Is Your Doctor Getting Cash Payouts from Big Pharma? (plus More Findings from the Drug Biz)
There’s been a lot of news from the Pharma realm these last few weeks. As you all know, I make a point of passing this kind of thing along…. Given the massive role pharmaceutical drugs play in our society’s conventional health care, I like to keep on top of the developments. Speaking of “massive,” first there’s news from the National Center for Health Statistics, which released a report measuring trends in prescription drug use and cost in the last decade. Between 1999 and 2008, prescription drug use rose in all age categories, as did the number of people taking multiple prescriptions. Approximately 88% of people over the age of 60 take one or more prescription medications on a regular basis. A whopping 66% use five or more prescriptions. Not surprisingly, cholesterol-lowering medications topped the list for this age group. In those 20-59, the most popular prescription was antidepressants. In children, 22% take a prescription drug, most commonly asthma medication. In the teenage category, the number jumps to 30%, with ADD/ADHD related meds first on the list. Not surprisingly, what we shelled out for Pharma products soared as well. Already taking inflation into account, Americans in 2008 spent more than twice ($234 billion) what they did in 1999 ($106.4 billion). Against this backdrop, we also learned that two popular prescription drugs were shown to actually cause the very problems they prescribed to prevent. Telling stories and statistics, I’d say. What’s more sobering, however, are a number of recent publications that illuminate the cultural and financial underbelly of the pharmaceutical industry as a whole. I think you’ll find it thought-provoking.
For those of you who have joined us recently, let me mention a few things first. I’m not against medication. In fact, I wholeheartedly support it when it genuinely and distinctively serves the critical health of an individual. I love living Primally, but I’m firmly planted in the modern age and appreciate its myriad of benefits. A number of us (and our loved ones), I know, wouldn’t be here without the help of medication at some point. When I refer to Big Pharma, I’m not referring to that worthy aim. I’m addressing instead the machinery that’s been built up around what should be a straightforward, transparent medical enterprise – a machinery that too often exploits and subverts the essential therapeutic purpose essential medication should serve. I’ve written before about underreported issues like manipulated statistics, off-label marketing, questionable research standards, and the FDA’s minimal reach. It’s not about mass conspiracy. These are simply the facts. I, for one, believe knowledge is power. You as a reader can choose what to do with it.
That’s why I appreciated a recent article in The Chronicle of Higher Education that a friend in the academe sent me a few weeks ago. Author Carl Elliott takes on “The Secret Lives of Big Pharma’s ‘Thought Leaders’” by revealing the staffing strategies pharmaceutical companies employ. The article focuses especially on the “key opinion leaders” (KOL’s), who Elliott describes as “a combination of celebrity spokesperson, neighborhood gossip and the popular kid in high school.” Within their academic circles, Elliott says, these big name researchers and practitioners have the professional clout to create inroads for the Pharma companies with their medical colleagues. Although the Pharma companies paint the KOLs role as “education,” their more strategic job is infiltration.
Reeling in these types of figureheads promises a unique and efficient means for reaching their medical field colleagues. All in all, pharmaceutical companies spend approximately one-third of their marketing budgets on this KOL program. The industry, Elliott explains, lures big name physicians with big money (sometimes much more than they earn from their medical practice or research) and with the enhanced sense of status that Pharma offers (complete with badges – no, seriously). The KOLs conduct industry sponsored studies, but their primary purpose is to create buzz within the medical field through their personal contacts and their mostly industry-written presentations. (Stray from the slides, dear doctor, and you’ll likely end up de-badged at the close of the conference.) KOLs also play a unique role in Pharma’s skirting of off-label marketing laws. Pharmaceutical companies manipulate the employment status of KOL physicians to allow KOL representatives the legal loophole of promoting off-label uses of the company’s drugs.
There has been public push back, however. As Elliott’s article notes, last year’s health care reform legislation included the “Physician Payments Sunshine Act,” a provision that legally compels pharmaceutical and medical device companies to regularly divulge to the Dept. of Health and Human Services all of their financial dealings with physicians and hospitals. It’s a start, but a more efficient means of controlling industry’s reach would be for universities and teaching hospitals to crack down on these Pharma ties. That move, Elliott explains, is unlikely given the number of academic physicians and administrators embroiled in corporate associations. Enlightening examples? As Elliott explains, University of Michigan’s president sits on the board of Johnson & Johnson. The president of Brown was a board member of Pfizer. So much for academic neutrality.
Other reports out this week, however, add another more disturbing layer to this picture. A public interest group, ProPublica, in partnership with Consumer Reports and National Public Radio have compiled and released a series of reports assessing the pharmaceutical companies’ payouts to doctors and the public’s discomfort with their physicians’ industry ties.
Although the industry’s financial dealings are still private material, lawsuits aimed at Pharma’s marketing have required many of the larger companies to disclose much of their payout information. Although the details are scattered in public websites and documents, ProPublica compiled the information from these various resources. The result? A list of 17,000 doctors and $257 million dollars in payout. Additionally, the organization found that hundreds of physicians on the Pharma payroll lacked board certifications in their claimed fields or had been sanctioned by state medical boards for unprofessional (and in some cases heinous) behavior.
ProPublica’s site allows you to view top Pharma payouts and even check whether your doctor is on the payroll of one of the listed drug companies. The researchers acknowledge that their report represents only a partial tabulation. When the Sunshine Act goes into effect, we’ll get to see the full financial picture. In the words of a Coen brothers thought leader, “New s— has come to light.” Indeed.
Thoughts? What do you make of the emerging depictions and statistics? I’ll look forward to reading your comments. Thanks for reading, everybody. Have a great day.
Grab The Primal Blueprint Cookbook Today and Receive Free S&H and a Free Primal Blueprint Poster
Posted By: Mark Sisson
don’t get me started! We are constantly bombarded by ads which take longer to state their side-effects than their benefits. I intend to stay pharma-free indefinately.
Any push to get drug ads off TV. That would be a good start.
Or even better yet, a push to get rid of T.V.s!! I don’t miss my T.V. and I know I am not missing anything worth watching. I recommend!
In addition to the horror of the blog post above, the whole idea of marketing drugs directly to would-be patients mortifies me. Nobody should be self-diagnosing (either with an illness, or deciding on a drug) and then instructed to “ask your doctor if Medication X is right for you!”
I mean, this isn’t like deciding to take more Vitamin D…
You’re absolutely right.
Advertising medication makes people diagnose themselves and run off to their doctor to literally ask for that medication.
All I can say is wow…those slick bastiches.
I can honestly say there is way too much cash exchanged. Can we do anything, probably not. I recently QUIT a high paying pharma job to teach primal living and weightloss. Ethically, I could no longer be a part of something that treats everyone and everything with a pill. FDA regulates both food and drug companies, coincidence?? I think not. The fatter, more unhealthy they make us, the more drugs we go on, the more drugs the more drugs! CYCLE that needs to be broken!
How did you go about doing this? I would love to be able to teach the Primal lifestyle for a living.
Wish I could get my parents off pharm. drugs… they’d most likely be more healthy without them if their lifestyle choices were more primal.
Big Pharma, while creating meds that can save lives, has a dark side too, as you illustrated. Another dark side to that industry is that they make no money off of healthy people. Their next goal is for otherwise healthy people to take one drug or another.
Isuspect Big Pharma is in bed with the Junk Food producers to make people sick which causing them to take meds.
my doctor is listed on the website as being payed off by pharm companies.
yikes.
People (including me) need to do more research on their doctors and the medical information they’re getting.
This is one of the risky side-effects of a free market. People get conned into using certain medication by doctors on payroll. We just need to learn to do our homework before taking advice from any seemingly credible professional.
Don’t be so hasty to blame “free markets”.
Politicians are every bit as corruptible as anyone in the private sector. Greed and corruption are omnipresent, even where there are no markets at all!
But you are right: We do need to learn to do our homework before blindly following someone else’s advice.
Free markets are what have allowed the knowledge of the PB to spread and propagate as much as it has. If you’re anti-free market you’ve got more than one screw loose. Greed is good; it is AVARICE that is bad.
Perhaps you think Mark somehow does not deserve the wealth he generates for himself from his knowledge and production. Perhaps you think jackasses like Emperor Dumbo can do better by everyone, spreading Mark’s knowledge in a more efficient, more efficacious way.
Perhaps you are an idiot, too.
Puh-lease — get off of Eduard’s back and lose the “free-market good, government bad” oversimplification.
Both government and business are corruptible, as are science and religion. All human institutions are. It’s when we fail to be critical of our institutions that they become corrupted.
—- Gos
Wow, that was dramatic. Charles is just making a point that there’s more to it than market forces, and somehow it turns into “anti-free market” and “perhaps you think Mark” and “perhaps you are an idiot”?
Why do you think most Dr’s have no idea how interrelated diet is to health? Big Pharma starts indoctrinating IN med school. Very sad but true. Drugs do have their place, but not to the extent that the human population is drugged up now. I wish my parents understood this too—as they are on ALL the pills that people their age are on—cholesterol lowering, blood pressure, blood thinners, antibiotics, thyroid—yikes!
I remember seeing an interview with a gerontologist who said when he gets a new patient, invariably he has to unwind all the drugs they are taking that are causing all sorts of side effects.
The elderly patient in the piece was feeling much better just taking the essential drugs for his condition. Lucky patient that found a doc that knew what he was doing.
The is a big trifecta out there working against us. The processed food industry, pharma and the government lobbyists.
Poor nutrition makes you reliant on medication and the politicians are lining their pockets with lobbyist $$$$.
It just goes to show you have to take care of yourself.
My biggest fear is that the lobby gets strong enough to start affecting our ability to truly practice a minimalist\natural\holistic lifestyle.
I’m with you. I try to treat health issues for myself and family holistically and it seems big pharma and FDA are trying their best to prevent it.
You are correct. I just had a friend’s older brother become diagnosed with melanoma. He went to a holistic doctor who diagnosed and cured him. The powers that be have been actively trying to supress and destroy holistic practicing physicians. All over the country. Your biggest fear is in full swing my friend!
I checked all of my doctors and none appeared on the site. I would’ve been surprised if they were, as I’ve nearly always been recommended generics as a first line of attack.
And don’t even talk about the money big pharma gives to politicians. They want to keep the FDA in check to do their bidding.
Love the Big Lebowski reference at the end.
Oh snap!!
I don’t have a doctor to check because I haven’t seen one in over a decade. This issue is just another in a long list of reasons why I will continue to avoid doctors and pharmaceuticals as long as possible. I too, am glad they exist, but I just don’t turn to either one of them until I try other reasonable options, and I count my blessings that, so far that has worked for me. I know it isn’t an option for many other people with serious conditions.
I’m not defending the physicians or the pharmaceutical companies at all, but as patients we are not blameless. Have a common cold, run to the doctors office and demand antibiotics, feeling blue, demand antidepressants, sore back, we want muscle relaxers. Your kid acts up in class, his teacher demands Ritalin.
Popping a pill is easier and faster than letting nature take it’s course.
And FYI a doctor doesn’t have to be board certified in a specialty to practice as a specialist….
Right on the money with that.
Not many people realize that most medication are nothing more than symptom relievers.
There is usually no treatment or investigation to underlying causes.
No continuing profits in a cure.
this is true. i am doctor. patients ask and expect an rx……. i counsel all day long when antibiotics are appropriate and not. the list goes on.
your last statement is not entirely true. a general practitioner may be able to practice without being board certified, but specialists ARE board certified…… otherwise we can’t get malpractice insurance. now, it can take years to become board certified. after school, then residency, it might still take up to 5-6 years before you are board certified and not just “board eligible”. just f.y.i…….
I work in the physician credentialing field, you’d be surprised at what some docs will try to get by with.
Conventional doctors are taught to trust modern medicine in med school. I don’t think they have much exposure to a holistic approach.
It’s sad but that may be a function of pharma contributions to the education sector.
In light of full disclosure, I am a health care provider.
I make no money from any drug company.
It is important that you check to see if your provider is being paid by a drug company to promote a drug, but that may not have anything to do with what they are prescribing for your illness. If you have a strep throat and your get a prescription for penicillin, it doesn’t really matter if your physician gets paid to lecture on high blood pressure medication.
Off-label use of medication is widespread and is often beneficial to the patient. There are a number of medications that we use in the Emergency Room to treat a migraine, for example. Many of these are off-label, taking advantage of knowledge of the pharmacology of the medication and the pathophysiology of vascular headaches such as migraines.
Many of the discussions I have with patients center more on their desires for the latest medication they have seen promoted on television, and my impression of their application for the person’s illness.
I like the idea of a Primal lifestyle and am a devote’ of Mark. I also assume that he is making money from the book sales and products he offers. Does this mean his products are not reliable or trustworthy? Not necessarily, it is just information I keep in mind.
It is important that we all do research of how we take care of ourselves and establish an open communication with our providers.
It would have been impossible to write a small article that would satisfy every faction of the medical establishment. Mark’s references to “off label” prescribing has more to do with pharmaceutical companies working to find more uses and more customers, than with doctors and emergency room staff looking for solutions to important medical problems. Our child’s doctor prescribed a drug for an “off-label” use until we drew line because the drug was causing tachycardia and GERD. The only reason she agreed to withdraw the prescription was because it was in “off-label” use. The problems with pharmaceuticals and prescriptions are made more complicated when there is obvious corruption and collusion by docs and salespeople.
Since Big Pharma and all the corruption associated with it was created by the FDA, why would you want to give it more power?
Agreed!
Right, because there was totally nothing wrong with all the medications that were created and sold and poisoning people _before_ the FDA was created to at least try to address that… yup.
when I had my herniated disc…my back doctor walked around with his prescription pad ready to give as many pain killer as I needed. When I managed to close the hernia with yoga back bending poses ( a long and sometimes painful therapy) he was quite amazed…and asked me if In needed any more pain killers..!!
Could you elaborate on how you were able to reverse your herniate disk, Richard? Are there particular yoga poses or a particular style of yoga that worked for you? How often did you do it? Any details would be appreciated. Thank you!
Just Google yoga poses for back pain. Thats what I did. When I started, and was in tender state, I did it once a day, in the morning, As I improved I did it twice a day. I have been practicing for a long time. I do not know if you practice, but simple back bends done gently on the floor (locust pose) and knee to waist leg raise were the primary poses.
A few words about generics: I work in the chemistry industry, specifically chromatography. Generics are not to be trusted. Most are produced out of the country in China and India. The factories are not using GMP’s and during the rare inspection by the FDA (a domestic agency), they receive a monetary fine for violations, they are not forced to stop production. That is why a lifestyle like the Primal Blueprint is so important! I’ve heard Robb Wolf talk about how much he thinks Boomers love medication and how hard it is to get them to try revising their nutrition. He’s right! That’s my parents. And the abuse of prescription meds like Xanax and Vicodin among my age set (late 30′s) is incredibly alarming.
agreed………sometimes, i think generics are fine and are equivalent “enough.” and, i certainly understand $$ being an issue, but there are instances where generics are not necessarily the same. there can be as much as 25% leeway in drug concentration and impurities between some name brands and generics.
She’s got to feed the monkey.
It’s “Coen” Mark
Well, like what everyone else has said, ditto. I haven’t seen a doctor since getting diagnosed with this strange Metabolic Syndrome X, No explanation why, how, how to fix or how to anything. simply take this fiber pill for the rest of my life and all will be better. never took it and never went back.
It seems to me that we in the UK are headed the same way although we are not exposed to nearly as much direct advertising of drugs as you are in the US.
It seems to be the norm to treat raised blood pressure and abnormal cholesterol readings with drugs as the first line of attack.
Only today I was talking to a hair products rep who stopped by the salon whilst I was having my hair cut … he was no more than 45 and had already had a heart attack and was overweight, one glance at his reflection in the mirror I was facing and my head said ‘carb head’ … I had the chance to talk about Primal and this website, he was really interested, seemed like no one had suggested his diet and lifestyle might be at issue.
Very sad.
I recently moved back to the U.S. after 4 years in the UK and one of my first (of many) culture shock moments was the number of pharmaceuticals advertised on TV. I was probably desensitized to it having grown up with it. Bill Bryson made a similar observation when he returned to the U.S. after 20 years in the UK (he has since returned to Yorkshire).
I was prescribed blood pressure meds by my Scottish GP and took them with little noticeable impact. Two years ago I discovered Mark’s site, among others, and after only a month of pure primal my blood pressure was way down and within the conventional normal range.
Sadly, I have found in both America and Britain people are deeply skeptical of my dietary approach and success, and simply have an expectation of drug treatments as they age.
Yes! I came back in 2005 after living in the UK, too – and I’ve been talking about this for the past five years, in which time it’s gotten worse.
I remember getting an ear infection while living in England (a recurring problem for me every years), and my shock when the GP suggested I use olive oil drips at night in lieu of writing me a prescription. The NHS certainly has its problems, but it was still far, far better than any treatment I have gotten in the US, nevermind the cost difference! I pay the same income tax rate here as I was paying over there. I would trade my public university state government health insurance for the NHS *IN A HEARTBEAT*.
very worrying indeed. what can u do? well first off do your research to see if your doc is on one of these lists, though as u say these lists are very incomplete.
next, if your doc suggests u go on meds, ask him straight up whether he has any links to any drug companies, espcially any companies associated with the drug he recommends (including parent companies, suibsidiaries, etc, and not just the sort of links mentioned in this article, but does he own shares, has he done any paid ‘consulting’ work for them etc).
dont let him fob u off, ask him for a straight yes or no. if he is evasive it will be obvious he has something to hide. so unless he gives u a straight “no” i would be very skeptical of his suggestion and get a second opinion (and if he does say no then u have to hope he isnt telling u a bare-faced lie).
dont be afraid of this seeming rude, or being none of your business. it absolutely IS your business – this is your health we’re talking about.
of course this wont solve the problem kb mentioned about doctors being indoctrinated by pharma in med school, but at least its a start.
i cant think of any other walk of life where u can go to what is supposedly an independent expert for advice, and yet not have any means of knowing whether he was effectively a paid employee of one of the companies whose products such an expert might recommend u to buy. absolutely outrageous!
You are right sir.
Yah…. then we have the big name people like Dr. Oz hustlin the swine flu vaccination on us, and he is invested in the makers of the swine flu…
Disturbing… but not surprising
Funny, I brought up this topic with my wife, who is not as..”fanatic” about these issues as I am. She simply responded “when did you ever think a big corporation has your best interest in mind”! Simply put.
I’ve known this for a long time. I always assumed that if a medical provider was pushing a name-brand med there was something in it for him/her. I’m over 65 and still take no meds whatsoever. Heck, it’s even hard for me to remember to take my vitamins!
Is this just the U.S. or do other countries with where they have more centralize medicine have this problem too. I would think not as much as medication cost are shared by the public. Just a thought.
Thanks for the great post Mark. It is an important topic. The power of Big Pharma, Big Agra and the junk food companies is really scaring.
Maybe in the USA things are extreme but in Germany we are heading in the same direction.
I will print out this post for my family doctor who has conventional training but is very interested in what she learns from me. I will give her Robb Wolf’s book as a christmas gift.
I mean there are a lot of honest, hard working MDs who just have no clue what is going on outside the Pharma-dominated conventional healthcare industry (actually sick-care-industry).
I work in a pharmacy as a technician and have seen the disparity between the whole sale price of medication and the retail price. For example, the pharmacy pays around $0.01 for a bottle of 1,000 aspirin. The retail price is $11.99 no matter if you are prescribed 1 pill or 90 pills. That is just the tip of the iceberg. Big Pharma is definietly a problem, but don’t forget the retail pharmacies who bilk the money out of their customers. That is the main reason why pharmacists make $115,000 per year at the major chains.
Also, don’t believe the hype about Big Pharma using their profits for additional research. They only apply about 1/6th of their earnings to research.
again….totally agree. the pharmacies are a big part of big pharma….
You need to do some research…this is untrue. They use a great deal of their money on research. I agree with you on retail pharmacies.
Why is no one mentioning insurance companies in all this mess. If you want to see who controls the drugs in the world today it is them. It is scary.
I do agree a lot of $$ is spent on research. Perhaps if reps weren’t paid 100,000/yr and provide offices with elaborate lunches and KOLs expensive dinners there would be even more $$ for research. I see about 14 overweight pts a day on rx’s that could have been avoided if the diet and lifestyle had been under control. However, yes, insurance would rather pay for 3 drugs than for 100/mth for prevention which is hopefully temporary. I spent 12 years telling docs additional drugs to use to basically TREAT side effects of other drugs. really??? 150 bill $$/yr spend on obesity related diseases. Lets address the uderlying problem. Fortunately, I teach primal living to my weightloss pts and they love it. Not a diet, a lifestyle!