Tuesday, September 1, 2009

Pharm Corruption

The NY Times today uncovers further nefariousness from the psychiatric drug industry and the physicians who profit from their aims. A document from Forest Laboratories (FL) in 2004 was recently made public by a Senate subcommittee which details the gameplan FL executives had to make the anti-depressant Lexapro financially successful. Lexapro is biochemically almost indistinct from Celexa, a drug with a relatively short patent life. Lexapro costs about 90 bucks a month vs. $15/month for generic Celexa.

FL is already under investigation by federal prosecutors in Boston surrounding allegations of kickbacks given to physicians who prescribed Lexapro and Celexa to children. In this document, we find out that the corruption runs deeper. The company had budgeted nearly $35 million in 2004 to pay thousands of psychiatrists and family practice docs to give "marketing lectures" (parlance for CME conferences in Big Pharma vernacular).

Now I don't really blame Forest Laboratories. They're just another soulless giant conglomerate that exists in order to maximize the profits of its shareholders. But what about those doctors? Our profession is fighting tooth and nail to ward off unfounded accusations that we are the source of the healthcare failures in this country (see: ridiculous McAllen extrapolations, blue pills vs. red pills, ENT docs whacking out kids' tonsils rather than just giving them some allergy medicine, vascular surgeons getting five figure paychecks for chopping off diabetics' legs, etc etc). The last thing we need is the accredited bad press of physicians succumbing to financial incentives and betraying their ethical obligations....


OHN said...

The timing of your post is eerie. This afternoon my 14 year old was doing home work with a pen from my desk. It happened to be a pen from a pharm rep for AndroGel. My son asked me where I got the pen,(because it is a great pen;) and I explained to him that pharm companies used to give all sort of perks to doctors to nudge them to prescribe their drugs.

I told him that long ago, there were even lavish trips involved for the "right" specialist, though truthfully, none of my physician friends/clients ever leaned more toward one drug over another because of the reps lunches etc.

Truthfully, now that the reps cannot even leave pens, I thought the whole 'being influenced' thing was passe...guess I was wrong.

rrs said...

minor correction to your post. you quoted the amount set aside by Forest for lunches as 35 Billion. In the article it is 35 million.

Jeffrey Parks MD FACS said...

Thanks rrs...Fixed.

Guiac said...

Interestingly in overdose there do seem to be some important differences in the cardiotoxicity of the two agents. Citalopram seems to exhibit far more QTc prolongation that Escitalopram, which likely carries over into daily use as well. Multiple case reports of citalopram induced torsades exist, though the significant of a slightly increased QTc in a non-overdose population is not entirely clear.

Not that these drug companies had the noble goal of reducing the already rare TdP events associated with citalopram overdose.