Big Pharma Manipulates Physicians and Corrupts “Best Practices”

Pharmaceutical companies have relationships with the regulatory agencies, and then they also heavily influence the education the physicians are getting

Ben Swann‘s channel, 29 Jun 2016.

Episode 3 of 4 in Truth in Media series on Big Pharma manipulation of healthcare.

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  • The third episode of this serie, How Big Pharma Manipulates Physicians and Corrupts “Best Practices,” discusses how companies in the pharmaceutical industry influence doctors’ “best practices” as well as offer funding for research and court physicians and their staff in hopes of gaining loyalty.
  • How Big Pharma Manipulates Physicians and Corrupts ‘Best Practices’, Truth In Media, Jun 29, 2016.
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Understanding Big Pharma’s Propaganda Machine

Corrupting Science : More and More Bias introduced into Medical Research

Ben Swann‘s channel, 21 Jun 2016.

Episode 2 of 4 in Truth in Media series on Big Pharma manipulation of healthcare.

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  • The second episode of this serie, Understanding Big Pharma’s Propaganda Machine, Ben Swann discusses the how companies within the pharmaceutical industry are able to attract positive media surrounding its drugs, regardless of whether or not their claims are founded.
  • Understanding Big Pharma’s Propaganda Machine, Truth In Media, Jun 21, 2016.
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The Revolving Door Between The FDA and Big Pharma

Big Pharma’s Bad Influence Over The FDA

Ben Swann‘s channel, 8 Jun 2016.

Episode 1 of 4 in Truth in Media series on Big Pharma manipulation of healthcare.

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  • The first segment of this episode, Big Pharma’s Influence Over The FDA, examines how the pharmaceutical industry exerts heavy influence over the FDA as well as the media and the medical community.
  • Big Pharma’s Influence Over The FDA, Truth In Media, Jun 8, 2016.
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Guérissez l’industrie pharmaceutique

Pétition contre les prix prohibitifs des médicaments en Belgique

Vidéo publiée le 23 juin 2016 par la chaîne de Testachats.

Les prix demandés par les firmes pharmaceutiques pour leurs médicaments sont devenus exorbitants.

  • Avec d’autres organisations, Test-AchatsLe Défenseur des Consommateurs – exige des mesures pour enrayer cette spirale des tarifs à la hausse.
  • Montez au créneau avec testsachats.be pour des soins de santé solidaires et signez leur pétition!
LA Campagne de Médecins du monde
En Savoir Plus

Pourquoi garder son indépendance face à l’industrie pharmaceutique?

Futurs soignants : se former à l’indépendance

Vidéo publiée le 8 octobre 2015 par la chaîne de La Troupe du RIRE.

Les liens d’intérêts et l’influence de l’industrie pharmaceutique constituent un risque sanitaire non négligeable. Où se cache cette influence dans notre parcours de soignant ? Comment se manifeste-t-elle ? Pour quelles conséquences ? C’est à ces interrogations que ce petit livret tente de répondre..

La couleur qui symbolise la santé ? Le blanc, comme celui des blouses de médecins !
Mais qui dit blanc ne dit pas forcément transparent.
L’industrie pharmaceutique est, avec la banque, la plus profitable du monde.
Dans le budget d’un laboratoire, le marketing est désormais le premier centre de coût, devant la recherche et le développement.
Des gros sous pour entretenir avec les professionnels de santé… un dialogue sonnant et trébuchant !
Il faut dire qu’avec 18 000 visiteurs médicaux employés en France, l’industrie sait entretenir les contacts.
333 visites par médecin en moyenne chaque année, soit un coût de 25 000 € par professionnel, un record en Europe !
Pas étonnant que des propos alarmistes se fassent entendre :

“L’influence de l’industrie pharmaceutique est hors de tout contrôle. Ses tentacules s’infiltrent à tous les niveaux, médecins, patients, régulateurs, chercheurs, associations caritatives, universités, médias, soignants et politiciens. Ses multinationales planifient, sponsorisent, orchestrent et contrôlent les publications sur tous les essais de médicaments. Sa réputation est aujourd’hui très mauvaise. Il faut de grands changements. “

Sauf que là, cet extrait est tiré d’un rapport du Parlement britannique repris dans le Lancet, l’un des journaux médicaux les plus réputés au monde !
Cette situation pas terrible-terrible s’explique – entre autre – par l’absence de formation des professionnels de santé pour se prémunir de l’influence de l’industrie.
Un constat plutôt fâcheux… Heureusement, l’OMS publie en 2009 un manuel d’enseignement pour remédier à la situation : “Comprendre la promotion pharmaceutique et y répondre“, traduit par la Haute Autorité de Santé en 2013.
Mais quand on fait ses études de médecine, on ne prend pas forcément le temps de lire un manuel de 180 pages qui n’est malheureusement même pas au programme.
Du coup, NOUS – collectif d’étudiants en médecine de La Troupe du Rire avons résumé et adapté le fameux rapport de l’OMS. Ca donne ça : Ce livret – petit mais costaud : il tient dans la poche d’une blouse blanche – analyse les principales techniques utilisées par l’industrie et cherche à déterminer leur impact :
– Conduite de la recherche clinique,
– financement de la formation continue des médecins à 98% ,
– leaders d’opinion recrutés parmi les professeurs de médecine les plus influents,
– cadeaux, voyages,
– financement et publicité dans des revues spécialisées
– et bien d’autres manières encore, de tisser des liens d’intérêts avec les professionnels de santé !
Il met aussi à disposition des ressources pour se former et s’informer de manière indépendante (eh oui c’est tout à fait possible!).
Le livret fait des propositions concrètes pour faire face aux situations où l’on est confronté directement à cette influence, à l’université, à l’hôpital ou dans son cabinet.
Nous attendons toujours qu’une véritable formation soit donnée aux futurs professionnels de la santé sur ces influences contraires à l’intérêt des patients…
Pour combler ce vide, il faut nous informer et nous former par nous-mêmes.
Si comme nous, vous souhaitez mettre à l’ordre du jour les questions de formation des professionnels de santé face à l’influence des laboratoires : aidez-nous à financer l’impression de ce livret pour le faire connaître !

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Medical industry payments to doctors associated with higher rates of prescribing brand-name drugs

Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts

Another Study Finds Link Between Pharma Money and Brand-name Prescribing, propublica, May 9, 2016.

A group of researchers at Harvard Medical School has found that medical industry payments to physicians in Massachusetts are associated with higher rates of prescribing brand-name drugs that treat high cholesterol.

Abstract

Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts, JAMA Internal Medicine, doi:10.1001/jamainternmed.2016.1709, May 09, 2016.

Importance
Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed.

Objective
Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol.

Design, Setting, and Participants
Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011.

Main Outcomes and Measures
The exposure variable was a physician’s industry payments as listed in the Massachusetts database. The outcome was the physician’s rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians’ industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments.

Results
Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P < .001). Payments for educational training were associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not.

Image: David Sleight, ProPublica – Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds, March 17, 2016.

Conclusions and Relevance
Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to reign in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

Les relations particulières entre médecins et laboratoires pharmaceutiques

Jérôme du labo “SANOFIST” nous explique sans détours les relations médecins-labos dans une vidéo

Vidéo publiée le 20 novembre 2012 par la chaîne de Julie Goyave.

Congrès des jeunes médecins généralistes – table ronde sur la place des laboratoires pharmaceutiques dans la formation des médecins.

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US Drug Pricing

Drug prices top Americans’ list of health care concerns

Americans are worried about the cost of prescription drugs for serious diseases, following weeks of news coverage about companies hiking prices for critical medicines.

How Pharmaceutical Companies Entice Doctors into Prescribing Expensive Medication

An excerpt from Dissenting Diagnosis, by Arun Gadre and Abhay Shukla, published by Random House India

Written by the doctors and public health advocates Arun Gadre and Abhay Shukla, Dissenting Diagnosis is based on a study conducted at Support for Advocacy and Training to Health Initiatives, a Pune-based non-governmental organisation. During the course of this study, Gadre and Shukla interviewed 78 doctors from across the nation in an effort to confront what they consider is an ongoing crisis of the medical profession: doctors, they write in their introduction to the book, are finding “their traditions of ‘keep patients foremost’ rapidly buried under the ruthless logic of ‘keep profits foremost.’” Gadre and Shukla discussed with these medical professionals issues such as lack of regularisation in the private sector, unlawful and unethical practices routinely followed by doctors, the influence of pharmaceutical companies, the state of medical education, and the possibility of a universal healthcare system.

How Pharmaceutical Companies Entice Doctors into Prescribing Expensive Medication, caravanmagazine, 16 April 2016.

In the following excerpt from the book, interviewees speak to the writers about the hold of the pharmaceutical companies over the medicines prescribed by doctors. They describe how, through offers of gifts and benefits, aggressive marketing and sheer persistence, representatives from pharmaceutical companies routinely entice doctors into prescribing expensive and often unnecessary medicines to their patients. The pharmaceutical companies, one of the doctors said, are “like a pack of wolves.”

“Some of my doctor friends boast to me that they have travelled the world, sponsored by pharmaceutical companies. One was telling me with pride that even their shirts, pants, vests and underwear are given by pharmaceutical companies!” says an ophthalmologist from a medium-sized city.

Dr Suchitra, a general practitioner in Chennai, mentions, “The pharmaceutical companies offered to sponsor me for a conference, but I refused. I usually prescribe generic medicines or cheap, branded medicines. But the interesting thing is that once these pharmaceutical companies realized I don’t prescribe their medicines, they stopped visiting me.”

“I have been practising for thirty years. I have not given any ‘cuts,’” a super-specialist from a metropolis shares. “I did not encourage pharmaceutical companies. I change the medicines prescribed to my patients, prescribing cheaper medicines if expensive medicines have been prescribed. And what a big difference this makes to the patient! Sometimes the cost is reduced as much as Rs 35–40 per tablet! Patients are often unnecessarily prescribed expensive brands of medicines, for years on end, sometimes for life. The hapless patient keeps taking these medicines.

“Once, four medical representatives visited me with their bosses. They tried to convince me that I should not replace their brands, while prescribing cheaper brands to patients. We discussed the matter for an hour and their argument was that their company does a lot of research, on which they spend crores of rupees. That is why their brand is more expensive by Rs 30 per tablet.

“After they had finished their speech, I took Rs 1000 out of my pocket and handed it to one of the bosses. Surprised, he asked me what this was for. I answered: ‘You are doing such good work for humankind. This is my small contribution!’”

“After that I emphatically told them that I would help them, but how could I do this at the patients’ expense without telling the patients? Of course, they had no answer to that.”

A big-city surgeon remarks, “Pharmaceutical companies sponsor conferences where nobody bothers to listen to the lectures. Doctors just go to the stalls, and collect gifts. They enjoy the free drinks. It is a filthy business. What can one say?”

“Medical representatives influence the doctors. One of them offered me a trip to Singapore. I refused and told him that I would go at my own expense, and when I wanted,” said a general practitioner from a big city.

A super-specialist from a metropolitan city also shares, “The medical representatives are really persistent; they don’t leave you alone. Earlier, I would get angry at them. One of them pleaded with me, “Sir, you are the only one left. The other doctors, like you, who would earlier not take gifts, have all gradually succumbed. That’s why I am now meeting you too.” Since then, I don’t get angry with them.

“Recently, a medical representative brought along a diamond necklace as a gift, worth Rs 1 lakh.

“I asked him, ‘What’s this?’

“‘A diamond necklace, sir.’

“‘For whom?’

“‘It’s for your wife.’

“Controlling my temper, I asked him, ‘How do you dare to put a necklace on my wife’s neck?’

“The poor fellow was taken aback. ‘It is you . . . you will put the necklace on your wife’s neck.’

“Giving it back to him, I told him in a calm voice, ‘If that is so, then I will buy it with my own money. That is, if she wants a necklace at all!’

“The poor fellow left with the necklace.”

Dr Sumit Das, a psychiatrist from Kolkata notes, “Pharmaceutical companies exist to do business and make profits. But what about doctors? They too put pressure on pharmaceutical companies, telling them, ‘If I prescribe your medicines, send me on a tour to Europe.’

“In the field of psychiatry, pharmaceutical companies bring out new medications every day. There is no evidence that the new medications are better than the cheaper and effective medications that are already in use. And keep in mind the fact that our patients don’t take these medications for just a few days, but often for months or even longer. Yet these unnecessarily expensive medicines are sold and also prescribed.”

“Pharmaceutical companies could have donated money to our department and our institution by cheque. But instead of doing that, I would repeatedly be offered personal gifts, foreign trips, etc. Those salesmen would tell me openly that they are willing to spend on an individual, not on the institution,’ comments a general surgeon from a metropolitan city.

A paediatrician from a metropolitan city suggests, “The practice of pharma companies sponsoring doctors for conferences and CME (Continuing Medical Education) workshops must be stopped immediately.”

A gynaecologist from a big city observes, “The area manager of a pharmaceutical company once paid me a visit along with his army of representatives. He asked me why I regularly use a certain product manufactured by them.

“I answered, ‘It is cheap, it is effective. That’s why.’

“He was confused. He asked me in bewilderment, ‘Madam, we never give you any gifts.’

“I replied, ‘There is no need for that.’

“He just could not believe it. He kept asking, ‘How can this be, madam? Please tell me the reason.’

“This is the ridiculous situation that prevails. This is the reality.”

A paediatrician from a big city mentions, “Our branch [of a doctors’ association] was functioning well. We would organize CME workshops with our own funds. Gradually, the pharmaceutical companies pushed their way in. From 1995 onwards they began to organize their own CME workshops. Earlier, we would focus on the issues of importance that we had decided upon. But then the pharmaceutical companies began to select only those topics that would help them promote their new drugs. The workshops were free, with liquor thrown in. Finally the doctors in our city decided that all workshops henceforth would be organized by the pharmaceutical companies. I would ask them why they couldn’t spend Rs 1000 per year on their own education. Why do you want it free? Finally, through a secret ballot, my opposition was set aside and the basic principles of our [doctors’ association] branch were changed in favour of the pharma companies. Obviously, I withdrew from it. Now all workshops in our city are conducted by pharmaceutical companies.”

“A rampant malpractice is in the area of prescribing vaccines—it is organized, and takes place on a large-scale in planned fashion. The practitioner gets a cut on the Maximum Retail Price (MRP). The more expensive the vaccine, the higher the cut. The cut is even more than the consultation fee. The doctor gets both—the cut from the company and the fee from the patient,” notes Dr Vandana Prasad, a paediatrician from Delhi.

“The pharmaceutical companies are like a pack of wolves. They keep pestering you and encourage you to accept some incentives. Once you take anything from them, they immediately become arrogant. Now they begin to ask you directly, ‘Why don’t you prescribe our medicine?’ They start dictating terms, and because you have accepted money and gifts, you are morally bound to them,” Dr Sanjay Bhatnagar, a paediatrician from Delhi, also shares.

A surgeon from a megacity mentions, “The government cannot provide funds, and if the pharmaceutical companies therefore sponsor conferences in a transparent manner, there is nothing wrong with it. The MCI wanted to do something about this.”

A skin specialist from a big city says, “The pharmaceutical companies have created mayhem. Things like conference sponsorship by drug companies must be stopped. The MCI is aware of the problem, but there are lots of loopholes that can be exploited. Nowadays, doctors take money from pharmaceutical companies and prescribe ten to twenty medicines in a single prescription. There is always an antioxidant tablet prescribed, whether it serves any purpose or not.”

A skin specialist from Kolkata, Dr Jayant Das also remarks, ‘Now pharmaceutical companies are resorting to a new strategy. “For example, they don’t even produce Doxycycline (an established antibiotic) capsules, which cost less than Re 1 per capsule. Instead, they add a useless component like lactobacillus with Doxycycline, and then sell each of those capsules for Rs 5. And when the ordinary, cheap Doxycycline capsule is not even available in the market by design, one has no choice but to prescribe the expensive medicine. This is happening without any check with respect to many medications. One company recently withdrew a medication available for Rs 2. They made some token changes in the formulation and the same tablet is now sold by them for Rs 15!”

Another skin specialist from a big city observes, “Pharmaceutical companies try to give money to doctors under the pretext of conducting studies on their medicines. Such bogus clinical trials are conducted openly. The doctors lure the patients with the promise that the stated medication has come from abroad, and if you want to have it free, you would have to just sign this form, that’s all! Please sign here. Doctors collect the signatures on the forms. Sometimes they just fill up the details. Once they have given the papers for ten to twelve cases (even without prescribing the medication) they get a cheque from the pharmaceutical company.

“If one puts an end to the money pharmaceutical companies spend on doctors, medicines will definitely become much cheaper. That must be ensured, for the benefit of patients. Doctors should be legally compelled to prescribe only generic medicines.”

A general surgeon from a big city offers, “Take the example of Lactulose, which is used to treat constipation. It costs about Rs 180 for 200 ml, that is, around Rs 900 a litre. This is a by-product of the sugar industry. Actually, this should cost less than sugar, i.e., less than Rs 60 per kg. Elderly people will be taking this for years together. Shouldn’t the prices of such medicines be regulated? No. The loot continues.”

 

Doctors and Pharma Ties…

Are doctors really immune to gifts and marketing?

Can we easily find out about the ties between doctors and drug firms?