The Ethical Nag

No, these are not NHL hockey players’ salaries.  They’re last year’s annual incomes of the 17 highest paid pharmaceutical company CEOs. Please note that there are no women on this list. Figures include the full compensation package of stock options, annual incentives, performance-based grants (equity and cash), restricted stock grants, and other corporate perks.

As nice as these numbers look, Big Pharma über-salaries have largely escaped the scathing attacks that wealthy health insurance company execs have endured since the American health reform adventure began. Could this be because of the $200 million that the powerful Pharmaceutical Research & Manufacturers of America have donated to help President Obama’s overhaul of the U.S. health care system?   Read the list

Drug giant Merck & Co. is paying the families of more than 3,100 Vioxx painkiller users who died of heart attacks and strokes that were blamed on the drug. Merck introduced Vioxx in 1999 but withdrew it from the market in 2004 when a study showed the drug doubled the risk of heart attacks and strokes. By 2007, Merck had set up a fund of $4.85 billion (yes, that’s billion with a ‘B’)  to cover claims of death and lesser injuries, after reserving $1.9 billion to fight over 26,600 Vioxx lawsuits in court. “We don’t know any drug right now with this number of deaths associated with it,” said Houston attorney Mark Lanier. “This is a very sad chapter in the tragedy of pharmaceutical companies gone wild.” 

And – quelle surprise! - Vioxx turns out to be one of countless prescription drugs that have been fraudulently promoted in industry-funded ghostwritten articles in medical journals. According to a study published in April 2008 in the Journal of the American Medical Association, Merck hired medical ghostwriters who drafted dozens of ‘research’ studies for Vioxx, then lined up prestigious doctors who agreed to fraudulently claim to be the actual authors for submission to journals. JAMA itself published one of the ghostwritten Vioxx articles.  The New England Journal of Medicine sold 929,400 reprints of a single Vioxx-friendly ‘research’ article (mostly sold directly to Merck for their sales reps to distribute to physicians as part of the sales pitch) bringing in more than $697,000 in revenue for the journal.

The New York Times reported at the time:

“The JAMA study provides a rare, detailed look at the industry practice of ghostwriting medical research studies that are then published in academic journals.”     Read more…

If you want to predict what you should be worrying about tomorrow, find out what insiders are worried about today. For example, it’s ever-so-enlightening to eavesdrop on the internal reports that Big Pharma stakeholders are reading, where the lowly, uninformed patient can find intriguing musings from pundits, those who are paid to stay one step ahead of the prescription pad. At the Pharma Chem Outsourcing conference this month in New Jersey, speaker Stefan Loren of the investment firm Westwicke Partners revealed a sobering view of Big Pharma in his talk, “The Pharma Titanic: It’s Time To Root For the Iceberg”.

Mr. Loren opened his presentation with an overview of the U.S. national health care debate. He said that mandatory health insurance will be good for Big Pharma. But he also believes that there will be strong pressure for mandatory comparative effectiveness testing between drugs -  not good for Big Pharma. He sees global pharmaceutical sales declining, except for future growth coming in Asia and Latin America. He also sees evidence of “health care avoidance” – practices like unfilled prescriptions, unfinished courses of prescriptions, and people just not visiting medical and dental practitioners, also not a good trend for Big Pharma.

“The coming wave of patent expirations of the top 10 drugs will hit Big Pharma hard. Generics will grow: in 5-10 years, 80% of all prescriptions will be generic.  That means trouble ahead. For investors, the return on investment for Big Pharma is largely negative. It’s a “death spiral.”  Read more…

Little Lyam Kilker’s mother Michelle David had no idea that the antidepressant drug Paxil she was taking when she found out she was pregnant would cause a life-threatening heart defect in her baby boy. She didn’t know this because the drug’s manufacturer, GlaxoSmithKline, didn’t bother to share birth defect warnings that they allegedly had known about for decades. 

Lyam’s mother now claims that Glaxo, the world’s second biggest drug company, withheld information from both consumers and regulators about the risk of birth defects, and failed to properly test Paxil.  Her Pennsylvania court case is the first of over 600 lawsuits alleging that Glaxo knew Paxil caused birth defects, but deliberately hid those risks to increase profits. * See update below

Coincidentally, Paxil is just one of countless drugs whose sales were boosted by medical journal articles that were actually written by industry-paid ghostwriters.  According to an internal Glaxo memo written in April 2000, the ironically-named CASPPER ghostwriting program was designed to “strengthen the product positioning and overcome competitive issues”.  It was a unique twist on garden-variety ghostwriting fraud, because it used Glaxo’s huge drug sales force to convince private practice physicians on their routes to lend their names to Glaxo-written articles for journal submission – articles that downplayed Paxil’s association with serious side effects such as suicide and birth defects. At the time, Paxil was competing with rival antidepressant blockbusters like Eli Lilly’s Prozac and Pfizer’s Zoloft. Paxil has since lost its patent protection and now competes against cheaper generic versions of the drug. Read more…