Interview of me by Neil Shulman MD about my experiences with the pharmaceutical industry. Exclusive footage you won’t see on the mainstream media.

Part 1

Part 2

Part 3

Part 4

Part 5

This weekend we had the Emory International Medical Volunteerism Conference here in Atlanta, GA. George Lundberg MD was the keynote speaker and there were sessions on volunteering in third world countries, advocacy for patient rights and a range of other topics.

Lindsay Jones, the attorney who took on the case of the Grady Hospital dialysis patients who got yanked off dialysis with a certain death sentence, talked about advocating for the uninsured (See “Grady Hospital Tells Dialysis Patients to Leave or Die” and my posts from the court room “These are Real People” and “Healthcare is a Right“). Well, at least it is a right in most of the world, but not in the US, I guess, where a convicted mass murderer at least has the chance to have his day in court before they take his life away, unlike the unisured in this country, who get yanked off of dialysis with no due process. The Europeans who joined the Grady facebook page (see links in my prior posts, we got a couple hundred members) thought we were complete barbarians for acting like that.

Lindsay made the point he argued in court that healthcare is a right, and that you can’t deprive a person of their life without due process.

Lindsay Jones

I gave a lecture about advocating for victims of medication related problems along with other members of the Grady Coalition who banded together to advocate for the dialysis patients who had no voice, and were being deprived of life as victims of the corporate medical model where sickness is viewed as a way to make money and making profits is put ahead of people’s lives.

Isn’t it great to live in America!

EIMVC panel on advocating for the uninsured. L to R John Shippee (Cancer Patient Advocate), James W Reed, MD (Professor at Morehouse School of Medicine, Chief of Endocrinology, Grady Hospital), Vincent Fort (Georgia State Senator), Bonnie Hillsberg, (Vice-President, Association of Clinicians for the Underserved), Tim McDonald (Reverend, First Iconium Baptist Church), Pamela James Aliniece, (Founder, Laughing at Leukemia), Doug Bremner MD

A local FOX Atlanta show, you can see me and read about it here.

Reported By: Beth Galvin | Edited By: Leigha Baugham

Nearly 20 percent of American doctors get paid by drug companies to be consultants or speakers, and in some cases, they’re making quite a lot of money. So does that influence the decisions your doctor makes about your care?

Doctors earn money by giving professional talks to their peers about the latest research and the practice is pretty common.

For years it’s been unclear how much money physicians were actually earning for these speeches. Now, three major drug companies are going public revealing who is on their payrolls and how much money they’re making.

On Eli Lilly’s website, the company lists faculty on the drug company’s payrolls, including educators, advisors and contractors.

Nearly 200 Georgia doctors are on the list and they pulled in over $2.2 million dollars last year.

Some of Georgia’s highest paid physicians on the list are Emory urologist Dr. Muta Issa, who earned $ 91,000 from GlaxoSmithKline. Atlanta endocrinologist Dr. David Robertson cashed in over $78,000 from Eli Lilly and Roswell psychiatrist Dr. Michael Banov banked over $68,000 from Eli Lilly.

Some healthcare providers are earning much more by working for several companies at the same time.

“It’s common, that people who are very active, can make several hundred thousand dollars or more,” said Emory psychiatrist, Dr. Doug Bremner.

“We don’t sell medications. We simply educate physicians about data, and they make their own mind up,” said Dr. Banov.

Dr. Banov, a private practice psychiatrist, was paid over $68,000 by Eli Lilly. The Roswell doctor said he gives speeches for about five companies with competing medications.

“I think my patients welcome the fact they have a doctor who is meeting other doctors, actively involved in research, actively communicating with other physicians, someone who’s on top of the game,” Dr. Banov said.

Dr. Banov said the drug company, not him, creates the materials used in his speeches, and he also said there’s a reason for that. “We are only able to present the data. We’re not able to present our personal opinions, our personal preferences, how we use the medication off label, any of that. So we’re held to a very tight standard by the FDA.”

Emory’s Dr. Bremner said he thought paying doctors to speak for drug makers was a bad idea. Bremner said he used to do it, until he got a wakeup call about six years ago.

“I was going out to give a talk and the sales, the marketing guy like, slapped me on the back and said, ‘Go on out there and sell some,’ I’m not going to say the name of the drug. ‘Sell some of that drug,’” said Dr. Bremner.

Dr. Bremner said he worried that even the most independent doctor can get hooked on all that extra cash coming in. “Doctors are human, and once you get into this routine of making outside income, you become dependent on it.”

When asked how receiving money from the drug companies could from influencing how a doctor treats a patient, Dr. Banov said, “When I close that door, and I’m with a patient, my 100 percent interest is in getting that patient better.”

Last fall, Emory University’s School of Medicine banned staffers from making promotional talks for drug companies after congressional investigators accused the school’s chief of psychiatry, Dr. Charles Nemeroff of failing to report to the university over a million dollars he got from pharmaceutical and medical device manufacturers.

Dr. Nemeroff resigned his chairmanship, and has since left the school.

Another Emory staffer, urologist Dr. Issa listed his earnings as $91,000 in the first three months of 2009 from GlaxoSmithKline. Dr. Issa declined to comment on this story. A school spokesperson said Dr. Issa left the speaker’s bureau when Emory changed its policies.

Atlanta diabetes specialist Dr. David Robertson, who earned $78,000 for giving 47 promotional talks for Eli Lilly, said he only speaks about medications he actually prescribes.

“I think a presentation a physician makes should represent their own practice,” said Dr. Robertson. The doctor did admit that some physicians spend too much time promoting too many products. “That’s bad for everyone. That’s bad for the pharmaceutical companies, that’s bad for physicians as a profession and that’s bad probably for physicians as recipients of information because they become mistrustful.”

So are public lists like this a good thing?

Doctors on both sides say yes.

“I think it’s gotten to the point where the public is looking at it for what it is and they’re saying, ‘What’s going on here?’” said Dr. Bremner.

“Why not let the public know? There is nothing to hide. There is no shame. We’re not doing anything illegal,” said Dr. Banov. “I think it’s terrific. [It] should be completely open.”

So far, GlaxoSmithKline, Eli Lilly and Merck have published online lists of who’s on their payroll. Pfizer will be doing the same this spring.

Related Links: statements and public registries for Eli Lilly, Merck (also see here) and

GlaxoSmithKline (also see here).

Complete statement from Emory University School of Medicine regarding its new Conflict of Interest policy.

“In June of 2009, Emory’s School of Medicine adopted a comprehensive new policy governing faculty relationships with industry. The policy meets the recommendations of the Association of American Medical Colleges, the Association of American Universities, and the Institute of Medicine. Professors Issa, Pacifici, and Schulman are respected faculty members who are in compliance with that policy. Dr. Nemeroff resigned his position at Emory in fall of 2009 to become chair of psychiatry at another medical school.”

Having read the Open Letter to Dr. J Douglas Bremner of Emory University published on September 12, 2009 by Dr. David Gorski in Science-Based Medicine Blog in defense of Dr. Peter Lipson’s criticism of Dr Bremner I was immediately brought back to three articles all published in the 1999 medical literature.

One was by Dr Elliot Fisher from Dartmouth who was among the very first to dare to ask the basic question about “more possibly being worse” in US bio-medicine in JAMA. The second and third articles were from Dr Larry Dossey who then edited The Journal of Alternative and Complementary Medicine who wrote eloquently about intolerance among bio-medical scientists toward even considering Alternative Medicine. (see references below)

I would ask Drs Gorski and Lipson if an iconoclast like Dr Bremner might be serving a valuable role as gadfly to an entrenched failing status quo in bio-medicine who have made the mistake of deifying science? I would posit that the very essence of science is always and incessantly asking the question- “is it possible that I may be wrong?”. And I strongly support the return of narrative- the patient’s individual story- to the practice of medicine. The incomparable Sir William Osler, one of my heros in medicine, knew that well.

I believe that of all the determinants of successful US bio-medicine medicine going forward that a strong dose of humility is in very tall order.

To make progress our egos must die first- a basic psychiatric principle. It is much better and much more important to be tolerant and kind than to be right.

I support Dr Doug Bremner’s role as a colorful and passionate iconoclast. We need more like him.

Dr.Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com

Ref-

-Fisher ES, Welch HG. Avoiding the unintended consequences
of growth in medical care: how might more be worse? JAMA 1999;
281:446-53.11.

— Dossey, Larry‘You people’: intolerance and alternative medicine. 1999;5(2):12-
17,109-112

Those who have been following this blog know that last month I was told to remove the name of my university from this blog and then a few days ago my university backtracked and said I could use the name (not the letterhead, which I never disputed). The incident attracted the attention of the American Association of University Professors (AAUP) and the Foundation for Individual Rights in Education (FIRE) who wrote a followup article on it here after the reversal of the decision as well as abel pharmboy on scienceblogs. There was also a humorous post by Margaret Soltan on University Diaries, who follows university politics, here, where she wrote a limerick (she is an English professor I think, so that makes sense). My friends perform it below. That’s Billy Tauzin in the middle, head of PhRMA, with of course the always lovable lolcat:

After I wrote this post yesterday called “Motherhood is Not a Medical Disorder” about the Mother’s Act, which advocates for widespread screening of moms for post-partum depression (PPD), something I don’t think is a good idea because it medicalizes a normal stage of life, increases the chances that people will be but on antidepressant medications that they may not need and that may have side effects, and represents yet another intrusion into privacy, I got this response from John Grohol at psychcentral (”False Claims by Bremner”).

First he grumbles about my pointing out that the psychiatrist quoted in the Time article, Katherine Wisner, MD (you can follow the link to the Time article in yesterday’s post), was on the speakers bureau for Pfizer and Lilly (something not noted in the article but which I found on my own), makers of Zoloft and Prozac, respectively, which as a commenter pointed out are promoted as the two safest antidepressants for pregnant and lactating women. Being on a speaker’s bureau these days means giving “promotional talks”, which translates into working for the drug company to advertise to other doctors, and is relevant. In addition, the psychcentral website has paid ads, most of them for treatment (which includes medications), while this site has no ads. And don’t say I am trying to profit off my book, which now goes for a nickel on amazon.

Grohol further takes issue with my statement that women without a prior history of anxiety or depression are not at risk for PPD and therefore would not benefit from widespread screening. However in support of that he cites Ross et al 2009, claiming that history of abuse and alcohol or substance abuse are risk factors for PPD as well. However a perusal of Ross et al shows that a history of childhood abuse is not in fact a factor, rather only abuse during pregnancy. In addition, it is alcohol and substance abuse during pregnancy that is a risk factor, on the order of a pregnant woman drinking a six pack a day or actively abusing cocaine. That kind of substance abuse is a risk to the fetus, and needs to be stopped.

If you have a man beating his pregnant wife, or a woman snorting cocaine while pregnant, that it is a situation much more serious than PPD, and should be stopped. These extreme circumstances hardly justify mass screening for PPD.

I still say NO to the MOTHER’S ACT.

This recent article in Time Magazine discusses the Mother’s Act, legislation initiated in response to the story of Melanie Blocker-Stokes, who leaped to her death from her hotel room in Chicago three months after the birth of her daughter. Officially known as the Melanie Blocker-Stokes Post Partum Depression Research and Care Act, but referred to as the Mother’s Act, this legislation would require screening of all women post-partum for depression.

The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous. And whenever you start screening the general population, you get into problems with over-identification of people and an increase in the number of people that go on antidepressants. I am opposed to mandatory screenings of the population, like Teenscreen, which are bonanzas for the pharmaceutical industry, but a major intrusion into the privacy and autonomy of American citizens. In the case of Melanie Blocker-Stokes, she had already been treated with multiple courses of psychotropic drugs and electro-convulsive therapy, so there is no reason to think that her life would have been saved by “screening”. This legislation is typical of much that comes out of an individual tragedy, that results in an intrusion into the personal lives of individuals and the further relinqueshment of individual freedoms to the government.

The article quotes psychiatrist Katherine Wisner MD as stating ”how can you be opposed to something that will help mothers?” But an examination of the fine print from one of her articles here shows that she is on speakers bureaus for Pfizer and Lilly, makers of Zoloft and Prozac, respectively. 

In it is quoted Amy Philo, a leader of the coalition against the Mother’s Act. Her experience was that after her baby choked on his vomit and needed emergency treatment, she became increasingly anxious about his health. Her doctor gave her Zoloft, telling her that it would make both her and her baby happier. After treatment with Zoloft, she started having alarming suicidal thoughts and thoughts about hurting her baby. When she weaned herself off of Zoloft she felt fine. This experience led her to start the United Non-Profits and Individuals for Truth and Ethics (UNITE), a coalition opposed to the Mother’s Act (click here to sign their petition). Time magazine recently corrected a statement that she had post-partum depression and developed thoughts of harm before taking Zoloft, which wasn’t true.

[update: read more on the debate that arose after this post here at Amy Philo's The Bitter Pill blog and my responses to John Grohol's attack on this post ("Bremner makes false claims...") here and here.]

Yep! For a nickel you can now get several years of research and the contents of hundreds of research articles read by someone who is not on the payroll of pharmaceutical companies. That would be in the form of a used copy of my book Before You Take That Pill, purchased on amazon.com. Or if you want a new book that might have an overstock mark you can pay $2.78.

You might want to do it fast though because with all of this free publicity the book has been getting lately it might go fast. At this point either the book, or me, will be going fast I think.

If this seems like gratuitous self promotion, that’s because, well, it is. If you aren’t interested in the book you might want to buy it as an act of solidarity since my university refused to issue a press release and otherwise squashed publicity and my local paper the Atlanta Journal Constitution refused to write about it even though I only said that drinking a sugar added beverage each day would make you gain five pounds a year, and didn’t actually use the word “soda” (OK, I said it).

Here is a recent amazon review from Carolyn, July 6, 2009 (no I don’t know her)

Now that every other commercial on television is urging us to “talk to your doctor about” and dispensing marketing disguised as bogus medical advice, we need objective information if we are to avoid the pitfalls of being over medicated for no good reason.

You can read this book cover to cover, as i did, even though i take no medication or you can look up the chapters that apply to you. here’s a perfect example: i sent the book to my 85 year old father to read. for some reason, he had been put on simvastatin. after reading the chapter on cholesterol lowering medication, he decided to stop taking it. when he told his cardiologist, the doctor said “i don’t know why you were ever on it to begin with!”

Obviously, another doctor had prescribed it a long time ago and no one was keeping track. so aside from helping to keep the country’s wildly out of control medical costs in check, my dad also noticed that a mysterious rash he had developed went away, in addition to muscle aches which he had attributed to his age.

He also quit his advair and has had no problems so far without it.

Now he is like any normal healthy 85 year old living in a country that doesn’t ram drugs down people’s throats to keep stock options soaring- he mows his own lawn, trims his hedges, treated his garage for termites and is getting ready to rehang all the windows in his house.

Yes, some people need drugs for short periods to fight infections and save their lives. but this chronic use of drugs for everything and forever is nonsense. we are certainly no healthier for it and certainly way poorer.

That a doctor was willing to examine his profession objectively and point out this very big weakness is something we must be grateful for.

Thank you, Dr Bremner

You’re welcome, hon.

Well it has been an interesting week. After word got out that I had been banned by my university from using their name on my blog with follow up actions, which was covered almost immediately by Inside Higher Education, there were quite a few comments on the internet. There were a number of comments about a double standard where others had used letterhead from the university to promote medications on behalf of drug companies, but they pounced on me for using it in a satirical piece, or where they pampered other authors with their own web sites and publicity but shunned me. BNET pharma speculated that their suppression of the press release of my book and subsequent squashing of publicity may have been a clever ploy (I think the word was “genius”) amongst the PR dept to create a conspiracy theory that would create even more publicity than a normal press release.

Actually the suppressed book release was over a year ago before they made the papers for too close ties to pharma. So it might have been a conspiracy, that actually wasn’t a conspiracy, that actually was a conspiracy. If that makes any sense.

But what was involved in the conspiracy probably wasn’t what he had in mind.

Gary Schwitzer showed interest in something that combines “academic freedom, double standards, and blog censorship.” Other comments are here and here and here, including one entitled “University Throws Doctor Under the Bus for Pharma Ties“. I liked that one, so here you go.

University throws doctor under the bus for pharma perks. That's Billy Tauzin, head of PhRMA lobbying group, at the wheel.

It’s getting a little tight down here.

On the actual questions of fact, the head of the American Association of University Professors offered his opinion in the Inside Higher Ed piece that the university absolutely had no right to block me from identifying myself as a member of that university. This seems in contradistinction from the “policy” of preventing the use of the name for “non-university” activities which could be construed as anything other than buying pencils on your university account. I mean alot of professors are writing blogs, writing books, speaking in public, making movies, whatever, and I think it really strikes a nerve to say that they cannot identify themselves as a university professor in the things they do, which is why this case has basically drawn national attention. As for the blog, I think many professors see their blogs as an extension of their professional life, and in fact it is an excellent way to quickly express ideas on newly breaking events in their field and get instant feedback. Not to mention twitter.

Amy Philo wrote the following about this situation: There is a case called Garcetti v. Ceballos involving government employees that limits the employee’s right to free speech if the speech is considered part of their official duties. Therefore if your university declares your blog ‘personal’ that would imply that you could not be retaliated against for whatever you write on the blog. On the other hand having you remove their name could be considered retaliation since it does relate to academic freedom. However, in Garcetti the Supreme Court said that their decision does not apply to scholars / academic freedom, implying that a professor would still have the First Amendment right to say whatever they wanted.

Statements made by public employees pursuant to their official duties are not protected by the First Amendment from employer discipline…

…The Court instead found a reason for limiting First Amendment protection to public statements made outside the scope of official duties “because that is the kind of activity engaged in by citizens who do not work for the government.

The Court also reserved for a future decision the issue of whether its analysis would apply in the same manner to a case involving speech related to scholarship or teaching.

Hat tip to Amy Philo [this does not represent legal advice]

Why the Drug Industry May Be Bad for Your Health, is available on Amazon last time we checked for $2.84.