Wednesday, February 20, 2008

Medical Bribery: We Want Details

When drug companies provide kickbacks and bribes to physicians, they sometimes make the news for a brief spin around the news cycle, followed by shock when the same thing happens again a few news cycles later. But the point of this post is not to describe the amnesia that has befallen the media, but to wonder why nobody calls out the recipients of such lucre.

To give credit where it is certainly due, Health Care Renewal and some other blogs keep a close on such behavior. But my take is that the occasional sense of outrage regarding bribes, kickbacks, and other goodies tends to be shoved nearly entirely in the direction of the drug/medical device industry. Don't get me wrong -- they deserve some serious blame and shame, but if physicians wouldn't take the enticements, then there would be no problem to begin with. As the hackneyed phrase goes, it takes two to tango.

And these legal deals work out great. Merck or Bristol-Myers Squibb or whomever can simply settle the claims with the feds, pay out a sh*tload of cash, but admit no wrongdoing. And the doctors who were bribed -- we rarely know much about them. They seem to get a free pass. Yet when we catch an occasional whiff of what these doctors are up to, it is quite telling.

To quote from my post in May 2007 (which I humbly suggest that you should read in its entirety)...

"Anya’s doctor, George Realmuto gave several educational marketing speeches for Concerta, manufactured by Johnson & Johnson, which also makes Risperdal. He had the following to say (and I hope he was misquoted) when asked about why he gives marketing speeches for drugs.

“To the extent that a drug is useful, I want to be seen as a leader in my specialty and that I was involved in a scientific study,” he said. [i.e. I wanna be a key opinion leader???]

The money is nice, too, he said. Dr. Realmuto’s university salary is $196,310. “Academics don’t get paid very much,” he said. “If I was an entertainer, I think I would certainly do a lot better.”

Hey, can someone fetch me the Kleenex? Making $196,310 per year is a sign that he does not “get paid very much.” Cry me a river. In-blanking-credible."

And I'm just referencing legalized bribery, the kind where docs take cash to become product spokespersons. It would be quite tantalizing if we actually had a better idea of what, exactly, these bribes and kickbacks entailed. Yeah, we know that drug companies blatantly buy off some doctors in developing countries, providing cars, air conditioners, cameras and a wide variety of other products. We also know that drug companies must be a bit more subtle in how they bribe doctors in the so-called developed world. Sure, we have the vacations disguised as "educational meetings", the speaking engagements, seeding trials, and the like -- dressing up bribery as a form of education and/or research. Please feel free to add a few more tricks of the trade in the comments section. I've hit my limit for press releases which mention legal settlements and bribing doctors, yet fail to mention what "bribing" actually means.


Anonymous said...

In the world of big pharma, we never say bribery. It's known as gifting, as bribery is illegal.

One if not the primary objective of a big pharma rep is seeking out opportunities to pay prescribers to fully utilize thier speaking budget. This seems to actually excite them, possibly because they view this activity as job security for them.

And I agree that many if not most who accept big pharma inducements rationalize thier acceptance of this gifting. Helps them live with themselves. Others who do the gifting do so out of deliberate ignorance or reckless disregard for the integrity of the health care system for thier own benfit.

Others who gift who are with big pharma ignore what they do, believing somehow that this eliminates the existence of thier action.

My apologies for the digression, but this really would be a good thesis project in behavioral sciences.

CL Psych said...

Great comment. It would be a fantastic thesis project.