Systemic Failure: "Doctors Prescribing Meds Based On Drug Company Kickbacks" Edition

Tyler Durden's picture

Submitted by Mike Krieger via Liberty Blitzkrieg blog,

When the drug maker Genentech introduced a major product in 2006, it found itself in an awkward position: persuading eye doctors to start using its new more expensive drug instead of a popular cheaper version that the company already sold.

 

Ophthalmologists had been enthusiastically using the company’s cancer drug Avastin, which cost about $50 a dose, to treat a common eye disease in the elderly, wet macular degeneration. Then Genentech introduced Lucentis, a nearly equivalent drug that cost $2,000 a dose and was approved specifically to treat the disease.

 

Now, a new federal database shows that many of the doctors who were the top billers for Lucentis were also among the highest-paid consultants for Genentech, earning thousands of dollars to help promote the drug. The data raises questions about whether financial relationships between doctors and drug companies influence treatment decisions, even though physicians maintain they cannot be swayed.

 

Half of the 20 doctors who received the most money from Genentech to promote Lucentis in 2013 were among the highest users of the drug in 2012, billing for higher amounts of Lucentis than 75 percent of their peers. The figures were compiled from two federal databases that covered different periods, and it is not known whether or how much Genentech paid the doctors in 2012.

 

– From the New York Times article: Paid to Promote Eye Drug, and Prescribing It Widely

The topic at the heart of the following post is not a commonly discussed one here at Liberty Blitzkrieg. It has to do with big corporate money influencing and corrupting the medical profession. The reason I chose to highlight this particular article, is because it perfectly puts into focus two of the most important macro cancers plaguing these United States today: A complete loss of ethics, and the dangers of over-centralization/corporatization.

Let’s start with ethics. If there’s one thing I want readers to take away from reading this site, it’s an understanding that the banker bailout following the 2008 financial crisis was one of the most destructive events to happen within the U.S. during my entire lifetime. The other was the government and public’s reaction to the attacks of 9/11. The terrorist attacks turned most of the American public into groveling cowards, while the bailouts taught every criminal and person of questionable moral character that systemic crimes are encouraged and rewarded, while petty crimes will be punished to the full extent of the law.

In other words, if your criminality is compatible with and supportive of the status quo power of large corporations and government bureaucrats, it will be permitted to flourish without punishment. On the other hand, if you commit even the slightest infraction against anyone or anything even marginally related to the status quo (police, banks, government bureaucrats, corporate profits, etc) you will likely end up dead or in jail.

While criminals will often be attracted to positions of power in order to conceal and protect their schemes, criminal tendencies and a lack of ethics exists throughout all socio-economic layers of a society. Such a mindset is particularly dangerous in certain professions, which is likely why the hippocratic oath came into prevalence to begin with. Here’s a brief description from MedicineNet:

Hippocratic Oath: One of the oldest binding documents in history, the Oath written by Hippocrates is still held sacred by physicians: to treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation, and so on.

Basically, the idea is to do no harm. While the medical industry/profession hasn’t been a key theme of mine, I’ve covered some disturbing trends and developments previously. See:

Americans are Now Traveling Overseas for Surgery

Fraud Alert: FDA Allowed Drugs with Fraudulent Testing to Remain on the Market

Problems in the Education System? Solution: Give Toddlers Powerful Drugs

The second main problem I want to highlight, are the dangers of centralization and corporatization and how these things provide a fertile environment for systemic criminality.

The overwhelming majority of people who become doctors do so with good intentions. You don’t enter medicine to make as much money as possible, particularly not these days. The few friends I have who became M.D.’s are good people with strong ethics. This is where centralization and corporatization come into play.

There is no doubt that the historically personal and intimate relationship between patients and doctors has been in a long-term decline in the U.S. My contention is that a lot of this has to do with the centralization and corporatization of the industry. In this day and age, most of us merely owe a copay and some deductible when we go in for treatment, but beyond that, one’s insurance company or the government is responsible. Thus, when a doctor decides to prescribe a much more expensive medicine versus a cheaper alternative, in that person’s mind he or she isn’t directly harming the patient. The insurance company or the government pays for it, so such a decision becomes much more ethically justifiable in the doctor’s mind.

Of course, taxpayers and society as a whole ends up footing the bill, but it is this disconnect between patient and doctor that makes it an easier choice. That, and the overall decline in societal ethics ever since the no strings attached banker bailouts told everyone that systemic crime pays.

The people who blew up the global economy are doing better than ever, as well as better than everyone else. What sort of message do you think that sends? What sort of culture does it promote? You’re seeing the answers to those questions all around you.

Now from the New York Times:

When the drug maker Genentech introduced a major product in 2006, it found itself in an awkward position: persuading eye doctors to start using its new more expensive drug instead of a popular cheaper version that the company already sold.

 

Ophthalmologists had been enthusiastically using the company’s cancer drug Avastin, which cost about $50 a dose, to treat a common eye disease in the elderly, wet macular degeneration. Then Genentech introduced Lucentis, a nearly equivalent drug that cost $2,000 a dose and was approved specifically to treat the disease.

 

Use of Lucentis took off, and it has become one of Medicare’s most expensive treatments — costing the federal government about $1 billion a year — even though several studies have concluded Lucentis has no significant advantage over its cheaper alternative.

 

Now, a new federal database shows that many of the doctors who were the top billers for Lucentis were also among the highest-paid consultants for Genentech, earning thousands of dollars to help promote the drug. The data raises questions about whether financial relationships between doctors and drug companies influence treatment decisions, even though physicians maintain they cannot be swayed.

 

Half of the 20 doctors who received the most money from Genentech to promote Lucentis in 2013 were among the highest users of the drug in 2012, billing for higher amounts of Lucentis than 75 percent of their peers. The figures were compiled from two federal databases that covered different periods, and it is not known whether or how much Genentech paid the doctors in 2012.

 

The 20 doctors earned $8,500 to $37,000 over five months in 2013, payments that included consulting and speaking fees as well as travel expenses and meals. Genentech says it has an annual cap of $50,000 a doctor for speaking fees.

Sure they have an annual cap of $50,000 per doctor, but this is just one company. If a doctor can earn that amount from 2 or 3 companies, that quickly adds up to real money.

Since Lucentis was approved in 2006, several studies have shown that the drugs are nearly equivalent, including a large government-sponsored clinical trial involving 1,200 patients that was completed in 2011. Avastin is still the most popular choice of doctors: About half of patients who were treated for wet macular degeneration received Avastin, with Lucentis and Eylea sharing the rest of the market.

 

Genentech has aggressively promoted Lucentis to doctors to encourage them to switch, even paying rebates to those who use large amounts of Lucentis, a practice that critics have described as improper but the company says is legal. For Genentech, the stakes are high. Lucentis is one of its top products, generating $1.3 billion in sales in the first nine months of this year, an increase of 5 percent over that period last year.

 

Even with widespread Avastin use, injecting Lucentis remains one of Medicare’s costliest procedures. In 2010, Medicare paid $1 billion to treat macular degeneration patients with Lucentis, while it spent $27 million for such patients treated with Avastin, according to a 2012 study from the Office of the Inspector General for the Department of Health and Human Services.

Here’s the problem I alluded to earlier. When a doctor can say to him or herself “who cares, Medicare pays for it,” you make a questionable ethical decision much easier to justify.

In 2011, the office determined that if all patients being treated with Lucentis were instead given Avastin, the federal government would have saved about $1.4 billion.

 

A review released this year of nine clinical trials showed that Avastin and Lucentis had similar safety profiles and that Avastin did not appear to increase deaths or serious side effects. The review was conducted by the nonprofit Cochrane Collaboration.

 

Still, several doctors, including those who speak on behalf of Lucentis and those who do not, said the choice between Avastin and Lucentis was not simply a matter of cost.

 

For example, Lucentis is specially prepared to be injected into the eye, but Avastin must be divided into smaller doses by outside compounding pharmacies, which can lead to contamination in rare cases. In 2011, more than a dozen people developed severe eye infections, and some were blinded, after they received injections of contaminated Avastin.

You’d think Genentech could figure out a way to safely divide Avastin into smaller doses, wouldn’t you?

Some doctors say there is no good reason to use Lucentis more frequently than Avastin.

 

“They keep talking about evidence-based medicine, and they keep pretending the corporate-sponsored research is nonbiased,” said J. Gregory Rosenthal, a retina specialist in Toledo who has become an outspoken critic of Lucentis and Eylea. “The evidence says that Avastin has at least the clinical efficacy of Lucentis and is perhaps safer.”

As above, so below.

Corruption and lack of ethics is now endemic to American life and the economy.

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Jlasoon's picture

And this is a surprise to who?

Ignatius's picture

When William Binney blew the whistle at NSA he had two major complaints.  One, was the illegal mass surveillance of US citizens contrary to their oath and the law.  The second, was that systems were alll ready to go post 9/11, but it had been developed in house and the cost was modest.  But the corporate vender rats wanted to re-invent the wheel and bag a few billion in the process.

HobbyFarmer's picture

My health is MY concern.  I exercise hard.  I eat very healthy.  I find ways to reduce stress.  I find hobbies that allow an outlet for me.  I find ways to enjoy my kids and spend quality time with them.  I read and work my mind.

If you're popping pills for health, you're missing the secret to great health.

Lose a few pounds.  Pick up an athletic hobby.  Play with your kids/grandkids.  Garden.  Devour a good book.  Spend an extra hour making a healthy, delicious meal and share it with people you love.

Eat well.  Converse (face to face) with intellectually stimulating friends and people you care about.  Exercise!  Live longer because you love life. 

Headbanger's picture

No thanks!

I drink (tequila) heavily and avoid arrogant health nuts like you who are always getting severe head injuries doing those "athletic hobbies"

Cause as you can see, I get enough of my own!

James_Cole's picture

Interesting that this phenomenon of drug company / doctor kickbacks, which has been so prevalent in US&A 'private healthcare system' is a relative non-issue in single payer healthcare the world over..

http://www.eoionline.org/wp/wp-content/uploads/2013/01/us_spends_much_mo...

I drink (tequila) heavily and avoid arrogant health nuts like you who are always getting severe head injuries doing those "athletic hobbies"

I can imagine the distaste is mutual. 

AldousHuxley's picture

Kickbacks exist everywhere there is prescription power.

 

Other countries you don't need prescription....

 

Urtica ferox's picture

Thanks for the links. Slightly OT. Based on replies to another post I made there are doubters in the USA who maintain that Government-run single payer is a non-starter. Maybe in a nation as corrupt as the USA, yes. But I guess the doubters simply won't even look at the contrary evidence from most other nations, and refuse to exercise their critical faculties (if they even have any ;-) ). Cognitive dissonance, psychological denial, willful ignorance, heads in the sand (or up their own arses), call it what you will...

NZ and Oz are examples of healthcare systems that work "well enough", especially on limited budgets.

Here endeth the rant.

TheReplacement's picture

The lack of rule of law is the problem.  The drug company is defrauding the patients with the doctors acting as frontmen.  It really is that simple.

String a few up and see if behavior changes.

Or

Implement full blown medical communism so that someone at the top can make better decisions for all of us.

Oh and go to hell Jame_Cole.

combatsnoopy's picture

and brag about your side effects?  Go You!

shovelhead's picture

Good Whiskey, fast horses and loose women do the same for me.

Headbanger's picture

I'll drink to that!

Now about how old are these loose women you got there??

And are the horses for gettin to em, or gettin away?

DaveyJones's picture

along with loose whiskey, good horses and fast women

reader2010's picture

You will die the best looking 135-year-"young" dude on your block. Progress!

freewolf7's picture

After 36 year old Charle Parker died, the doctor thought they had the numbers reversed on his chart.

Fiscal.Enema's picture

I lived healthy and did all the things you write about. Then a drunk driver pulled out and struck me. no fault of my own. 100% his. It wasnt his car he was driving. the car didnt have insurance. It was his 4th offence. His license was suspended. My insurance company abandoned me He was out celebrating his birthday. he was jobless and living with a girl friend who was taking care of this "bad boy". The collision could have killed me. The fucker refused to take responsibility and ran from the law. He finally got caught and got a free lawyer and all the rest of the shit you get for being a criminal. Life isnt about living well... its about luck and circumstance. If that "drunk driver" comes your way there is nothing you can do about it. You are going to DIE. Eat... drink  and be merry.

pippi68's picture

Awfully preachy, doncha think? And I don't think more exercise or a specific diet will prevent you from getting macular degeneration in your elderly years if you have the gene markers for it. Nor will a special diet and more exercise help you slow the loss of your sight. There are appropriate uses for drug therapies.

ThirdWorldDude's picture

After I took my xanax I didn't even care.

ebworthen's picture

Love that stuff.  Ex-Girlfriend got all she asked for; I had to beg because I was a Man and was supposed to "take it".

Relative who is a Doctor lamented to me years ago that the Pharmaceutical reps. made as much as she did, or more.

Big pharma handed out sky-box season tickets to the local NBA team, Club Med vacations, and paid for catered lunches for their office. 

No conflict of interest there!  Too bad the A.M.A. and the Medical profession has been bought just like CONgress.

zhandax's picture

ew, not disagreeing with most of that, but usually the AMA is buying; not bought.  Conceptually, the AMA and the medical profession is the same relationship as the fed and the banks.  A Cartel.

boattrash's picture

Xanax hell, I think we're probably all about ready for some good ole LSD, just to help tolerate this fucked up world...

Have they Re-Marketed that yet?

wendigo's picture
wendigo (not verified) boattrash Dec 9, 2014 4:49 PM

There's quite a large psychedelic community in my town and such things are easily found. I ate entirely too much though. 

boattrash's picture

But I bet it was a great attitude adjustment!

swmnguy's picture

I think in the prevailing state of mind, an acid trip would be a terrible idea.  The stuff completely dismantles your filter.  That's the last thing you need in a world like today's.  Mushrooms would be the furthest down that road I'd be willing to go, with the dire thoughts back in the corners of my mind.

I've heard most of the "LSD" available actually isn't LSD anymore.  Mostly derivatives of it with a slightly different formula.  Sometimes the difference is very consequential.  Sometimes not.  Either way, pretty risky and no way to know what you're getting until you're too far committed.

Bro of the Sorrowful Figure's picture

youve clearly never done LSD. all about love and opening your mind to new ideas. im at least partially convinced that my frequent marijuana use and my two or three hallucinogenic experiences when i was in college were the first step of my waking up. if you dont currently smoke pot, i would advise you start immediately. i use it when i have a problem that i cant solve or need a different take on a situation. it's amazing how quickly these drugs can provide clarity and profound introspection. also helps to put your problems in perspective.

i also really want to try DMT. anyone ever done it? apparently it lasts for 5 minutes and you get to talk to god and see the entire universe. yes please.

wendigo's picture

I've tripped maybe 40 times. 3 of those were on DMT. 

1st DMT trip: went to a church of impossible architechture and attended a mass given by an alien priest. All the worshippers were from different species. 

2. Was up on a stage. Got a standing ovation from an infiinite number of nutcrackers. Not a lot. Infinite. 

3. This one is sort of hard to describe. You know how you can remember the past and speculate about the future? All that was reversed. 

Even though objectively a DMT trip lasts 5-10 minutes, subjectively due to time dilation t feels like forever. Literally. 

DMT is completely worth it. If you have the opportunity, do it. It's a lot better use of your time than what you'd be otherwise doing. 

 

 

Dr. Richard Head's picture

Kickbacks driving a government controlled industry? Say it ain't so!

NoDebt's picture

Kick-backs is such an ugly word.  The preferred term is "revenue sharing".

dirtyfiles's picture

this country is toast....

cynicalskeptic's picture

More like a burning bag of.....

I don't recognize this place any more.....   we don't MAKE anything are obsessed with faux news focused on mindless celebrities and, frankly, are well on our way to the future of 'Idiocracy' (but with a few evil 'smart' ones pulling the strings and profitting off the proles)

August's picture

You gotta love the Ivy league.

zhandax's picture

Alternative version; "You gotta love the Ivy league on Roundup".

JustObserving's picture

USA represents 4.3% of the world's population and spends more than 50% of the world's spending on pharmaceuticals.  Nothing like fraud, deceit and chicanery to ramp up spending.

Besides, it boosts the GDP. So it is all good.

Dr. Richard Head's picture

Also consumes 25% of the world's energy resources.

JustObserving's picture

Americans spend at least $50 billion a year on statins.  MIT scientist calls them poison:

https://www.youtube.com/watch?v=TZomZEPBdbM

Total US spending on pharmaceuticals a year is at least $500 billion.  Or $1577 per person per year.  Per capita spending on food in USA is $2400 per year.

pods's picture

Per capita food is $2400 a year?  Damn, someone ain't eating!

We are way on the high end of that bell curve.

But look at every old persons counter, medicine cabinet, etc.  They don't even know why they are taking many of their pills anymore.

If they had to pay for them, well that would be different. 

Cost shifting is a big influence.

When I hurt my back years ago and had the $20 per script I didnt care what they gave me. Now with everything out of pocket I would find out what is absolutely necessary.

Most shit doesn't work anyways, and the fun ones (meaning addictive) aren't handed out anymore. Hell, Vics went schedule II now.  Easier to just buy heroin.

Or just buy some coke with fentanyl in in like just happened here and have your Uma Thurman moment before you die.

What if governments didn't regulate what you put in your body?  

pods

sleigher's picture

"What if governments didn't regulate what you put in your body?  "

 

We wouldn't have nearly the problems we have today.  If only because many would have taken themselves out of the system.  (Uma Thurman moment and all...)  

Skateboarder's picture

Western "medicine" is a most disgusting practice.

Mask some symptoms with some pills, present the belief of betterness, wait for more symptoms to reappear with more vigor, inse and repeat.

For a few dollars more...

Dr. Richard Head's picture

They don't call it the "practice" of medicine for nothing, you know.

Bunghole's picture

The only time I visit those leeches is once a year for my company mandated physical.

Otherwise I say fuck em.

NoDebt's picture

"If you have to ask how much the treatment is, you deserve to die from the disease."

-  Somebody said this, I guarandamnedtee you

Frankie Carbone's picture

The powers that be formed the AMA last century. What the hell did you expect??

lasvegaspersona's picture

The current AMA has only 17% of current docs on their rolls. It has become an insurance company with a good source of income. It is sad that people still they they represent doctors in any way. The AMA has become a socialist organization that chums up to government to receive continued cash flow. They are like AARP. They lie about who benefits from their suggestions.

combatsnoopy's picture

I wonder if the AMA can buy their health with their robbed funds.
As far as health is concerned, they're parasitic thugs who have no idea of what they're doing.

As Joan Crawford and Steve Jobs pointed out, money can't buy you your health.
I can HELP- unless the status quo is pulling for quality control, God help us.

reTARD's picture

Just don't do drugs. ANY drugs, especially from the legalized "professional" drug dealers.