Pharmaceutical Companies Pay Doctors, Universities, FDA Billions of Dollars; Critics Say that’s a Conflict of Interest
If you’re a fan of natural remedies, you’re already aware of the real dangers posed by many pharmaceutical drugs and devices. Whether it’s the many possible side effects we’re sometimes, but not always warned about, or we develop reactions that medical doctors don’t yet know about, or the adverse effects of long-term use, there are important reasons to beware of a lot of what pharmaceutical companies and medical device makers sell.
A recently published report should only increase a consumer’s apprehensions. A years’ long investigation found that drug and medical device manufacturers give cash payments and other gifts to most American doctors, totaling in the billions of dollars. It’s not just an occasional free pen and drug samples, as many patients may have thought.
The analysis by ProPublica, a non-profit investigative journalism organization, co-published with The New York Times in that newspaper and in Scientific American in late 2014, details startling information: since 2009, the year ProPublica started its investigations, pharmaceutical and medical device firms made 3.4 million payments to doctors, totaling more than $4 billion. Of that, $2.5 billion were paid for what the pharmaceutical industry calls research, which includes doctors turning over bundles of anonymous information about patients (such as reactions to drugs or performance of devices) to pharmaceutical or device companies.
In 2013, the last year for which figures were available, there were 1.2 million payments made, totaling close to $1.4 billion. Those numbers represent payments to doctors by 17 pharmaceuticals or device manufacturers, which combined sold half of all pharmaceuticals and devices that year.
Surveys done in 2004 and again in 2009 found that the majority of doctors had at least one type of financial agreement with a drug or medical device maker. In 2004, 94 percent of doctors said they had such a relationship, and in 2009, the figure was 84 percent, according to Eric Campbell, PhD, professor of medical ethics at Harvard Medical School.
Dr. Campbell has not conducted surveys recently, but suspects that the percentage of doctors getting money from drug and device makers may have decreased some since then, in part because such payments are now required by law to be made public — a mandate from the 2010 Affordable Care Act that requires disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists.
What Does the Money Pay for?
The money is paid for different things, like promotional speaking, consulting, research, seminars, vacation-style conventions, air travel and meals. Pharmaceutical firms also pay for a substantial percentage of the billions of dollars spent on continuing medical education courses that physicians are required to take in most states.
The journalists included figures from the websites of some large drug makers that are now required to publish their payments to doctors as a condition of settling federal whistle-blower lawsuits that alleged improper marketing and payments for prescribing a company’s products.
Among the companies that were investigated by the journalists, and not counting research payments, Pfizer was found to have made the most payments to doctors in 2013 (142,600); AstraZeneca was second (111,200); Johnson & Johnson and Forest Labs were third (about 100,000 each).
However, big companies aren’t always the ones spending the most; some smaller ones spend a lot of money on doctor speaking fees, for instance, as they don’t advertise on television the way the bigger drug makers are able to do. Also, companies with newer drugs, or newly approved uses for existing drugs, make more payments to doctors than those with fewer new drugs or drugs that are about to lose patent protection.
Some highly sought-after doctors can earn in the hundreds of thousands of dollars a year doing work for pharmaceutical companies; speaking engagements can command thousands of dollars each, and some doctors have financial ties with half a dozen or more companies in a given year, according to the New York Times-Scientific American article, which referenced IMS Health and ProPublica’s “Dollars for Docs” investigation as sources. Some doctors may even work for several pharmaceutical companies that compete in a specific drug category (such as, say, blood-thinning drugs).
The biggest payments were made to orthopedic surgeons who consulted for medical device makers. Some doctors in this category were paid hundreds of thousands and even millions of dollars by device manufacturers. Ironically, a few of these device makers are now facing many lawsuits over hip and knee implants that have caused serious, debilitating complications. The companies have settled many suits for millions of dollars, with many more pending.
Meals were by far the most common form of gift/payment made to doctors; an attorney speaking on behalf of a pharmaceutical trade group stated that sales representatives often treat doctors to lunch because it’s a good time to inform them about new drugs or devices, when the doctor isn’t busy seeing patients.
Although meals were the most frequent type of payment, they were only a small fraction of the money spent. For example, almost 50,000 of Amgen’s 55,000 payments were meals; but at $3 million, they were only about 20 percent of the money paid. Amgen spent almost twice that, $6 million, on 600 doctors it paid for speaking engagements.
In the case of Massachusetts, where state law has required since 2009 that drug and device makers publicly report payments made to health professionals, the journalists found that between 2010 and 2012, 60 percent of all doctors who got payments received them only for one year; 20 percent were paid in two of those years, and 20 percent got compensated in all three years, according to the website drugwatch.com, which provides consumers and patients with information about prescription drugs and medical devices that have been found to harm many users, leading to lawsuits against the pharmaceutical and device companies involved.
Since the ProPublica report was published, another comprehensive article has appeared online, on drugwatch.com, shining a light on just how far-reaching and pervasive Big Pharma’s influence is. In addition to its direct payments to physicians, pharmaceutical firms and device makers contribute a sizable chunk of the Food and Drug Administration’s yearly budget. The FDA is the federal agency that regulates drugs and devices made by pharmaceuticals.
Big Pharma Lobbies Politicians Heavily
In the political arena, the pharmaceutical industry employs more than a thousand lobbyists who work to persuade members of Congress to pass legislation favorable to the industry’s business interests. Between 1998 and 2013, pharmaceutical and medical device makers spent almost $2.7 billion on lobbying expenses — more than any other industry. Further, since 1990, individuals, lobbyists and committees connected to the industry have given $150 million in political campaign contributions, according to drugwatch.com.
The pharmaceutical industry’s trade association, PhRMA, has dozens of current or former employees who previously worked in politics; that further helps the industry gain influence with politicians. These employees include many who worked for members of Congress or a federal agency, and some who worked for the White House and the court system. (Source: drugwatch.com.)
Big Pharma Spends Billions on Advertising
The pharmaceutical industry’s yearly net profits approach $100 billion, with gross global sales estimated at about $1 trillion (source: IMS Health). Because the stakes are so enormous, pharmaceutical firms spend a combined total of several billion dollars a year marketing their products on television, radio, online and through other media.
The United States and New Zealand are the only two countries in the world whose governments allow prescription drugs to be advertised on TV. Drugwatch.com cites Pradaxa, a blood thinner made by Boehringer Ingelheim, as an example of the kind of money that pharmaceutical companies are willing to spend, to push their products. In 2011, the drug maker spent $464 million on advertising for Pradaxa. The next year, the company sold more than $1 billion of the drug.
According to numbers from GlobalData, 9 out of 10 pharmaceutical companies spend more on marketing their drugs to consumers than they do on research and development. For every dollar that pharmaceutical firms spend on basic research, they spend $19 on advertising and promotions (source: drugwatch.com).
Many critics believe that the kind of money spent to advertise Big Pharma’s products, and the amount of constant advertising that buys, can’t help but to sway lawmakers, the FDA and the public at large. These critics charge that this level of influence produces hypochondria in people, causing them to run to their doctors to get prescriptions for drugs that they don’t need.
Pharmaceutical Companies Fund University Researchers and Influence Content in Respected Medical Journals
But it’s not just doctors, consumers and politicians who may become susceptible to the power that Big Pharma’s big money buys. Many medical researchers, medical journals, teaching hospitals and university medical schools are also dependent on big dollars from pharmaceutical companies.
According to the drugwatch.com site, pharmaceutical and medical device makers pay for 67 percent of the estimated $100 billion spent on biomedical research in the United States each year.
A 2011 investigation by an international team of researchers examined sources of funding for 29 meta-analyses (studies of past studies) involving 509 individual drug trials. In seven of the meta-analyses, all funding for the studies mentioned, or part of it, came from the pharmaceutical that made the drug being evaluated — or the studies’ authors had direct financial ties to the pharmaceutical company. In six of the seven meta-analyses, study authors did not disclose their source of funding.
The above is cause for concern, given that these studies, brimming with conflict of interest, are presented in even the most respected medical journals as unbiased scientific results.
And even when the editors and publishers of the journals have the best of intentions, they may be sabotaged by Big Pharma, which plays hardball with advertising dollars.
According to drugwatch.com, it is not uncommon for pharmaceuticals to pull ads from medical journals when the journals question the accuracy of an advertisement, or when journals publish an article that goes against a pharmaceutical’s financial interests. Pharmaceutical firms can wield power over medical journals in that way, because often, pharmaceutical ads make up the majority of a journal’s revenue.
In addition, pharmaceutical companies sometimes pay doctors to allow “ghostwritten” articles attributed to the doctors, but in truth written by a copywriter at the pharmaceutical firm. These articles can appear in respected medical journals and offer favorable impressions of new drugs that companies are trying to push.
Physicians who are experts in their fields are sometimes paid by Big Pharma to write comprehensive, positive reviews about a new drug, to be published in prestigious journals. This is troubling because being that they are getting paid, the doctors lose the objectivity that they’re supposed to have when they write the articles.
Big Pharma Influences What Medical Students Are Taught
Another way in which pharmaceutical firms directly influence the field of medicine is by having doctors who are professors, department chairs and deans at medical schools sit on pharmaceuticals’ boards of directors. This tends to influence what is taught in medical schools, and it leads student doctors to learn a drug-intensive way of practicing medicine. In addition, young doctors are given plenty of free drug samples to give to their patients by pharmaceutical sales representatives.
Clinical Trials Are Sometimes Manipulated to Yield Desired Results
According to the drugwatch.com site, pharmaceutical firms sometimes take steps to insure that a drug will yield favorable results in a clinical trial. For example, they may compare their drug to a competitor’s drug that’s used in the wrong strength; they may pair up the drug with another drug that is already known to work; or they may end the trial before any bad results can occur. In addition, if 1,000 trials are done to test a drug, and only two are successful, that is enough for the drug to be approved, and the study to be published. The other 998 trials are never written about (source: drugwatch.com).
Dangers of Many Pharmaceutical Drugs Can Be Serious or Deadly
When someone uses a natural/naturopathic medicine to prevent or cure an illness, the worst that may happen, barring rare allergic reactions, is that the medicine might not work for the person, and they will have to keep searching for a medicine that’s effective for them.
In the case of many lab-made pharmaceuticals and medical devices, on the other hand, we all know from the very ads that appear on TV and in other media that quite often, the potential side effects are numerous, diverse, and can be severe or even fatal. Sometimes, side effects cause permanent damage.
With respect to the blood thinner Pradaxa that topped $1 billion sales in 2012, the drug has now been blamed for hundreds of deaths related to uncontrollable bleeding.
Another notable example of bad outcomes is the popular painkiller Vioxx, made by drug giant Merck & Co. Thousands of patients who used the drug reported cardiac side effects; in some cases, the patients died. Merck has paid out billions of dollars to settle tens of thousands of lawsuits against the drug. Merck currently also faces litigation for its drug Fosamax, used to prevent bone loss, and for other drugs the company makes, including the popular hair treatment Propecia, used to prevent male baldness. Many users have suffered serious side effects from these drugs.
Merck is hardly unique in making drugs that have caused serious complications in some people. Even companies that make popular over-the-counter drugs, which are usually not a problem when used infrequently, such as Bayer HealthCare’s aspirin, Aleve and Alka-Seltzer, can run into trouble when they introduce new drugs and devices on the market.
Bayer HealthCare’s birth control pills and IUD’s have been blamed for serious, life-threatening side effects. The FDA now warns consumers that the hormone used in Yaz and Yasmin raises the risk of blood clots significantly. The IUD Mirena can lead to pelvic inflammatory disease and ectopic pregnancy.
Bayer has so far paid out $1 billion, settling close to 5,000 Yaz lawsuits involving blood clot-related injuries; thousands more lawsuits are still pending. Mirena lawsuits claim that the company’s advertisements exaggerated the benefits of the product, while not adequately warning of its risks.
Another category of drugs that’s run into frequent problems are antidepressants. Many consumers are now aware of the dangerous side effects from popular antidepressants, which only became apparent to the pharmaceutical industry over time. Antidepressants have been linked — ironically — to suicide, to decreased libido, and to birth defects when taken by pregnant women.
Hormone-replacement therapies, which have been heavily marketed and thus have surged in popularity among aging baby boomers in the last two decades, have been linked to higher risks of heart disease, stroke and blood clots. These risks are seen in both women and men. AbbVie, Inc.’s AndroGel, which is used to treat low testosterone in men, accounts for 60 percent of the testosterone replacement therapy market; it generated the company more than $1.4 billion in sales in 2013. The company is now facing lawsuits alleging that it did not adequately warn men of the heart risks associated with use.
Affordable Care Act Has Begun Holding Pharmaceutical Firms Accountable
Since 2013, President Barack Obama’s Affordable Care Act guidelines have required pharmaceutical and medical device makers to gather specific information about doctors on drug or device investment interests, ownership and monies paid to doctors. As of 2014, drug and device makers have to report this information to federal agencies, or face fines as high as $1 million per year.
However, the billions of dollars still being spent on pushing drugs and devices on the public — and the billions of dollars pharmaceutical companies have to pay out in lawsuits — can only make a lot of us conclude that a little Big Pharma goes a long way. Only you can decide what’s best for you or your family, in consultation with your healthcare providers; but many of us need no further evidence that in most cases at least, natural disease prevention and natural medicines are best.
By Cynthia Sanchez. A graduate of the University of Washington, Cynthia has extensive experience writing about health and wellness topics for different media.