New York Times: Doctors in Bed with Big Pharma

A New York Times investigative report in today’s editions has further exposed a dangerous and growing concern within the medical community: physicians with significant financial ties to the pharmaceutical industry. Research has shown that these financial connections can unduly influence a range of important medical decisions made by doctors, including the crafting of general clinical practice guidelines and the use of specific prescription tendencies for their own individual patients.

The genesis of the Times’ report was a review of records kept by the state of Minnesota, which was the first state to pass a law requiring disclosure of all financial transactions between drug companies and physicians. (Vermont, Maine, West Virginia, California, and Washington, D.C., have similar statutes on the books.)

According to Gardiner Harris and Janet Roberts, authors of the report, “The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products. Patient advocacy groups and many doctors themselves have long complained that drug companies exert undue influence on doctors, but the extent of such payments has been hard to quantify.”

According to the state’s records, which they began collecting a decade ago, more than 5,500 Minnesota health-care professionals received an aggregate total of more than $57 million from the industry between 1997 and 2005. In addition to these “direct” payments, the industry also dumped $40 million into clinics and research organizations in the state. Startlingly, the Times notes that more than one out of every five of the state’s licensed physicians received money from drug companies and that more than 100 medical professionals each received more than $100,000.

“There is nothing illegal about doctors’ accepting money for marketing talks, and professional organizations have largely ignored the issue,” write Harris and Roberts. “But research shows that doctors who have close relationships with drug makers tend to prescribe more, newer, and pricier drugs whether or not they are in the best interests of patients.”

Interestingly, the sector receiving the most amount of industry money was psychiatry. However, in terms of median payment per doctor, the highest figure was for allergy and immunology specialists.

Of particular note in the Times report was the mention of payments to Dr. Allan Collins, the president of the National Kidney Foundation and director of a government-financed research center on kidney disease. The paper says that “Amgen, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins” and that in 2005 he received from them more than $25,000 in speaking and consulting fees.

Dr. Collins’ situation may be cause for alarm. The $1.9 million payment by Amgen in 2004 went to fund the Minneapolis Medical Research Foundation (MMRF), of which Dr. Collins is senior researcher. However, many experts and physicians are dubious about the effects this may have on his role as president of the National Kidney Foundation, which is instrumental in crafting guidelines for the treatment of kidney patients.

The paper quotes Dr. Daniel Coyne, a kidney specialist at Washington University, as saying, “Amgen’s funding for Dr. Collins’s MMRF is another huge financial connection to individuals at the National Kidney Foundation. The foundation’s recent pro-industry anemia guidelines and the revisions due next month have to be viewed with great skepticism.”

According to Dr. Coyne, the kidney foundation had no problem recommending and supporting the expanded use of Amgen’s drugs to treat anemia in kidney patients even though several studies pointed to an increased risk of fatality with increased usage.

In fact, the U.S. Food and Drug Administration (FDA) issued a new warning earlier this month about erythropoiesis-stimulating agents (ESAs), including darbepoetin alfa (Aranesp) and epoetin alfa (Epogen and Procrit). All three of the drugs are made by Amgen (Procrit is distributed and marketed by a Johnson & Johnson subsidiary).

“Recently completed studies describe an increased risk of death, blood clots, strokes, and heart attacks in patients with chronic kidney failure when ESAs were given at higher than recommended doses,” the FDA said at the time. Last November, two studies in the New England Journal of Medicine cited the overuse of anemia drugs in the treatment of kidney patients. Scientists have found that anemic kidney patients are susceptible to heart problems or death when aggressively treated with these drugs.

However, the FDA has maintained its approval of these drugs for treating anemia in patients with chronic kidney failure. Combined domestic sales of the three drugs reached approximately $10 billion last year alone.

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