Doctors Reap Millions for Anemia Drugs

[Donnachaidh]

Source: NY Times

Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.

Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.

Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year.



Read more: http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=1&th&emc=th&oref=slogin

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And doctors wonder why people are suspicious of their motives? Please kick this up. This is frightening.

[sutz12]

1. Definitely....K&R

:kick:

[blueworld]

2. K&R

Bravo to the NYT for ascertaining & publicizing the legal kickback system that governs Big Pharma. If most consumers knew, they'd be furious.

[kestrel91316]

3. Violation of medical ethics. Period.

[Jamnt]

4. A few notes about these drugs...

I'm a hospital pharmacist and have followed these drugs very closely in our population for about 2 years. I can say with experience that these drugs do not work that well. Just a few % of patients see improvement in their hemoglobin levels, many still require transfusions despite being on these drugs. I've given this feedback to our docs and our use has dropped off some, but the reps are busy people.

That being said, most of our docs know full well the dangers of trying to push the hemoglobin levels above 12, and none even try. It's a struggle to get them above 10 in most cases, even with higher doses. (The danger of increased heart attack risk and strokes is speculated to come from higher blood viscosities.) The FDA recently put out a med watch alert warning of this danger when results of a recent study became available.

The practice of kickbacks is deplorable, even more so in a setting where the drugs have questionable effectiveness. I have seen in our hospital system these drugs cost as much as 15% of our total drug budget. This is big pharma at its worst.

[Justitia]

5. My son, a dialysis patient, receives these drugs & they are vital to him.

I responded to this topic on another thread:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=2839388&mesg_id=2839388

For my son, they are very effective and most importantly, they do not jeopardize his priority for a transplant - which a blood transfusion (the only alternative) would.

[Donnachaidh]

6. Are you happy with the FACT that doctors are being BRIBED to prescribe them?

There is a real problem with the ETHICS of this situation.

[Justitia]

7. That is hardly accurate in terms of dialysis patients. I cannot speak to cancer patients.

For dialysis patients (as was explained in the article), the drugs are purchased by dialysis clinics (not the doctors), but prescribed only by the patients individuals doctors (not the dialysis clinics).

The dialysis clinics have NO influence over what the individual doctor prescribes, and the doctor receives NO financial incentives since the doctor does not purchase the medicine.

My son's dialysis clinic wouldn't give my son as much as an aspirin without clearance from his nephrologist.

I know nothing about the use of these drugs in cancer therapies, but I suspect the vast majority of these drugs are used for dialysis patients, not cancer patients.

[dbackjon]

9. Right you are.

The problem is with the cancer industry. EPO has a LONG history of being very effective for dialysis patients. Without EPO, most would die in a matter of months, instead of years and years.

[dbackjon]

10. Right you are.

The problem is with the cancer industry. EPO has a LONG history of being very effective for dialysis patients. Without EPO, most would die in a matter of months, instead of years and years.

[dbackjon]

11. Right you are.

The problem is with the cancer industry. EPO has a LONG history of being very effective for dialysis patients. Without EPO, most would die in a matter of months, instead of years and years.

[Donnachaidh]

12. and you know this for FACT?

Certainly the clinic may not have drug company contacts -- but your nephrologist certainly may. Next time you're at the clinic - keep an eye out for drug company reps. They haunt these places like vampires.

[Justitia]

13. Yes, I do. I spend 12 hrs every week there. The nephrologist does not BUY any drugs, so the reps

would not be interested in him whatsoever. And in all my time in dialysis clinics, I have NEVER seen a drug rep in any of them.

You have to think of dialysis clinics as an extension of the hospital, and it's pharmacy works like a hospital pharmacy. Now recall how the doctor's relationship works with the hospital pharmacy and you will begin to see why this is a non-issue between nephrologists and dialysis clinics.

[Donnachaidh]

14. 12 hours a week -- what about those other 28 hours?

I realize you may feel you owe allegiance to your doctor for your son's health. I too have a child with serious health issues. But I've opened my eyes and I'm not willing to elevate his doctors to sainthood.
That's one of the serious issues with health care today. Far too many people look the other way when they should be watching what is going on.

[Justitia]

18. The only "allegiance" I claim is to my son's health. His medical team is a means to an end.

I've been caught up in this chronic care situation for long enough to be cynical about making anyone a "saint". My sons current medical team happens to be very, very good. But, this is way off topic, back to the anemia drugs.

My son has two choices ONLY: these anemia drugs or a transfusion
The result of doing nothing is death from his congestive heart failure.
Transfusion means no transplant, transplant failure or death from transfusion reaction.

Decisions get really, really simple when your life is on the line.

Everything I've said applies to our situation of kidney disease / dialysis only.
I know nothing about the employment of these drugs in cancer therapies.

[mhatrw]

15. So the fact that the dialysis clinic gets kickback makes it kosher?

Sorry, but that doesn't wash. I'm glad these drugs help your son, but that doesn't in any way mitigate this deplorable practice.

[Justitia]

24. I don't know anything about "kickbacks" & I fail to see how they would really work

Bear w/me, I'm thinking through it out loud...

The clinics buy the drugs in massive bulk from the drug company. They get a rebate, volume discount, whatever you want to call it. The clinic stocks it on it's pharmacy shelf.

However, only a patient's doctor can prescribe it's use. The doctor is not an employee of the clinic, he has practicing privileges there, like a hospital.

So, the clinic buys the drug, but they have no control over it's use. If they buy more than is used by a patient's doctor, it simply goes bad and their $$$ is wasted. Why would they do that? Medicare is not billed for the drug until it is administered (I get copies of the bill), so it's not like the clinic gets paid for hoarding drugs not used.

Having said that, I don't know anything about how it is administered for cancer therapies. I believe that some cancer doctors administer it directly to their patients in their own offices, but I don't know.

I will say, these are very powerful drugs and I just don't see so many unethical doctors willing to risk killing their patients (seriously), for rebates.
I'm sure somebody will accuse me of not being cynical enough :)

[ismnotwasm]

25. I work in transplant

We do in-unit dialysis. We're fairly conservative with EPO and the like with our adult patients--it's a state hospital, but I don't know if that makes a difference as far as "kickbacks" I'll ask around, out of curiosity.

Dialysis is no fun, none of the consequences of kidney failure are. Anemia can be devastating.

Keeping your son as healthy as possibly prior to transplant is crucial as of course you know. Kudos for being an great advocate for your son.--it's makes all the difference in the world. :hi:

[Justitia]

27. Hi there! Everyone I personally know in dialysis is very conservative w/EPO, renal patients are so

tricky, as you know. They don't call them "trainwrecks" for nothing. Constant monitoring of the heart, kidneys, eyes, lungs, brain and blood.

My son suffers off and on with very severe anemia. He was down to 35% heart function recently and I was praying to all the gods I don't believe in to avoid a transfusion. Good news, he's back to 45 - 49%.

We start all our transplant testing in a few weeks. Even just the testing scares me (stress tests, raising & lowering the heart rate, etc, etc). And of course, I don't want him to so much as scrape a knee. He's got IgA Nephropathy, age 24, BTW.

Thanks for your work in renal, it's such a difficult area of medicine. :hi:

[ismnotwasm]

28. Good luck!

The work-up process is stressful, I know. We "do" kidney's, livers and pancreas transplants on our floor. You're very wise to have avoided transfusions. (As I'm sure you know)

If it helps, our particular transplant program has had particularly great success with kidneys. We've done many with IgA nephropathy. It's a great feeling watching them walk out the door dialysis free.

Give your son a hug, tell him a complete stranger is definitely in his corner, as is sending good vibes and thoughts

[Justitia]

31. Thank you, so very much. I'm glad to hear you've done many w/IgA.

Even though we are in a big med ctr area (Houston), we still hardly see any other IgA patients.
My son worries about the IgA attacking a new kidney, but it's got to be better than today.

Thank you so much for your warm thoughts and well wishes!

[HiFructosePronSyrup]

21. How dare you treat your son's medical conditions.

Don't you know you're just a shill for Big Pharma?

Just pulling your chain, Justitia. Best wishes for you and yours.

:hi:

[Justitia]

22. LOL - Unfortunately, I see where this thread is going...

This particular alert was a big concern of mine when it first came out (and it remains so, obviously), but I can see that rationality is about to go right out the window.

I thought about posting more, but really, unless you or a family mbr is living this, I could never begin to explain all the complexities, so it's pointless to try to boil it all down.

So yeah, I guess my kid is just another pawn in the evil agenda of the Medical Industrial Complex & Big Pharma :evilgrin:

Thanks for the hello!

:hi:

[gravity]

8. I took that drug and it was expensive as hell

I remember it being around $2000 a shot, which you take once every one or two weeks. To put it in perspective, a blood transfusion cost $1000. I wonder how much they mark up these drugs, if they are able to give doctors large amounts of money.

I remember the doctor telling me that some cyclists use Procrit to dope their blood, and many would experience heart attacks from too many blood cells or something. Luckily I was young, so I was not at risk for heart problems.

[mhatrw]

16. If they can give doctors 2.7 million for prescribing 9 millions worth, that's a 30% commission.

And the doctors are part-time drug salesmen making a higher commission than most aluminum siding salesmen.

[earth mom]

17. Anemia Medication?! Years ago, I had anemia & was told to buy over the counter Iron pills.

And to eat lots of broccoli etc. So why do people now need "Anemia Medication"? :wtf:

Obviously, this is just another example of the medical industry scamming America. :grr:

[gravity]

19. Chemotherapy nt

[earth mom]

20. Yes, I saw that after I posted. So perhaps the drugs are needed...however

I'm not wrong about the scamming part.

[HiFructosePronSyrup]

23. Years ago, if you had a bacterial infection they gave you sulfa drugs

I think "years ago" is the relevant point here.

[knitter4democracy]

29. No, it's still standard treatment.

The article is referring to the epo drugs, which are used for people undergoing chemo or dialysis.

[earth mom]

32. Okay, Okay, I was wrong, didn't realize it was for chemo.

:shrug:

[StarryNite]

26. Big Pharma strikes again

[knitter4democracy]

30. Frankly, this is massively disturbing.

They're put down as "consulting fees" (Hubby was offered one once, that's how we know, and he was disgusted with the idea and threw it out). Our friend who's an oncologist wouldn't take that kind of crap, and I doubt my kidney doc would, either (very upstanding kind of guy--came in on a day off the day after my surgery to check on me, always returned my calls himself, etc.). I doubt they're spending that kind of money in our area, but it is still highly disgusting.

Pharma needs more regulation, frankly. They disgust me.