Wednesday, May 09, 2007


People who know me understand that Big Pharma is not on my Christmas list. I am not the type of person that gets too worked up (these days) about the various dramas going on out there in the real world, and that I believe tend to be over-sensationalized by our media (the OTHER group that's not getting a card from me).

But when I read this NY Times article this morning, I was taken aback.

The thrust of the story is that there is a legal rebate program, where drug companies pay doctors to use their products. But that wasn't the point of the story. The point was that in so doing, they might be using excessive dosages that are proving to be unsafe.

But wait a minute here. Can we back up the truck? Why is there a legal rebate program in the first place?
Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians’ offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors’ purchase price.

Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients.

The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company’s drugs exclusively typically receive higher rebates.
Does this make any sense? So apparently, we have the same thing going on in our hospitals and with Big Pharma, that we have in fast food restaurants and soda machines around the country -- negotiated prices for exclusive use of a specific brand (e.g., Coke vs Pepsi), and increased payments with larger usage patterns.

I don't know about you, but my hope/expectation was always to get the minimum amount of drugs pumped into me, and to have the selected drug reflect the best thinking of the medical community, and not be profit motivated or corporately incentivised.

Now I'm not that naive, and I have also always had some aversion to Western medicine in general for being too prescription-happy, and not holistic enough in concept. But to imagine there is a legal program that lets rebates be paid to doctors that provide financial incentive to select one drug brand over another, and to use more rather than less medication, strikes me as something of an outrage. Am I missing something here?
Dr. Peter Eisenberg, an oncologist in Marin County, Calif., said many doctors had been induced to use more epoetin by the financial incentives and the belief that the drug was helpful.

“The deal was so good,” he said. “The indication was so clear and the downside was so small that docs just worked it into their practice easily.

“Now it’s much scarier than that,” he said. “We could really be doing harm.”
Frankly, I'm saddened that the only way this is a reportable "story" is that there are harmful effects now being detected. The fundamental practice itself is just rife with conflict of interest. So where shall I place my blame for this -- FDA or Congress? Somewhere else? Let me know what you think.

(Oh, and the picture? Yes, that is a giant spider sculpture in Roppongi Hills, Tokyo, Japan, and yes, it is carrying "eggs", and yes, that is just about what I think of when I think of Big Pharma ;-)


Pat said...

This is a devastating revelation, considering how many drugs have been pumped into my body in the doctor's office recently. Yet I'm not surprised. "Profit" is the motivation for a lot of the ills in this world. Why should we think doctors, mere mortals, would be exempt from the common temptation?

Thanks for writing this, Steven.

Steven Crisp said...

Thanks for your comment Pat; yes, you've had more first hand experience with this than just about anyone I know.

Now I'm not so outraged at the doctors -- sure, we should all strive to avoid conflicts of interest. OK, maybe I am.

But I'm really taken aback that this legal rebate program exists in the first place. Isn't that precisely why we have Gov't regulation -- to avoid profit motivation from compromising our public health systems (and elsewhere).

To me this should all be just "off the table". There seems to me to be no justification for it. If anyone can enlighten me, I'm all ears.