According to state records, drug companies bestowed $88 million in gifts, grants, and fees to Minnesota doctors and caregivers since 2002, including $782,000 to the two University of Minnesota psychiatrists who oversaw Dan Markingson’s participation in a clinical drug trial. A lawsuit over Markingson’s suicide—which occurred during the drug trial—accused Dr. Stephen Olson and Dr. S. Charles Schulz, chairman of the University of Minnesota psychiatry department, of coercing Markingson, a 27-year-old schizophrenic, into the study.
Mary Weiss, Markingson’s mother, charged that the doctors were under pressure to recruit patients such as Markingson to increase both payments from AstraZeneca and their status by participating in the national study. Markingson was enrolled for over five months in the university’s “CAFE” study, which compared three antipsychotic drugs. Weiss sued the university, the psychiatrists, and AstraZeneca and said doctors have a conflict of interest when they are financially benefiting from studies and caring for patients in those studies at the same time. “I think they lose sight that these are people,” she said, “not their own special little guinea pigs.” Weiss’ attorneys argued that AstraZeneca’s goal with the CAFE study was to gain a marketing edge by using selective information from the study to promote Seroquel.
In court depositions, both doctors said their roles were appropriate and the money didn’t influence their decisions over Markingson—including when his mother argued that he wasn’t getting better in the study and should be withdrawn. Schulz was dismissed from the lawsuit in February; Olson recently settled for an amount a university official described as little more than court costs. Federal reviews of the death didn’t result in any penalties against the doctors or the university.
The case exposed the kind of financial payments to doctors that some health policy experts and congressional representatives say should be restricted or—at the very least—fully disclosed to the public. The case also scrutinized the ethics of drug company research funding, an element of drug industry gifting that has—until now—received less public attention and criticism than the free lunches, dinners, and trips such companies provide to doctors to promote their drugs.
Minnesota requires drug companies to report how much money they gift to each doctor; however, the system is limited and does not always make a distinction between money for a doctor’s travel expenses and money for a research trial. Distinctions are also not made for money issued in a doctor’s name, but passed directly to a research institution.
U.S. Senator Chuck Grassley, Republican-Iowa, is urging a national reporting system and held a hearing last year in which two doctors said their colleagues have become “trapped by the lures and pressures of drug company money.” “Physicians face a difficult choice,” testified Dr. Greg Rosenthal, an Ohio eye specialist. “One path is to go along. With drug company money, you can increase your income, prestige, build your practice or fund a department, research, or professorships. The middle ground is to simply look away. The hard choice is to fight back.” Olson received $220,000 from six companies since 2002, including $149,000 from AstraZeneca, according to the state records. Schulz received $562,000, including $112,000 as a researcher and consultant to AstraZeneca.
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