Seems not all physicians are as sanguine about this as Dr. Novella:
http://www.billyrubinsblog.org/2012/07/health-news-belongs-in-health-section.html

Perhaps the article’s most important point is that, while seemingly a huge fine, it may be regarded as no more than a parking ticket to company executives. For starters, no individual will face any charges. “What we’re learning is that money doesn’t deter corporate malfeasance,” former NY attorney general Eliot Spitzer is quoted as saying. Stifle the laughter: Spitzer, before his own fall from grace, sued GSK on behalf of New York back in 2004 for similar issues, so he’s an appropriate sound bite for the article.

He even refers to “Big Pharma” as if such a thing actually existed! As does a former Secretary of Labor:
http://robertreich.org/post/26568286162

Both card-carrying NCCAM members, no doubt.

I am concerned about the following statements in your article:

“One recent article, for example, found that doctors who have no access to pharmaceutical reps were up to four times slower to adopt new medications than physicians with some access to reps. In addition, they were also four times slower to stop using a drug that has a new black box warning, meaning that negative information about safety has come to light. It seems, therefore, that pharmaceutical companies can be a useful conduit of information to physicians, but that also comes with a lot of baggage.”

The article you link to is an industry-sponsored study that I find to be thin on useful information. Why do you refer to it without question as if it is a valuable study? Have you looked at it in detail? As a proponent of science-based medicine, why are you just quoting relative differences instead of absolute differences? Regarding one of the measures used in the study: is being more or less likely to prescribe Januvia when it was first put on the market a direct measure of quality care? Is NOT using Januvia a sign of an uninformed physician or just good sense? I have always been and I am still reluctant to use Januvia for my diabetic patients–it is expensive and does not do much to improve the A1c.

I feel using the study to draw even the limited conclusion “that pharmaceutical companies can be a useful conduit of information to physicians” is a big stretch. I am concerned that this is a weak study being overblown by the pharmaceutical industry to counter some of the restrictions imposed by med schools and hospitals on the activities on drug reps. Is this really a good study, or did you fall for little more than drug company propaganda posing as science? I was hoping to see someone from Science-Based Medicine to take a long hard look at this very study, especially the statistical analysis, but instead you are treating it as accepted science. I am a bit disappointed.

[this question was also posted on this article in Science-Based Medicine--sorry for the duplication, but I wasn't sure which forum you would prefer to respond in]

The black box warning thing is clearly one positive (and I’m sure that some of it is mentioning the black box warnings of competing drugs), but it is not clear to me that being more likely to prescribe a new medication is a good thing. Since this is a relative comparison I wonder which group is closer to an ideal rate of adopting new medications- I tend to think that it would be somewhere in between. Though personally, I would prefer to be the later adopter… in many cases the best evidence is with the medications that have been around a while and we know more about them- good and bad.

In total, though this information looks at only potential positives, which are countered by the misleading and sometimes misinformation provided to physicians by people in sales. Their objective is more sales, not better medicine, and to think of that that as an overall positive “push” of information is hard to defend

“The problem is physicians are busy, and there is an overwhelming amount of new information constantly being generated. ”

I’m sorry, but this sounds like an excuse. It seems to me that this is one of the most important duties of a physician, and if they can’t find proper channels to weed through this information then something is wrong with the medical industry.

Also, there seems to be an assumption here that physicians are the noble scientist being taking advantage of by the greedy corporations. Are we really so sure that there aren’t plenty of physicians out there with dollar signs in their eyes and who love the attention they get from pharma reps? Maybe some of the existing rules were so easily violated because physicians themselves looked the other way.

I think you jump too quickly to the regulation solution (especially since, as you clearly point out, GSK violated already existing regulations). Don’t the AMA and other medical organizations have some responsibility here? After all, it is their reputation and the reputation of their members that are at risk. I’m sure they already have some guidelines around these issues (I could be mistaken), but why aren’t they being pressed to police their members? Maybe they already do, but I don’t hear anyone clamoring for the AMA, et al to step up their enforcement.

Steve wrote:

“The GSK settlement, in my opinion, is just the most recent evidence that industry cannot be left to their own devices without proper monitoring and regulation.”

This may be true, but in some of the violations mentioned above there were two parties involved – GSK and the physicians receiving the information/perks. Some of those physicians may have been dupes, but I can’t believe they all were. The industry doesn’t have to be “left to their own devices” – those that rely on the industry may need to step up.

I am not trying to defend pharma companies at the expense of physicians. I agree with Steve about the important relationship between the two and the information that needs to be shared. All I am trying to say is that centralized regulation by a third-party is not some panacea (think of the Public Choice considerations). Physicians and their organizations should be looking to step up their enforcement.

“What this recent settlement indicates, in my opinion, is that companies will bend the rules to maximize their own profits, and that effective regulation can bring them into line and protect the public. I also think this settlement is a significant piece of evidence against the typical “Big Pharma” conspiracy theory that government is in the hands of industry. It’s hard to dismiss $3 billion dollars as a slap on the wrist. This was a clear statement.”

While I agree with this statement, I think the damage to the health care system has been done. Psychiatrists, paediatricians and family doctors are now routinely prescribing Paxil and Wellbutrin (even in Canada, where I live) for off label uses (i.e. depression in children/teens) and the $3 billion penalty, while a large fine, is nothing compared to the 10′s or 100′s billions of dollars in revenue that the company will get from the off label use of these drugs for years to come. It also provides good reasons to mistrust big pharma and gives insentive for people to pursue “alternative medicine”, regardless of the fact that many of the “alternatives” are also made by big pharmaceutical companies.

I think that the private, for profit system of drug development is very, very broken. In order to pursue profits, big pharma pursues treatments for what I would consider to be minor health issues (i.e. male impotence), sometimes at the expense of other, much more important research (i.e. drugs to combat anti-biotic resistance, low cost drugs for HIV, etc.). They sometimes invent diseases in order to access additional, previously non-existant markets (i.e. childhood Bipolar Disorder). I have a friend who has worked for a few big pharma companies and she has candidly told me some of the horrible things that these companies have done in the name of profits, knowing that they are completely unethical and doing everything they can to cover up the truth. Having said this, I don’t know what the alternative drug system would be, although it likely involves monitoring and regulating the heck out of these companies, as well as criminal enforcement of the regulations. It would also likely involve lots of government funding for research into important drugs that are not being developed by big pharma due to the fact that they are not profitable.

The problem is physicians are busy, and there is an overwhelming amount of new information constantly being generated. What we lack, in my opinion, is a centralized mechanism to package critical updates and push them to every physician.

Pharmaceutical reps, in one sense, push information to the physicians they encounter, both positive (hey, look at our new great drug) and negative (I have to tell you we now have a black box warning on this drug). It’s an additional source of pushed information.

I would also like executives to be held personally responsible, but the Corporation as Person interpretation of law creates amnesty for executives. This has the effect of passing the legal buck upward to an imaginary “entity”, the corporation. It’s like punishing the car and not the driver in a hit and run accident.

Giving corporations who do illegal things the death penalty and wiping out shareholders’ equity would deter criminal activity, or at least it would prevent it from happening again.