• Quote: Glaxo says it will stop paying doctors to promote drugs

    The New York Times published a superb article this Sunday on the overdiagnosis of ADHD and the overprescription of stimulant medications (see Aaron’s discussion here). Among the lowlights of the ADHD story was the corruption of physicians by pharmaceutical companies, who paid them to shill for the drugs. A notorious case was Dr. Joseph Biederman,

    a prominent child psychiatrist at Harvard University and Massachusetts General Hospital. In 2008, a Senate investigation revealed that Dr. Biederman’s research on many psychiatric conditions had been substantially financed by drug companies… Those companies also paid him $1.6 million in speaking and consulting fees. He has denied that the payments influenced his research.

    ADHD is not unique. There are similar stories throughout medicine.

    But perhaps the tide has turned. Katie Thomas reports that:

    The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest.

    Let’s hope that the other drug and medical device manufacturers follow GSK’s lead. And hope hope hope that Direct-To-Consumer drug advertising might be the next practice to go.


    • One little-noticed provision in ACA is the creation of a data base to identify contractual relationships between vendors, including drug companies and medical device manufacturers, and health care providers (i.e., physicians) and a mandate for disclosure of those relationships. Can you say qui tam lawsuit.. Would I want to be one of those vendors or physicians when all those unemployed and underemployed lawyers start mining the data base. We are already experiencing a sharp rise in qui tam (whistle blower) lawsuits (a private party brings a lawsuit on behalf of the government to recover damages suffered by the government and gets to keep a large share of the recovery for her efforts) and I expect a flood in the coming years. Indeed, I advise physicians that the risk of those relationships isn’t regulatory sanctions but a hungry underemployed lawyer bringing a qui tam lawsuit.

    • the news is that GSK is stopping these practices in advance of law going into effect that prohibits them

      why not give them credit for their compliance…..they deserve it….after all they did not come up with this idea on their own…

    • To clarify, ACA doesn’t prohibit vendors (drug companies, for example) from making payments to physicians for providing services, nor do other federal laws (such as the Stark law). But those other federal laws prohibit kickbacks. What distinguishes kickbacks from legitimate compensation arrangements? The services provided by the physician. Being paid several hundred thousand dollars per year in return for giving a few “lectures” in the Bahamas is not a legitimate compensation arrangement. It’s those arrangements that federal (and many state) laws prohibit, and ACA’s data base was intended to flesh out. What’s remarkable about the Glaxo announcement isn’t that Glaxo has decided to terminate such arrangements, it’s Glaxo’s acknowledgment that it has been making payments to physicians based on “the number of prescriptions doctors write . . . .” Good grief, Glaxo is admitting that it’s been violating federal law! Where do I file my qui tam lawsuit.

    • A study published in 2010 by Annisa Lai Lee “Who Are the Opinion Leaders? The Physicians, Pharmacists, Patients, and Direct-to-Consumer Prescription Drug Advertising” Noted the following which is different from a study done at Kaiser.

      “This study investigates a 2002 Food and Drug Administration (FDA) survey and finds that patients searching for drug information through mass and hybrid media in newspapers and magazines’ small print, the Internet, and toll-free numbers are more likely to seek information through interpersonal communication channels like health care providers. Patients using small print, toll-free numbers, one’s own physician, and other physicians are associa- ted with influencing their physicians with various drug-requesting behaviors. But physicians only prescribe requested drugs to patients who are influenced by other health care providers, such as pharmacists and other physicians, not the mass media. The influence of expert opinion leaders of drugs is so strong that the patients even would switch from their own unyielding physicians who do not prescribe drugs as advised by the pharmacists. Physicians and patients all are influenced more by other expert opinion leaders of drugs than by the mass media and therefore still uphold the basic tenet of the two-step model.”