Senator Charles Grassley, up to his usual mischief, has released a brochure from a GlaxoSmithKline program called “Psychnet”, which was developed in 2000 in order to promote sales of their antidepressant Paxil (paroxetine). Psychnet involved getting a bunch of influential psychiatrists together and training them to go out and give talks to other psychiatrists. Here are the program objectives:
This is an internal document and shows what industry is thinking about psychiatry “key opinion leaders” (KOLS). Those are the influential physician guys. I think the choice of language is illuminating: “build advocacy” by “creating speaking opportunities”? In other words, set up high paying speaking gigs for the big boys, not cuz you are good guys who want to educate, but to provide a way to transmit money (and therefore good will and influence) with those leaders who will in turn influence the little guys to prescribe your drug.
That is actually a violation of federal anti kickback laws as far as I can tell. The Justice Department is actually using this law now to prosecute Forest labs for illegal promotion of off label use of the antidepressants Celexa and Lexapro for teenagers (for whom they do not work, and can be harmful). Here are some quotes from todays NY Times:
“Somehow physicians think they’re different from the rest of us,” Mr. Morris said. “But money works on them just like everybody else.”
Mr. Sullivan, the United States attorney, said officials hoped to send a strong message to doctors. “I have been shocked at what appears to be willful blindness by folks in the physician community to the criminal conduct that corrupts the patient-physician relationship,” he said.
Anyway the PsychNet Program goes on to state that:
PsychNet is an ideal way for key opinion leaders to influence clinicians in your region on the benefits of Paxil versus competitors.
PsychNet Speakers – Selection and training
Each region selected several physicians who are influential in their communities, credible and interested in speaking on behalf of Paxil. Specifically, the phyisicians met the following criteria:
- Local key opinion leaders
- Educated on the benefits of Paxil
- Strong communication skills
A list of regional speakers can be found at the back of this booklet.
I am not making this up, guys. The program goes on to say that only doctors that had gone through the program could give talks, because they were “educated” on the advantages of Paxil over competing drugs for depression and anxiety.
Those guys know that physicians look up to their KOLs, first during training, then later to get updates on what is new. That is why it is so concerning when they get co-opted by drug companies, which is what has happened in the US today.
I wanna be like u when I grow up!
That’s our dog Lydia, who tragically met her demise five years ago.
I actually gave a talk for a program like this somewhere around 2001 in Orlando, FL. Right before I went out to give my talk one of the industry guys said:
Go out there and sell some Paxil, Doug!
That was when I started to realize that something was terribly wrong.
My kids got to go to DisneyWorld, though. First and last time.
Bremner kids have fun while Dad sells drugs.
That’s a real picture. No kidding.
Anyhoo after the DisneyWorld show I had a gig for a year speaking in a program called “What Does Neurobiology Tell Us?” Well what it told us obviously was that we should be prescribing antidepressants, of course! I used to try and change the slide cuz I thought it was doing a paid infomercial to use only their slides but present myself as coming from Emory University (and not the drug company). They said they couldn’t do that cuz the slides were “FDA approved” (?). Go figure. So I would show up and switch the slides at the last minute. At the end of the year they dropped me.
In retrospect it would have been a lot easier to just go along with the program and not fight them.
Relax and have some wine with your drugs! And some cash!
But then I wouldn’t get to play with lolcats!
WE HAZ GOOD TIMZ HEAR AT DRUG NEWZ BLOG!
The next generation of young doctors seems to be putting up a fight against pharma corruption. But we all know about the ideals of youth.
Nevertheless, consider this an open invitation to the American Medical Students Association in the fight to withstand influence; I am willing to help in any way I can. Just let me know.
[update: more responses to the PsychNet brochure here. Also, as some readers point out in the comment section, why are some regions (SE, Midwest) not included in the brochure? Any bias?]
But why is this “pharma corruption”? Why is this not “physician corruption?” Don’t they know how to say no?
Reporters get paid a whole lot less than physicians and can usually appreciate a free meal or two, but, at a good newspaper anyway, they aren’t allowed any freebies. I’ve never understood why physicians think they are immune from influence.
I agree, it is physician corruption. It is a pay to play kind of system. They think they are immune because they think they are better educated/above it all, but study after study shows they are wrong.
It’s big pharma enticing, and therefore corrupting, health care providers and the restoration of health of others. This is done by off label promotion, quid pro quo, misbranding, and renumeration:
http://www.answers.com/topic/kickback
http://en.wikipedia.org/wiki/Off-label_use
http://www.nytimes.com/2007/05/11/business/11drug.html?_r=1
http://en.wikipedia.org/wiki/Quid_pro_quo
http://www.hpm.org/en/Glossary.html
Hi Doug!
Thank you for this.
Ana
Thank you, Doug, for posting the information on the federal anti-kickback statute.
The PsychNet brochure lists Chris Wilkinson as the contact person for the South East Region. However the list of the approved speakers for this region is missing. Do you know who was on the list of approved speakers for the South East Region?
No, I was wondering that myself. Must have been inadvertently cut off when they scanned it.
Doug, is the omission of information a curious oversight or an intentional redaction? It appears that the list of approved speakers for the Shore and River Valley regions are missing as well.
[...] this stuff out into a public discussion. I too used to give “drug talks” (see “Confessions of a Psychnetter“) but at the time I deluded myself into thinking that I was providing a useful [...]