Industry’s dirty secrets on display

You’ve got to hand it to Attorney General Andrew Cuomo. His recent triumph, forcing drug giant Pfizer to admit wrongdoing for engaging in illegal marketing of its drugs, is big stuff. We all have seen those well-dressed drug reps in our doctors’ offices. They look a lot like the people from certain religious organizations who come knocking at your door. They are well shaven, well dressed and, well, cute. Their job is to get doctors to prescribe their drugs, and they make billions of dollars for their firms.

I know and like a lot of doctors. For the most part, they are people of tremendous integrity who work hard to keep us healthy. These doctors rely heavily on prescription drugs to keep us alive. Of course, there are some people who think we would be a lot healthier if we took fewer drugs and did things “the old-fashioned way.” That’s interesting, since the average age of death in this country keeps going up and up. Could it be that antibiotics, heart medicine and drugs that treat certain cancers and stomach problems actually work?

But all too often, along with wealth and power comes arrogance and it turns out that Pfizer was marketing its drugs in unethical and illegal ways. The Food and Drug Administration says that you can’t market your drugs “off label.” That means you can’t try to convince doctors to prescribe drugs for uses that haven’t been approved by the FDA, even though we know very well that they may be effective for such purposes. Theoretically, the reason behind this is that they haven’t been tested for such uses and until they are, they shouldn’t be used since they might turn out to hurt someone. Makes sense to me. That’s what Pfizer had to pay up for. By the way, it is not against the law for doctors to use drugs “off label.”

It also turns out that the biggest dirty little secret in the industry has surfaced, and this goes for other drug companies as well. The drug companies have been helping doctors for the same reason that many doughnut joints provide free coffee to the cops — to influence them. I have known for years that a lot of doctors accept free lunches, dinners, trips and “speaking engagements” from drug companies. Their need to do this has been exacerbated by the lousy health care system in the United States.

You are probably aware that our most important physicians, general primary care practitioners and the like, are among the worst paid doctors.

Their colleagues, the specialists, can make hundreds of thousands of dollars doing procedures like stress tests and colonoscopies and endoscopies and ultrasounds. That’s where the big money in medicine is today. The primary care docs are lucky if they clear a hundred thousand dollars a year. The point being that these people are making so little money compared to the specialists that when the drug reps come to the office with roast beef sandwiches in hand, many docs do not throw them out.

In the old days in Congress and the state legislatures, one way to get lawmakers to do what you wanted was to offer them opportunities to give paid speeches even if the audience was five large men smoking cigars. Not bad work if you can get it. That racket got so sickening that it was made illegal.

Now many of the docs are facing the same conflict of interest charges.
One of the outcomes of the lawsuit brought by several states’ attorneys general was that Pfizer’s marketing activities would have an oversight operation looking over their shoulders. That may work for a while but sooner or later, people like the Bushies will get back in power and oversight will become no sight. That’s how we ended up with Bernie Madoff and the present banking scandal while everyone was looking the other way. That is why this is such a big coup for Andrew Cuomo and even this sometimes critic is impressed.

Originally published in the Legislative Gazette, 9/11/09

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