Submitted by Mike Krieger via Liberty Blitzkrieg blog [7],
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 [8]
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 [9]:
Hippocratic Oath: One of the oldest binding documents in history, the Oath written by Hippocrates [10] 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 [11]
Fraud Alert: FDA Allowed Drugs with Fraudulent Testing to Remain on the Market [12]
Problems in the Education System? Solution: Give Toddlers Powerful Drugs [13]
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 [8]:
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 [14]’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 [15] 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 [16] 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 [17] 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.
