[e-drug] Fraud by Abbott and Takeda (cont'd)

[John Urquhart <urquhart@ix.netcom.com>]

E-drug: Fraud by Abbott and Takeda (cont'd)
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In respect to Tim Dodd's question about how many practicing docs
accept extreme largesse from pharmaceutical firms, the answer is
very few, based on what has been published on the subject..

This kind of behavior has been seen in pharmaco-epidemiologic data
on numbers of prescriptions written by individual physicians for
newly launched pharmaceuticals. Back in the early 1990's, Bill
Inman, founding director of the Drug Safety Research Unit at the
University of Southampton, found in his Prescription Event
Monitoring data that a few percent of prescribers in England
accounted for large fractions of several then-newly launched drugs
prescribed and dispensed. Bert Leufkens and I looked at Dutch data
and saw the same thing. It is described in a letter we wrote to The
Lancet, commenting on Inman's findings, and describing our own:
     Leufkens HGM, Urquhart J. Prescriber profile and
     postmarketing surveillance. Lancet 342: 1178, 1993.

We saw, as Inman had, a few docs writing as many as a hundred
or more prescriptions for a newly launched product. Some must
have written a prescription for every patient who came through
their door. In the extreme case of a product that had little appeal in
the marketplace, and was thus hardly prescribed by anyone else, a
half dozen or so docs accounted for the majority of prescriptions
written for the product.

By coincidence, the Sunday Times (London), on the day following
The Lancet's publication of our letter, carried a front page story
based on the experiences of a pharmaceutical rep who had defected
from the firm of Fisons, telling about a scheme whereby docs who
had written more than 5 prescriptions for a then-new anti-asthmatic
would be paid some appreciable number of pounds -- 10-20 as I
recall -- for each prescription written beyond the fifth. There then
ensued echoing articles on each of the two succeeding Sundays of
similar stories emanating from other companies. In each case, the
companies involved vigorously denied all knowledge of such
schemes, insisting that these were 'rogue' sales efforts.

Leufkens and I saw considerable variability from one newly
launched product to another, suggesting that the 'buying' of
prescriptions was product-specific. As for the 'rogue' aspect, it
would be a foolish firm not to have a wall of credible deniability
between the groundtroops and the management. The penultimate
source of such mischief is intense pressure from management to
meet aggressive financial objectives for a newly launched product.

In today's world, this kind of prescribing behavior is rapidly
identifiable by payors, so it is an unwise doc who engages in such
activities, but of course greed and need are legendary wellsprings of
innovation, so there's probably a newer, less obvious way to skin
the same cat. In any case, the payment schemes we saw involved
very small numbers of docs. Of course such payments amount to
overt bribery, which makes it also interesting to look at it from the
perspective of a rep who is under intense pressure to meet stiff
sales goals: it is not a small problem to identify the small
percentage of bribe-receptive docs amongst the many who would
be shocked, outraged, and create no end of trouble if approached
with such an offer.

This kind of behavior is a symptom of a problem that has been
discussed previously within e-drug, which is the intense financial
pressure that research-based pharmaceutical firms are under to
continue to generate high shareholder returns. I earlier referred
readers of e-drug to the slide set from the plenary lecture that the
senior pharmaceutical analyst at PriceWaterhouseCoopers, Dr Steve
Arlington, gave at the 2001 annual meeting of the American
Society for Clinical Pharmacology & Therapeutics. Those slides can
be downloaded from the ASCPT website via one of the following
addresses:
    http://www.ascpt.org/annual/2001/
or
    http://www.ascpt.org/annual/arlington.pdf
If neither works, send an email to Sharon Swan, who is exec sec of
the ASCPT and ask her to direct you to the correct site:
sharon@ascpt.org

It's about 4 megabytes, so it takes a long while to download unless
you have a high-speed connection to the internet. It is, however, an
apt summary of the wellspring of the intense competitive pressures
in the marketplace.

John Urquhart, MD, FRCP(Edin)
Professor of Pharmaco-epidemiology, Maastricht University,
Maastricht, NL
Chief Scientist, AARDEX Ltd/APREX Corp, Zug CH, Maastricht,
Union City, CA USA
Professor of Biopharmaceutical Sciences, UCSF, San Francisco
home office: 975 Hamilton Ave, Palo Alto, CA 94301 USA
email: urquhart@ix.netcom.com


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