Tag Archives: pharmaceutical advertising

In China, pharma hires thousands of doctors to sell drugs

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Bloomberg News reports that pharmaceutical companies in China are poaching thousands of trained physicians, many of them recent grads, to become sales representatives in the massive push to take advantage of China’s exploding drug market. The companies can offer salaries that are two to three times those the physicians would earn otherwise, and Bloomberg’s sources estimate that as many as 14,000 more Chinese doctors will become marketers in the coming five years.

The hiring boom is hampering China’s three-year, $131 billion effort to stem a massive shortage of doctors in rural and peripheral areas and provide basic health insurance to at least 90 percent of the population. Paradoxically, it’s that same push, and the demand for drugs that it has created, that’s providing the incentive for big pharma’s Chinese campaigns. One pharmaceutical representative told Bloomberg that China is expected to overtake the United States as his company’s largest market within the decade, and companies have been budgeting accordingly.

Foreign drugmakers like Sanofi and their local affiliates will hire at least 35,000 sales staff by the end of 2014, Aon Hewitt China estimates, based on a survey of 24 companies. The same employers had 33,000 on staff at the end of 2010. About 30 to 40 percent of people recruited for sales jobs will have a medical degree, said Jarroad Zhang, a consulting director with Aon Hewitt in Shanghai.

Ex-pharma rep talks about pressure, tactics to sell

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

A story reported and produced by Gerri Shaftel at KTTV-Los Angeles (and presented by Christine Devine) gives viewers a look into the world of pharmaceutical representatives, a world of former beauty queens and long lists of off-label uses and side effects.

It’s based around a former pharmaceutical rep and cheerleader named Jennifer Shaw, and opens with the standard portrait of reps as former models with short skirts and even shorter scientific résumés, but also goes into how reps get the information about doctors’ prescribing habits.

Confessions Of A Pharmaceutical Rep: MyFoxLA.com

Over the course of the story, viewers learn how pharmaceutical companies track every prescription a doctor writes, press doctors to raise specific prescription numbers, and rank physicians on a scale of 1 to 100, then reward them accordingly with speaking engagements and the like. Even Jennifer, the rep turned tell-all author, has a compelling story about how she left the industry when her company pushed her to sell a reformulated drug despite the alarming side effects that were cropping up along her sales route.

It may come in a fancy package, but it’s wholesome stuff.

Australian journal says no to pharma ads

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Emergency Medicine Australasia, an Australia-based medical journal, has declared that it will no longer accept paid advertisements from pharmaceutical companies.

ozImage by acediscovery via Flickr

The journal’s editors announced their decision in an editorial, and we learned about it from Pharmalot’s Ed Silverman. In the editorial, the editors say they’re drawing a line in the sand and all but dare other publications to join them. Here’s Silverman with the how-and-why:

The ban followed discussions with other emergency medicine specialists, who worried aloud that advertised drugs were supported by evidence that was neither “of reasonable quality, nor independent.” There were cases of “dubious and unethical” research practices by pharma, including ghostwriting. And academics may face pressure to withhold negative research, which could “inflate views of the efficacy” of heavily promoted drugs.

For more, refer to this AAP story. In this case, the acronym refers to the Australian Associated Press, not the physician group. In Australia, medical journals are one of the only places where pharmaceutical advertising is legal.

BMJ exposes UK drugmaker’s astroturf attempt

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Pharmalot blogger Ed Silverman reports that, had they not been exposed by BMJ, the UK pharmaceutical company Norgine probably would have gotten away with quietly organizing doctors and patient groups to submit a letter to The Times protesting a government plan to require substituting generic drugs for brand-name ones where applicable. Norgine’s name appeared nowhere on the letter, which was written by a PR firm they’d hired. Furthermore, several patient groups which signed the letter also received funding from pharmaceutical companies.

In the end though, Silverman writes, Norgine came away from the incident pretty well, considering the outcry over their stunt.

Norgine may have had the last laugh, however. Apart from being lambasted publicly for being a secretive and manipulative company, the drugmaker issued a celebratory press release earlier this month trumpeting the decision by the government to scrap the proposed automatic generic substitution plan.

Related

For more European health news, see AHCJ’s Covering Europe initiative.

ProPublica investigates pharma payments to doctors

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

ProPublica’s massive investigation into the hefty fees pharmaceutical companies have paid doctors with dubious track records stamps an exclamation point on what has been a banner year for high-profile assaults on pharma-paid physician/marketers.

Books like Daniel Carlat’s Unhinged and Carl Elliot’s White Coat, Black Hat, and the promotional tours that came with them, led the charge and raised awareness of an issue that reporters Charles Ornstein (you may know him as AHCJ’s president), Tracy Weber and Dan Nguyen have driven home with tens of thousands of carefully researched data points and one flagship story.

The ProPublica database is built upon the voluntary disclosures of seven drug manufacturers (Eli Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer) which represent about 36 percent of the market. Reform law requires the other manufacturers to make similar disclosures by 2013. The package uncovered a bucket of horror stories — that mug shot of high-earner Dr. Donald Ray Taylor next to the paragraph describing why he was disciplined is the very definition of “disturbing” — yet also distinguished itself by giving doctors who rep pharma the opportunity to explain both their work and their motivation.

In its examination of pharma payments, the investigation goes beyond a simple database match with disciplinary records. Some physician/marketers had clearly earned their stripes and displayed impressive resumes and relevant research records, the reporters found, but others had disciplinary records, lacked any board certification or publications or appeared to have been manufactured by the drug-makers themselves.

“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.

“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”

If you can’t get enough of the investigation, see the work by ProPublica’s partners at The Boston Globe, Consumer Reports, the Chicago Tribune, Nightly Business Report and NPR.

Finally, don’t miss the comments on the article, headlined by a lengthy response from the leading pharmaceutical industry group.

Rise, fall of two St. Louis pharma companies

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Midwest Health Journalism Program fellow Jim Doyle, a reporter at the St. Louis Post-Dispatch, tells the story of Forest Pharmaceuticals (a subsidiary of Forest Laboratories), which has been accused by federal regulators of sketchy marketing practices, primarily involving its antidepressants Celexa and Lexapro and unapproved pediatric use. The company has pleaded guilty to federal criminal charges and agreed to pay $300 million in criminal and civil penalties, Doyle reports.

Armed with the breaking news, Dolye then goes deeper, finds the company’s local roots, charts its rise and tries to pinpoint where it went wrong. It’s the same formula he used for his story on another imploding local drug-maker, KV Pharmaceuticals, earlier this year.

Everyone reacts to Avandia roller coaster

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

First, the background: Avandia, also known as rosiglitazone, is an anti-diabetes drug that helps patients control their blood sugar. It made billions of dollars for GlaxoSmithKline until it became associated with higher risks for cardiovascular issues. On Sept. 23, the FDA and European regulators issued their verdicts on the drug. In America, it will still be available, though with much stronger restrictions than before. In the European Union, regulators are looking to stop sales entirely and steer patients toward alternatives.

If you’re looking for the official lines and basic news, start with CardioBrief, where Larry Husten recapped a few of the highlights and then provided each agency’s press release, as well as the official take of Avandia maker GlaxoSmithKline.

Then, it’s time for the reactions. On the NPR health blog, Richard Knox examined the dueling story lines that have emerged since yesterday’s announcements. This larger framework makes all subsequent reactions a little easier to contextualize.

Speaking of other reactions, The Hill‘s health blogger, Julian Pecquet, rounded up the thoughts of some Washington heavy hitters involved in the Avandia debate, from the omnipresent Sen. Max Baucus to the consumer group Public Citizen. Another key player, cardiologist and Avandia critic Steven Nissen, spoke to The Wall Street Journal‘s Alicia Mundy.

In terms of the big regulatory picture, Avandia is the 30th drug which has been restricted under the FDA’s risk evaluation and mitigation strategy provisions since they began in 2007. Merril Goozner says that the FDA has created a new class of drugs. “They are not exactly safe, but not so dangerous that we would deny them to physicians or patients who really want to have them,” he wrote. Five years ago, he said, Avandia would have been pulled from the market. Now, it just gets restricted. It remains to be see how effective those restrictions really are.

Finally, Pharmalot’s Ed Silverman brings us the thoughts of cardiologist and Yale professor Harlan Krumholz, who you might remember from his recent star turn in Forbes. His take emphasized a principle well-known to health journalists: Marketing matters, and often it matters even more than regulation does.

“The company has announced it will no longer promote the drug,” Krumholz wrote, “and the practical result in Europe and the US may be a lot more similar than the decisions at first appear. Usage will stop in Europe and new use should virtually stop here.”

That said, Krumholz raises some interesting questions, any one of which could form the basis of a follow-up story or two. I’ll paraphrase:

  • A long series of fortunate coincidences lined up to produce the evidence that led to Avandia’s delayed near-demise, which begs the question: Why are we relying on luck when it comes to spotting danger in major pharmaceutical products?
  • “Why does the FDA believe that the barriers to prescription in new users should be stronger than those for current users? There are no studies that indicate that the excess risk dissipates over time.”
  • Will the FDA really be able to effectively implement the regulations and guide physician/patient behavior, especially when it comes to a blockbuster such as Avandia?
  • Have we done anything to prevent the next Avandia? How do we even go about doing that?

Update: The European Association for the Study of Diabetes weighs in

Ethics professor takes on clinical trials, marketing

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for Mother Jones, University of Minnesota medical ethics professor Carl Elliott digs into the Dan Markingson story first covered by St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto. Elliott works at the same institution as the physicians who who administered a Seroquel trial that the 26-year-old was enrolled in when he committed suicide.

Given his teaching field and institution, it’s not surprising that Elliot couldn’t stay away from the Markingson story.

…the more I examined the medical and court records, the more I became convinced that the problem was worse than the Pioneer Press had reported. The danger lies not just in the particular circumstances that led to Dan’s death, but in a system of clinical research that has been thoroughly co-opted by market forces, so that many studies have become little more than covert instruments for promoting drugs. The study in which Dan died starkly illustrates the hazards of market-driven research and the inadequacy of our current oversight system to detect them.

Elliot goes after the idea that the new wave of anti-psychotics was any safer than its predecessors, then explains the clinical trial manipulations he says were used to claim they were.

From there, Elliot takes on the use of clinical trials for marketing purposes. Clinical trials can be dangerous, which is theoretically acceptable if they have the potential to advance medical care. But what if patients are just being exposed to those dangers in an effort to sell more drugs?

Pharma starts disclosing sample numbers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The health reform law will require drug makers to disclose the amounts of free samples they distribute, a requirement which promises to shed light on a practice whose scope could previously only be estimated. The Wall Street Journal‘s Jared Favole has found some preliminary disclosures; the resulting numbers can be found in the graph below. The numbers should only be treated as the roughest of estimates, as some companies disclosed the market value of the drugs while others gave wholesale numbers. Likewise, some measured the number of samples based on the number of doses, while others counted larger units. samples1 Samples, Favole writes, are a key weapon in pharma’s war against generics as they can be a gateway to brand-name medicines.

A 2008 study in the Southern Medical Journal found that doctors in a clinic were more than three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from that clinic. “Free drug samples may lead to higher costs for uninsured patients by encouraging physicians to write prescriptions for brand-name drugs only,” the study said.

A PDF of that study can be found here.

Feds take aim at off-label marketing

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Wall Street Journal‘s Jeanne Whalen writes that a recent string of charges against drug companies, including heavyweights like Pfizer, Eli Lilly, AstraZeneca, Johnson & Johnson and Novartis, shows that a decade of aggressive prosecution hasn’t deterred them from some shady marketing practices. [Article require subscriber access]

Whalen says the promotion of off-label prescriptions is still at the core of the most common offenses, and that, according to says Patrick Burns, director of communications at Taxpayers Against Fraud, problems are most likely to crop up “when drug companies are promoting therapies that are similar to others on the market.”

pills
Photo by somegeekintn via Flickr.

Whalen reports that the Justice Department, which often relies on corporate whistleblowers to spark investigations in this arena, has made such cases a priority.

“Combating health care fraud is a top priority of the Department of Justice,” said Tony West, Assistant Attorney General of the Justice Department’s Civil Division

Drug companies have apparently taken notice. GlaxoSmithKline recently started “capping its annual payments to U.S. doctors at $150,000 and publishing the figures” while AstraZeneca’s CEO said the crackdown had made pharmaceutical companies “more sensitive than we’ve ever been” when it comes to preventing illegal drug promotion. Whalen writes that these steps may not be enough.

But Shelley Slade, a former Justice Department lawyer who now represents corporate whistleblowers through the firm Vogel, Slade & Goldstein LLP, in Washington, D.C., said large criminal monetary penalties and civil settlements don’t appear to deter companies sufficiently. “It’s not going to stop until the government puts some of these executives in jail,” she said. “Many of these companies view the fines as a small fraction of what they have gained through illegal schemes, and just a cost of doing business.”