Pharmaceutical Payola — complemented by a host of tactics that in other circumstances might be called bribes.

Pharmaceutical Payola — Drug Marketing to Doctors - CommonDreams.orgSaturday, May 17, 2008 by Robert Weissman
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Among industrialized countries, only the United States and New Zealand permit drug companies to market directly to consumers. It’s a bad idea, it drives bad medicine, and it should be banned.

But although it has the highest profile, direct-to-consumer advertising is a small part of Pharma’s marketing machine. Researchers Marc-André Gagnon and Joel Lexchin conclude in a recent issue of the journal PLOS Medicine that direct-to-consumer ads make up less than a tenth of industry marketing expenditures ($4 billion of $57.5 billion in 2004). And Gagnon and Lexchin’s estimate of $57.5 billion on marketing excludes many industry expenditures that are really driven by marketing, including clinical trials conducted for marketing purposes.

The bulk of the industry marketing effort — more than 70 percent by Gagnon and Lexchin’s calculation — is directed at doctors.

Why?

Because it works.

The companies spend huge amounts paying firms that carefully track what doctors prescribe, and then they use the information to tailor messages to doctors, distribute samples and develop continuing medical education programs.

Gagnon and Lexchin report that Pharma spends more than $20 billion a year on “detailers” — the pharma reps that knock on doctor doors, ply the staff with free coffee and lunches, distribute samples ($16 billion worth), and prod docs to prescribe their drugs.

This is complemented by a host of tactics that in other circumstances might be called bribes.

“Virtually all physicians in America take cash or gifts from the drug companies,” says Melody Petersen, author of Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, and a former New York Times reporter. “A recent survey said 94 percent of physicians took something of value from the drug companies. Some doctors take hundreds of thousands of dollars a year from these companies, and there’s no law that says they can’t.”
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The drug companies weave these diverse strategems into an elaborate tapestry — not infrequently to push drugs for inappropriate purposes. One eye-opening case that Petersen details in Our Daily Meds concerns Neurontin, a mediocre drug for epilepsy that Warner-Lambert illegally peddled as an unapproved treatment for bipolar disorder, migraines, attention deficit disorder in children and other conditions. The drug does not work for most of these conditions. Many persons were injured by taking excessive doses of Neurontin, and many others wasted money and emotional energy on hopeless Neurontin treatment strategies. Warner-Lambert ultimately paid $430 million to settle criminal and civil charges related to Neurontin marketing, but Petersen says that, even so, the illegal marketing scheme was clearly profitable for Warner-Lambert (and Pfizer, which acquired Warner-Lambert in 2000). ...

Post-Traumatic Stress Soars in US Troops ... Longer, Multiple Combat Tours

Post-Traumatic Stress Soars in US Troops | Tuesday 27 May 2008 | by: David Morgan, Reuters

Washington - Newly diagnosed cases of post-traumatic stress disorder among U.S. troops sent to Iraq and Afghanistan surged 46.4 percent in 2007, bringing the five-year total to nearly 40,000, according to U.S. military data released on Tuesday.
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Army officials said the larger number of PTSD diagnoses in recent years partly reflects greater awareness and tracking of the disorder by the U.S. military.

Longer, Multiple Combat Tours

"But we're also exposing more people to combat," Lt. Gen. Eric Schoomaker, the Army surgeon general, told reporters.

Experts also say PTSD symptoms increase as soldiers return to combat for multiple tours of duty. ...

deductibles and co-payments are growing so big that insured patients also have trouble paying hospitals

Ralph Nader: America's Pay-or-Die Health Care SystemMay 6, 2008 | The Story of Lisa Kelly
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Advised by her physician to go to M.D. Anderson for urgent treatment of her leukemia, Mrs. Lisa Kelly was told she had to pay $105,000 up front before being admitted. The hospital declared her limited insurance unacceptable.

Sitting in the business office with seriously advanced cancer, she asked herself – “Are they going to send me home?” “Am I going to die?”

Time out from her torment for a moment. M.D. Anderson started this upfront payment demand in 2005 because of a spike in its bad debt load.

The Wall Street Journal explains – “The bad debt is driven by a larger number of Americans who are uninsured or who don’t have enough insurance to cover costs if catastrophe strikes. Even among those with adequate insurance, deductibles and co-payments are growing so big that insured patients also have trouble paying hospitals.”

It isn’t as if non-profit hospitals like M.D. Anderson are hurting. Look at this finding in an Ohio State University study: net income per bed at non-profit hospitals tripled to $146,273 in 2005 from $50,669 in 2000. And you also may have noticed the huge pay packages awarded hospital executives.

M.D. Anderson, exempt from taxation, recipient of funds from large government programs and research grants has cash, investments and endowment totaling $1.9 billion, with net income of $310 million last year, the Journal reports.

Back to the 52 year old, Lisa Kelly. She and her husband returned with a check for $45,000. After a blood test and biopsy, the hospital oncologist urged admittance quickly. Then the hospital demanded an additional $60,000-$45,000 just for the lab tests and $15,000 for part of the cost of the treatment.

To shorten the story, she received chemotherapy for over a year. Often her appointment was “blocked” until she made another payment.

In a particularly grotesque incident, she was hooked up to a chemotherapy pump, but the nurses were not allowed to change the chemo bag until Mr. Kelly made another payment. ...

Health care workers sue state over pay-cut plan - San Jose Mercury News

Health care workers sue state over pay-cut plan - San Jose Mercury NewsBy Shaya Tayefe Mohajer | Associated Press | Article Launched: 05/06/2008 01:37:48 AM PDT

LOS ANGELES - A coalition of health care groups sued the state Monday to prevent pay cuts to doctors, dentists, pharmacists and others who treat the poor, elderly and disabled.

The lawsuit filed in Los Angeles County Superior Court on behalf of California health care providers seeks an injunction to halt 10 percent cuts to Medi-Cal and Denti-Cal reimbursements scheduled to take effect July 1. ...

Getting married for health insurance - 25% keep or change jobs for health insurance ...

Getting married for health insurance - Los Angeles Times
| By Ricardo Alonso-Zaldivar, Los Angeles Times Staff Writer | April 29, 2008

Seven percent of Americans say they or someone in their household decided to tie the knot in the last year so they could receive healthcare benefits, a poll finds.
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"It's a small number but a powerful result, because it shows how paying for healthcare is reflected not only in family budgets but in life decisions," said Drew E. Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on healthcare.
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On a broader scale, the survey found that healthcare costs outranked housing costs, rising food prices and credit card bills as a source of concern. ...
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But with employer-based health insurance averaging $12,000 for family coverage and $4,500 for individuals, the public concern with costs is understandable. Nearly a fourth of Americans said they had decided to keep or change jobs in the last year because of health insurance. ...

(28 percent) report that the recent economic downturn has caused "serious problems" paying for medical care and insurance ...

April 29, 2008 | Ouch! Health costs rise as the economy falters | Chicago Tribune
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Slightly more than 1 in 4 Americans (28 percent) report that the recent economic downturn has caused "serious problems" paying for medical care and insurance, according to a new survey by the Kaiser Family Foundation, a California policy group.

It’s the third most frequent type of problem people are encountering, behind problems paying for gas (44 percent) and getting a raise or a good paying job (29 percent).

Research shows what happens when people get caught in this kind of economic squeeze – they stop writing checks for insurance premiums or they stop taking medications (even $10 per prescription can add up) or going to the doctor (avoiding those $10 or $15 co-pays for each visit).

The new survey confirms this is happening: 29 percent of people said they or a family member have postponed getting needed care; 24 percent went without a recommended medical test or treatment; 23 percent didn’t fill a prescription; and another 19 percent cut pills in half or skipped medication doses. ...

median income flat ... but family portion of health insurance jumps 25%

April 29, 2008 | 660,000 Illinois jobs lose medical benefits | Chicago Tribune
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Here’s the latest data: the number of jobs in Illinois with medical benefits plunged by 660,000 between 2001 and 2005, according to a study released today by the Robert Wood Johnson Foundation.
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Driving the trend are soaring medical costs – a consequence of more medical services and more expensive technologies -- that make health insurance ever more expensive for workers and employers.
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While median income for Illinois families was essentially flat between 2001 and 2005, the portion that they paid for health insurance provided by employers jumped 25 percent this five-year period. ...

“We have a deficit and a war.” ... NIH loses 2 per cent of funding every year for 7 years ....

Too few funds to fight cancer in U.S. | By Robert Weiner and Patricia Berg | April 18, 2008

With more than 500,000 cancer deaths in the United States each year, the underlying buzz all around the just concluded San Diego meeting of the American Association for Cancer Research, with 17,000 scientists from throughout the nation and the world, was, “Where is the federal government?"
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Despite fear of the torturous physical slide of cancer – people's No. 1 health fear – federal funds for research into early diagnosis, treatment and cures are plummeting. The National Institutes of Health has lost 2 percent of its budget to inflation in real dollars every year for the last seven years, a 14 percent decline, points out leukemia researcher Michael Sheard of Childrens Hospital Los Angeles. Ellen Sigal, chairwoman of Friends of Cancer Research in Arlington, Va., and the chair of a forum at AACR on alternative funding mechanisms, confirmed Sheard's numbers.

When we asked Sigal why there is the drop in federal funds, she responded, “We have a deficit and a war.” If funding potential disease cures is part of the price of Iraq, it is no wonder that 70 percent of Americans oppose the war and want its cost to end in the scheme of priorities. ...
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NCI now funds fewer than 10 percent of requested research projects, down from 25 percent a decade ago. President Clinton had doubled NIH's budget – explaining many of the amazing recent breakthroughs – but now, with the budget dropping, private organizations are desperately trying to pick up the pieces so that innovative science can continue. ...
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The bar is now impossibly high for many new discoveries. At NCI, researchers “must show real leads, not discovery,” says Barker. ...

Heparin Contamination Reveals Dirty Secret: Their Pills are Made in China! ... [but] FDA warned Americans not to buy drugs from Canada

Heparin Contamination Fiasco Reveals Dirty Secret of Drug Industry: Their Pills are Made in China!Thursday, May 01, 2008 by: Mike Adams

(NaturalNews) Remember a couple of years ago how the FDA warned Americans not to buy prescription drugs from Canada because they might be "contaminated by terrorists?" I'm not making that up: That was the official announcement of an FDA spokesperson, and it was part of their fear strategy for enforcing a monopoly on U.S. consumers so that Big Pharma could continue engaging in rampant price fixing.

The implication in that warning is that drugs purchased in the United States are therefore safer, correct? What the FDA didn't tell anyone, however, is that most pharmaceuticals purchased in the United States are manufactured outside the U.S.; many from China or Puerto Rico. So they're not even made in the U.S. anyway, and drug companies are simply importing them from other countries just like a consumer might do if she drove across the border and bought her medications in Canada or Mexico.
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Enter the blood-thinning drug Heparin. This blood-thinning drug, made by Baxter International, was recently discovered by consumers to have been manufactured in China. Worse yet, the quality controls in China were so low that this FDA approved, brand-name prescription drug was apparently deliberately contaminated with an adulterated chemical that has now resulted in the death of dozens of consumers in the United States. Sound familiar? It's precisely the scenario dreamed up by the FDA to warn consumers away from pharmaceuticals purchased in Canada, Mexico or elsewhere. But guess what? It turns out that brand-name, FDA-approved prescription drugs sold at monopoly prices right here in the United States are adulterated too!

Three astonishing facts about brand-name pharmaceuticals

So far, then, there are three astonishing facts that have come out of this recent news about Heparin:

Fact #1: Most U.S. prescription drugs aren't even made in the U.S.

Fact #2: Many U.S. prescription drugs are made in China, a country widely known to have the lowest quality control standards in the world.

Fact #3: U.S. drug companies don't even run quality control checks on the drugs they import from China!

That third fact should send a chill up your spine. What it means is that U.S. drug companies contract with cheap, low-end Chinese chemical factories to manufacture their drugs at something like two cents a pill (which they can mark up to $20 a pill or more...), and then they import these Chinese-made pills and don't even test them before selling them to U.S. consumers!

If it wasn't for the fact that so many Americans have now died from this, the whole thing would be quite hilarious. Why? Because the FDA and Big Pharma are always running around touting how "safe" their products are while screaming about how dangerous herbs and supplements are. And yet nutritional supplement companies test their ingredients for contaminants with far greater frequency than drug companies. ...

Merck - Vioxx Is Accused of Deception ... moving slowly to warn of possible hazards .. dressnig up studies

Maker of Vioxx Is Accused of Deception | By David Brown | Washington Post Staff Writer | Wednesday, April 16, 2008; Page A01

Two teams of researchers with access to thousands of documents gathered for lawsuits over the painkiller Vioxx allege that Merck waged a campaign of deception to promote its drug, moving slowly to warn of possible hazards while at the same time dressing up in-house studies as the work of independent academic researchers.

The reports in today's Journal of the American Medical Association in effect accuse one of the world's biggest pharmaceutical makers of various forms of scientific fraud.

One study alleges that Merck gave the Food and Drug Administration an incomplete accounting of deaths in a clinical trial of Vioxx in people with mild dementia. Federal regulators eventually received the data, which added to growing evidence that Vioxx increased the risk of heart attacks and strokes.

Simultaneously, Merck was using what the JAMA authors call "guest authorship and ghostwriting" to make it appear that research done by its employees or contractors was the work of scientists at medical schools and universities. That presumably gave the findings more credibility when they were published, in medical journals, boosting Vioxx's profile in the crowded painkiller market.
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Since then, Merck has been named in 26,500 lawsuits by people who say the drug harmed them. Last fall, the company created a $4.85 billion fund to settle the claims while not admitting that Vioxx caused heart attacks, strokes or deaths.

The two JAMA papers -- which were based on access to company documents made public through the lawsuits -- say they provide a look at widespread practices in the pharmaceutical industry. This view was endorsed in an editorial signed by Catherine D. DeAngelis, the journal's editor, who wrote: "But make no mistake -- the manipulation of study results, authors, editors, and reviewers is not the sole purview of one company." ...

FDA Raises Estimate of Deaths Linked to Blood Thinner - ingredients from China

FDA Raises Estimate of Deaths Linked to Blood Thinner - washingtonpost.comBy Marc Kaufman | Washington Post | Staff Writer | Wednesday, April 9, 2008; Page A03

The Food and Drug Administration yesterday raised from 19 to 62 its estimate of the number of people who may have died after having allergic reactions to contaminated Chinese-produced batches of the blood thinner heparin.
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In previous statements, the agency said it did not know whether the cheaper contaminant -- which may have come from pig cartilage -- was deliberately added to the crude heparin or was the result of a production problem.

China is now the world's largest producer of the raw ingredients in heparin. The contaminated batches of the drug have increased concerns among lawmakers and the public about the globalization of drug-manufacturing in lightly regulated nations. ...

creating jobs and managing the nation's finances, Democratic presidents demonstrate success while Republican presidents show failure

David Fiderer: The Simple Arithmetic of Republican Failure - Business on The Huffington PostApril 20, 2008 | David Fiderer
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When it comes to creating jobs and managing the nation's finances, Democratic presidents demonstrate success while Republican presidents show failure.

Job Creation

Jimmy Carter, 1977-1980: 10.5 million new jobs
Bill Clinton, 1993-1996: 11.6 million new jobs
Bill Clinton, 1997-2000: 12.4 million new jobs
Total: 33.6 million jobs created over 12 years, or 2.8 million jobs per year

Ronald Reagan 1981-1984: 5.2 million new jobs
Ronald Reagan 1985-1988: 10.8 million new jobs
George H.W. Bush 1989-1992: 2.6 million new jobs
George W. Bush 2001-2004: 0.2 million fewer jobs
George W. Bush 2005-2007: 5.5 million new jobs
Total: 24 million jobs created over 19 years, or 1.3 million jobs per year

Government Spending

How much did the government spend for every dollar of revenue?
Jimmy Carter, 1977-1980: $ 1.16
Bill Clinton, 1993-1996: $1.25
Bill Clinton, 1997-2000: $1.01
Democratic Average: $1.16

Ronald Reagan 1981-1984: $1.31
Ronald Reagan 1985-1988: $1.38
George H.W. Bush 1989-1992: $1.34
George W. Bush 2001-2004: $1.27
George W. Bush 2005-2007: $1.24
Republican Average: $1.29

The difference between $1.16 and $1.29 may not seem like a lot, but the impact on the national debt is huge, especially when you consider that $1.29 applies to 19 years, and the budgets under this president are so much larger.

Increases in Government Debt

Growth In Debt Held By the Public [$US trillions]
Jimmy Carter, 1977-1980: 0.2
Bill Clinton, 1993-1996: 0.7
Bill Clinton, 1997-2000: -0.3
Democratic Total: 0.6

Ronald Reagan 1981-1984: 0.6
Ronald Reagan 1985-1988: 0.7
George H.W. Bush 1989-1992: 0.9
George W. Bush 2001-2004: 0.9
George W. Bush 2005-2007: 1.1
Republican Total: 4.3 ...

reventable diseases and lagging public health care ...Life Expectancy Slips in Poor Parts of America

Life Expectancy Slips in Poor Parts of America | April 22, 2008

New Study Shows Drop in Life Expectancy in Deep South, Parts of Midwest, Texas and Appalachia, Particularly for Women

"One out of five American women have had their health either getting worse or at best not getting better," said Dr. Majid Ezzati of the Harvard School of Public Health.

The joint Harvard School of Public Health and the University of Washington study found that 4 percent of the male population and 19 percent of the female population experienced either decline or stagnation in mortality beginning in the 1980s.

Researchers say it comes down to preventable diseases and lagging public health care. The downward trend of life expectancy was most pronounced in just a few parts of the country, including the deep South, the southern portion of the Midwest, parts of Texas and Appalachia.

In these parts of the country, doctors say they're finding alarming increases in cancer, diabetes, heart and lung disease.
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Merck Wrote Drug Studies for Doctors ... raised broad questions about the validity of much of the drug industry’s published research

Merck Wrote Drug Studies for Doctors | By STEPHANIE SAUL | Published: April 16, 2008

The drug maker Merck drafted dozens of research studies for a best-selling drug, then lined up prestigious doctors to put their names on the reports before publication, according to an article to be published Wednesday in a leading medical journal.

The article, based on documents unearthed in lawsuits over the pain drug Vioxx, provides a rare, detailed look in the industry practice of ghostwriting medical research studies that are then published in academic journals.

The lead author of Wednesday’s article, Dr. Joseph S. Ross of the Mount Sinai School of Medicine in New York, said a close look at the Merck documents raised broad questions about the validity of much of the drug industry’s published research, because the ghostwriting practice appears to be widespread.
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Combing through the documents, Dr. Ross and his colleagues unearthed internal Merck e-mail messages and documents about 96 journal publications, which included review articles and reports of clinical studies. While the Ross team said it was not necessarily raising questions about all 96 articles, it said that in many cases there was scant evidence that the recruited authors made substantive contributions.

One paper involved a study of Vioxx as a possible deterrent to Alzheimer’s progression.

The draft of the paper, dated August 2003, identified the lead writer as “External author?” But when it was published in 2005 in the journal Neuropsychopharmacology, the lead author was listed as Dr. Leon J. Thal, a well-known Alzheimer’s researcher at the University of California, San Diego. Dr. Thal was killed in an airplane crash last year.

The second author listed on the published Alzheimer’s paper, whose name had not been on the draft, was Dr. Ferris, the New York University professor. Dr. Ferris, reached by telephone Tuesday, said he had played an active role in the research and he was substantially involved in helping shape the final draft.

“It’s simply false that we didn’t contribute to the final publication,” Dr. Ferris said. ...

Trade Debt: service amounts to $2000 for each working American per year ... [Econmy smaller] This comes to about $10,000 per worker

Peter Morici: The Corrosive Consequences of the Trade Deficit March 17, 2008 | The Damage Worsens Each Month | By PETER MORICI
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In the 2007, the United States had a $106.9 surplus on trade in services and a $106.9 billion surplus on income payments. This was hardly enough to offset the massive $815.9 billion deficit on trade in goods, and net unilateral transfers to foreigners equal to $104.4 billion.
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U.S. investments abroad were $ 1,206.3 billion, while foreigners invested $1,863.7 billion in the United States. Of that latter total, only $204 billion or 11 percent was direct investment in U.S. productive assets. The remaining net capital inflows were foreign purchases of Treasury securities, corporate bonds, bank accounts, currency, and other paper assets. Essentially, Americans borrowed or sold off real estate and other assets of about $600 billion to consume about 5.3 percent more than they produced.

Foreign governments loaned Americans $412.7 billion or 3 percent of GDP. The Chinese and other governments are essentially bankrolling U.S. consumers, who in turn are mortgaging their children's income.

The cumulative effects of this borrowing are frightening. The total external debt now is about $6.5 trillion. The debt service at 5 percent interest, amounts to $2000 for each working American.
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Lost growth is cumulative. Thanks to the record trade deficits accumulated over the last 10 years, the U.S. economy is about $1.5 trillion smaller. This comes to about $10,000 per worker.
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Peter Morici is a professor at the University of Maryland School of Business and former Chief Economist at the U.S. International Trade Commission.

In the name of free markets, we made ourselves and our economy vulnerable to the worst impulses of a greedy, remorseless few.

Truthdig - Reports - Slap Down ‘Free Market’ PiratesPosted on Mar 26, 2008 | By Joe Conason

For many years, Robert Morgenthau has warned America that the nexus of capitalism and criminality poses a serious threat to our prosperity, security and growth. Now in the wake of the collapse of Bear Stearns, which pushed global markets closer to the brink, perhaps the nation will listen to the Manhattan district attorney, whose scrutinizing gaze is fixed on targets well beyond New York.

As a legendary prosecutor of international financial crime, Morgenthau has long kept a watchful eye on the buccaneering crew at Bear, the firm that now symbolizes the worst in amoral capital. Its executives were notorious for testing the limits of the law by sheltering shady stock promoters and bucket-shop brokerages, and by swelling the assets of its hedge funds with dubious mortgage-backed assets.
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But as Morgenthau insists, we cannot sustain an economy of universal bailouts. A son of FDR’s treasury secretary, he understands how the New Deal saved democratic capitalism from mindless greed 75 years ago, and he knows that the undoing of those reforms during the past 25 years has led to our present troubles. More and more of our capital (including public pension funds) has moved into offshore havens, where banking and corporate secrecy laws allow hedge fund operators to avoid regulation and taxes. This escape from transparency will continue as long as it is permitted by law and rewarded by the tax code.

All that will soon have to end, or we will find ourselves again at the edge of disaster.
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As we mark the end of a long era of conservative excess, we could do much worse than heed Morgenthau’s advice. In the name of free markets, we made ourselves and our economy vulnerable to the worst impulses of a greedy, remorseless few. He saw that on the horizon and tried to tell us. Now, perhaps we will listen.

ACE Inhibitor as Effective as More Expensive Blood Pressure Drug

ACE Inhibitor as Effective as More Expensive Blood Pressure DrugStudy focused on more than 17,000 people with coronary artery disease or diabetes | By Ed Edelson |
Posted 3/31/08

MONDAY, March 31 (HealthDay News) -- Treatment with an ACE inhibitor drug was as effective in reducing deaths, heart attacks and stroke in a high-risk group of patients as a newer and more expensive angiotensin-receptor blocker (ARB) drug, a large international study has found.

The study of more than 17,000 people with coronary artery disease or diabetes found no major differences between those treated with the widely used ACE inhibitor ramipril (Altace) and those given the ARB telmisartan (Micardis).

"This is the first study in such a population that shows ACE inhibitors are as effective as ARBs," said study leader Dr. Salim Yusuf, a professor of medicine at McMaster University, in Hamilton, Ontario, Canada. ...