Health Headline
Pharmaceutical companies are turning to doctors in private practice to promote their products as universities have developed conflict-of-interest policies that limit their doctors’ activities, according to the latest report from John Fauber of the Milwaukee Journal Sentinel.
Fauber, who has been covering conflicts of interest in medical research for more than a year, reports that “So much money is at stake that in January one academic doctor resigned his job at Harvard rather than give up his speaking income.”
Medical schools can restrict doctors who work for them from advocating particular drugs and can require that they inform patients of their ties to drug companies, but private physicians have no such obligations.
In previous articles, Fauber has reported on University of Wisconsin doctors who were making six-figure sums from drug and medical firms by serving as consultants or doing promotional speeches.
Critics say the talks can be biased and contribute to spiraling health care costs by promoting the use of expensive brand-name drugs over generics. The practice, according to critics, also leads to more non-approved and potentially harmful use of those drugs, so-called off-label prescribing.
WebMD, Eli Lilly and a quiz about depression
Filed under: Conflicts of interest, Health journalism
Sen. Chuck Grassley, the prolific writer of public letters who often assumes the mantle of health consumer advocate, is at it again. This time he’s taking on consumer health information giant WebMD, whose ties with Eli Lilly seem to stretch back for some time. At issue is a WebMD quiz that purported to determine a user’s risk of depression. The fishy part? Until WebMD modified the quiz following Grassley’s letter and other outcry, even users who answered “no” to every question would be given the warning that “You may be at risk for major depression.”
As Daniel Carlat points out on his blog, the following disclaimer appeared at the top of the page: “This content is selected and controlled by WebMD’s editorial staff and is funded by Lilly USA.” As Carlat points out, 9 of the 10 symptoms in the quiz are taken from standard diagnostic criteria, but the one that isn’t (which relates to physical pain) just happens to dovetail perfectly with the pain-relief market Lilly is trying to carve out for Cymbalta.
Because Lilly markets Cymbalta as the “go to” antidepressant for patients who have both depression and physical pain. This is not really a “depression screening test” at all. Instead, it is a “Cymbalta-requester” screening test.
WebMD is telling the public a big lie. The say that “this content is selected and controlled by WebMD’s editorial staff” when in fact the crucial aches and pains questions was selected by Eli Lilly’s marketing team to encourage patients to ask their doctors for Cymbalta.
Grassley’s letter requested that WebMD respond with the details of their relationship to Eil Lilly by March 4. I didn’t find any evidence that such a response has yet been received.
Reporter finds conflict in N.Y. reform effort
Filed under: Conflicts of interest, Health care reform
A Syracuse University professor charged with reforming health insurance reimbursements gave up her position on an insurance company’s board on Friday after James T. Mulder, a reporter with The (Syracuse, N.Y.) Post-Standard, started looking into her ties.
Deborah Freund, a health economist and professor at Syracuse University, is overseeing a project intended to reform the health insurance system and eliminate conflicts of interest.
However, she has been on the board of Excellus since 2004 and received more than $61,000 from the health insurance company last year.
Freund oversees “FAIR Health Inc., a New York City-based nonprofit that is supposed to come up with a new, fair reimbursement system that will be used by insurers nationwide.” The project is funded by settlements from 13 insurers that used reimbursement data that rigged the system “to benefit insurers at the expense of consumers and doctors.”
At a news conference last year, [state Attorney General Andrew] Cuomo said the FAIR Health project will bring “ … transparency, accountability and fairness to a broken reimbursement system …”
Despite earlier statements from Excellus, the university and Cuomo’s office that Freund’s board position did not post a conflict of interest, a view not shared by consumer advocates, the professor resigned from the board Friday afternoon after Mulder spend several days looking into the situation.
Feds take aim at off-label marketing
Filed under: Conflicts of interest, Pharmaceuticals
The Wall Street Journal’s Jeanne Whalen writes that a recent string of charges against drug companies, including heavyweights like Pfizer, Eli Lilly, AstraZeneca, Johnson & Johnson and Novartis, shows that a decade of aggressive prosecution hasn’t deterred them from some shady marketing practices. [Article require subscriber access]
Whalen says the promotion of off-label prescriptions is still at the core of the most common offenses, and that, according to says Patrick Burns, director of communications at Taxpayers Against Fraud, problems are most likely to crop up “when drug companies are promoting therapies that are similar to others on the market.”
Whalen reports that the Justice Department, which often relies on corporate whistleblowers to spark investigations in this arena, has made such cases a priority.
“Combating health care fraud is a top priority of the Department of Justice,” said Tony West, Assistant Attorney General of the Justice Department’s Civil Division
Drug companies have apparently taken notice. GlaxoSmithKline recently started “capping its annual payments to U.S. doctors at $150,000 and publishing the figures” while AstraZeneca’s CEO said the crackdown had made pharmaceutical companies “more sensitive than we’ve ever been” when it comes to preventing illegal drug promotion. Whalen writes that these steps may not be enough.
But Shelley Slade, a former Justice Department lawyer who now represents corporate whistleblowers through the firm Vogel, Slade & Goldstein LLP, in Washington, D.C., said large criminal monetary penalties and civil settlements don’t appear to deter companies sufficiently. “It’s not going to stop until the government puts some of these executives in jail,” she said. “Many of these companies view the fines as a small fraction of what they have gained through illegal schemes, and just a cost of doing business.”
Joint Commission finds improved hospital quality
Filed under: Conflicts of interest, Health data, Hospitals, Pharmaceuticals, Studies
The latest report from The Joint Commission, a hospital accrediting organization, finds that “overall, hospitals are following evidence-based standards for treatment of myocardial infarction, heart failure, and pneumonia,” as MedPage Today reports.
The report, which looks at 31 evidence-based measures, did find decreases in two areas: measuring oxygen in blood for pneumonia patients and administering antibiotics to pneumonia patients in the intensive care unit within 24 hours.
The report, “Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2009,” (PDF) and those from three previous years are available on the commission’s Web site. Among the key findings:
- Hospitals accredited by The Joint Commission have significantly improved the quality of care provided to heart attack, heart failure and pneumonia patients over a seven-year period.
- Hospitals have steadily improved on individual surgical care performance measures – as well as on additional individual heart attack and pneumonia care measures - over a two-, three- or four-year period.
- Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma is excellent after only one year of measurement.
- Improvement is still needed.
- Where a patient receives care makes a difference.
As ProPublica’s Charles Ornstein explains in his tip sheet, The Joint Commission does routine inspections of participating hospitals to ensure they meet the standards required for accreditation. It compiles public reports on each hospital, which are available on the qualitycheck.org Web site. These reports include the hospital’s accreditation status, as well as some data on hospital outcomes and practices.
It does not release its detailed inspection reports to the public, and many states’ open records laws specifically exempt the reports from public disclosure. In the past, these inspections have not been surprises, and the group has been faulted for being slow to act against hospitals with problems Also, The Joint Commission rarely takes punitive steps against hospitals, preferring to work with them to improve.
Tip Sheets
A road map for covering your local hospital’s quality
Study: Hospital quality comparisons are inconsistent
News: Congress requires Joint Commission to re-apply for accreditation privileges (Sept. 17, 2008)
Rule limits Harvard docs’ conflicts of interest
Harvard doctors will now be limited to making $5,000 a year for serving as board members for drugmakers and biotech companies, under a new rule intended to reduce the conflicts of interest in medical research.
Scott Hensley explains and rounds up the coverage on NPR’s Shots blog, with links to stories in The New York Times and The Boston Globe. Hensley writes that the new rules also prohibit taking company shares as compensation and from serving on drug companies’ speaker bureaus.
Snyderman’s MSNBC show is canceled
Filed under: Conflicts of interest, Health journalism
In a little bit of news that may have gone unnoticed over the holidays, “Dr. Nancy,” a health program on MSNBC featuring Nancy Snyderman, M.D., has been canceled in the cable channel’s latest changes to its lineup.
The show launched on June 29, 2009. See earlier posts about Snyderman’s show.
Snyderman previously worked for ABC, which suspended her for a week after she made a radio commercial for Tylenol. She later left ABC to become vice president of medical affairs for Johnson & Johnson – maker of Tylenol.
Journal editor linked to spinal implant royalties
Filed under: Conflicts of interest, Hot Health Headline
John Fauber of the Milwaukee Journal Sentinel continues his coverage of conflicts of interest in medical research and journals with a look at journal editors. First, Fauber lays out the case in question:
- For seven years, a University of Wisconsin orthopedic surgeon (university bio | hospital bio) has been editor-in-chief of the Journal of Spinal Disorders & Techniques.
- During that time, he’s received more than $20 million in patent royalties thanks to spinal implants sold by Medtronic.
- Also during that time, an average of more than one Medtronic-related article appeared in each issue of the journal, most of them positive. Some were even co-authored by the editor/surgeon himself and related to the implant for which he gets royalties.
- Despite these coincidences, the journal never disclosed the potential conflict of interest.
Fauber then goes on to explore why journal editors aren’t mentioned more often in conflict-of-interest scandals, and then to explain exactly why those editors hold the sort of power that makes these conflicts particularly distressing. As Fauber explains, editors of medical journals can accept or reject manuscripts of studies involving drugs or devices - something that can make or break the product.
They can send a study out to peer reviewers who may be sympathetic to a particular drug or device by virtue of their own financial relationships with the companies that make those products. They can give authors more leeway to say positive things about a drug. They can turn down studies that say bad things about the product of a company they get money from.
The author of “On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health
Earlier coverage:
- Wis. researchers didn’t disclose conflicts to journals
- U. of Wisconsin conflict of interest policy gutted
- Wyeth paid university for ghostwritten articles
- University’s ties to testosterone therapy questioned
- Drug companies aim to sway docs through classes
- Wyeth-funded course promoted hormone therapy
- Academic docs collect money from manufacturers
Daschle pushes health IT to Obama, clients profit
Filed under: Conflicts of interest, Hot Health Headline
South Dakota Democrat and former Senate Majority Leader Tom Daschle is not registered as a lobbyist, and has not held public office since he lost a re-election bid in 2004. Instead, Fred Schulte and Emma Schwartz report for the Huffington Post Investigative Fund, that Daschle has existed in a nebulous limbo that’s allowed him to pivot deftly from pushing electronic medical records as an almost-HHS secretary to helping private firms profit handsomely from their implementation.
Daschle, as Obama’s first choice to head the Department of Health and Human Services last year, was a forceful advocate for using billions of dollars in economic stimulus money to help doctors and hospitals buy electronic medical records systems.
Tax problems led him to withdraw his name from consideration for the cabinet post. Then, a few weeks after Obama signed off on a stimulus plan that provided some $45 billion for digitizing the health system, Daschle began assisting private clients seeking to profit from the new law.
Public interest groups take issue with Daschle’s activities:
“He was in a position to drive public policy and develop connections within HHS that could provide his clients with an unfair competitive advantage in receiving taxpayer dollars, at the same time he and his firm benefits from his previous activities,” said Scott Amey, a lawyer with the Project on Government Oversight.
In the rest of the solid, in-depth piece, the reporters track both the breadth of Daschle’s influence (he has the ear of the president) and the impact he’s had on bottom lines across corporate America.
MIWatch.org calls for real disclosure reform
Filed under: Conflicts of interest, Pharmaceuticals, Studies
Phyllis Vine at MIWatch.org, a site that follows news about mental illness, asks whether drug company disclosures about payments made to doctors go far enough and whether anyone actually pays attention to such disclosures.
Vine raises the question of doctors taking part in “educational settings, including grand rounds, courses at professional conferences, or continuing education programs that pharma spends billions of dollars underwriting.”
She addresses the disproportionate number of psychiatrists who represent pharmaceutical companies and dominate the upper bracket of paid speakers. Vine also notes that, while many schools have drafted or are drafting policies about faculty-industry relations, enforcement of those policies is questionable.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
