Pfizer Discloses $35 Million In Payments To Doctors, Hospitals For Research And Promotion
02 Apr 2010
Pfizer, the largest drug maker in the world, disclosed 35 million in payments during the second half of 2009 to doctors who consulted or spoke on behalf of drugs and to the medical centers that tested them, The New York Times reports. This is Pfizer's first disclosure of this nature. "While other pharmaceutical companies have disclosed payments to doctors, Pfizer is the first to disclose payments for the clinical trials. The disclosure does not include payments outside the United States" (Wilson, 3/31).
"The drugmaker made the disclosure as part of a government settlement after it pleaded guilty last year to illegally promoting more than a dozen of its own drugs. It also paid a record $2.3bn fine in connection to the deal," the Financial Times reports. "Pfizer said the disclosures were in line with healthcare reporting provisions included in the new healthcare reform law that was signed by US President Barack Obama, last week" (Kirchgaessner, 4/1).
The Wall Street Journal: The payments reached 4,500 doctors and 250 medical research institutions. They "included an average of $5,000 each to about 1,500 health-care professionals to provide input and advice about the needs of patients. Also, about 2,800 professionals received an average of $3,400 apiece to serve as speakers who educate peers about the safe and appropriate use of Pfizer drugs, the company said." About 250 hospitals shared in $15.3 million for research, clinical trials and recruiting trial participants (Rockoff and Loftus, 3/31).
The Associated Press: Pfizer posted its payment data in a searchable database. "Data posted by three other drugmakers so far has not been so user-friendly, said Allan Coukell, director of the Pew Prescription Project, a consumer group." The database also provides information about nonmonetary rewards, such as meals, travel, office wall charts and other items. The firm spent $1.7 million on business-related travel for doctors in the six month period. The new federal law will require even more rigorous disclosure, to include items that cost $10 or more. If expenses and payments to a single doctor top $100, they will have to be reported the U.S. health department (Johnson, 3/31).
This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.
Article URL: http://www.medicalnewstoday.com/articles/184273.php
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I Fired My First Doctor on Day 15
The day after our visit with Dr. Star, we had an appointment with Dr. George Babbitt (whose code-name alas, won’t make sense without a background in American Literature).
As it happened, this first appointment with a physician did absolutely nothing to ease my growing suspicion of modern cardiac medicine. He reiterated the message from Dr. Ghoul: my medical needs could not be met in Naples and I was being referred to a surgeon in Tampa for a heart transplant.
I asked Dr. Babbitt about the Lipitor dose he had prescribed me. By then, I had already found for myself the safety and efficacy FDA studies that originally approved Lipitor. These studies had used doses of 2.5 mg and 5 mg daily. Yet interestingly, the lowest available dose of Lipitor manufactured by the pharmaceutical company, Pfizer, was 10mg – double the highest dose used in the FDA studies for safety and effectiveness!
If that wasn’t enough to raise my eyebrows, Dr. Babbitt prescribed 80 mg daily doses of Lipitor – 16 to 32 times the doses used in the FDA studies. I told my doctor about my research on the FDA studies.
“You shouldn’t worry about those FDA reports – I have studies showing that 80 milligrams per day are safe, and more effective than those lower doses.”
I asked him who had done his studies.
I didn’t tell him that I was already aware of the Pfizer sponsored studies.
I suspect that Dr. Babbitt never saw the actual Pfizer studies, but had simply taken the word of a “detail man,” a representative of a drug manufacturer who calls on doctors to promote the products from that company. I wondered if he would be so enthusiastic about high-dose Lipitor had he actually read the study.
In 2005, the New England Journal of Medicine published a report funded by Pfizer that described the efficacy of high-dose Lipitor in cardiovascular disease. The authors concluded that high-dose Lipitor (80 mg) was superior to a ‘standard dose’ (10 mg) in reducing negative cardiovascular events in coronary heart disease (CHD) patients. Ten thousand CHD patients participated in the five-year study. Half of them received a daily dose of 80 mg of Lipitor, while the other half received a control, ‘standard’ dose of 10 mg/day.
The Pfizer study observed a reduction in major cardiovascular events in the high-dose Lipitor group (heart attack and/or stroke) over the course of the experiment. In the 80 mg group, 8.7% (or 434 patients) suffered a major cardiovascular event, compared to 10.9% (or 548 patients) of patients in the standard 10 mg group. When you do the math, that’s a difference of 2.2% – or 104 fewer cardiovascular incidences in the high-dose Lipitor group – a statistically significant improvement over standard treatment. Furthermore, only 126 patients in the 80 mg/day Lipitor group died from cardiovascular problems during the study, as compared to 155 in the 10 mg/day group.
I was surprised to discover that treatments were tested and put into practice with such small efficacy ratings. But, 2.2% is better than nothing, right?
Not when you take into account that in this same study, 158 deaths due to non-cardiovascular events occurred in the 80 mg/day group (3.2%), versus only 127 (2.5%) in the lower dose condition. Cancer, particularly lung and gastrointestinal, was responsible for more than half of these deaths. Hemorrhagic stroke and other, non-traumatic causes contributed to the remainder of non-cardiovascular deaths in both treatment conditions. However, this difference of 31 more deaths from non-cardiac related causes in the high-dose group brings the total deaths to 282 in the 10 mg Lipitor group, and 284 in the 80 mg group – statistically, that means there was no difference at all. Your chances of survival were actually 1 in 5000 lower if you took a high dose rather than a standard dose of Lipitor.
Between the actual statistics revealing the serious side effects associated with Lipitor and other statin drugs, and the failure to improve overall survival rate by using higher doses of Lipitor, I suspected that my doctor, had he actually been up on the facts, could have made a wiser choice. However, the professional to whom I was entrusting my life didn’t seem to be as well informed on the subject as I was. Later I was to discover that this isn’t unusual; it doesn’t take much research to be better informed than some doctors.
However, it was easy to understand why the drug salesmen from Pfizer only talked about the (tiny) advantage in reducing cardiac events and failed to mention the fact that there was no overall advantage in reducing death.
So why were the patients in the high-dose Lipitor study dying more frequently from non-cardiovascular causes? At this point, the mechanisms underlying this effect are unclear – we just can’t tell. But as one expert in the field wrote, “we need further reassurance as to the safety of this approach before making this higher dose a standard practice in CHD pharmacological therapy.” Despite their prevalence, the statins are not the only available method that can be used to lower LDL-C levels. Hybrid therapies with other drugs, natural therapies, and nutrition can all be effectively used for this purpose. But my highly paid doctor didn’t know that, either.
I mentioned to Dr. Babbitt that, in spite of all the testing done so far, my cholesterol levels had never been checked, even though Bunny had asked on three different occasions for my cholesterol, LDL, HDL and triglyceride base levels, as well as for reports on relevant things like current kidney and liver functions. “Wouldn’t it be a good idea to know what Sam’s present levels are, so that we have a baseline against which to measure?” she persisted.
Evidently Dr. Babbitt had liberated modern medicine from the restraints of science, as well as from the need to listen to the concerns of, or share information with his patients. His response was, “It doesn’t make any difference where they are now, because I know I want them lower.”
I also expressed my concern about statin drugs’ effects on liver function. The University of California had recently issued a report to the effect that statin users do run a serious risk of liver damage following prolonged use. They strongly recommended frequent blood tests to monitor liver function, so that the doctor would be able to end drug therapy immediately, should any abnormalities appear.
“Shouldn’t we check my liver function, so we have a baseline to measure what effect Lipitor is having on my liver?”
“No, if your liver starts acting up we can deal with it then,” was his reply.
“What about CoQ10?” I asked next. Statin-induced CoQ10 depletion is well documented in pre-clinical and clinical studies, leading to detrimental cardiac consequences in both animal models and human trials. Furthermore, this drug-induced nutrient deficiency is dosage related (recall my 80 mg/day dose) and is usually seen more frequently in the context of either a pre-existing CoQ10 deficiency (such as in the elderly) and in heart failure patients. One source from an unnamed MD said, “Prescribing statin drugs without also including CoQ10 constitutes malpractice, in my opinion!”
Dr. Babbitt’s response: “We don’t use CoQ10.”
“I see,” I said. And I did.
I asked several other questions at that appointment, but my doctor grew increasingly annoyed and impatient. Dr. Babbitt was the first doctor I fired. And since Dr. Babbitt happened to be Dr. Ghoul’s partner, I actually got a two-for-one deal.
Does Your Heart Doctor Have a Drug Company “Pimp”? 
By Layne Lowery
Cardiologists are more than twice as likely to receive direct payments from drug companies for consulting and other services, a recent national survey concluded.
A study published in the April 26 issue of the New England Journal of Medicine says despite the potential for conflict of interest—almost EVERY practicing physician in the United States has some type of relationship with pharmaceutical manufacturers. The study says these relationships vary based on the kind of practice, patient mix, medical specialty and professional activities. Researchers at Massachusetts General Hospital, Yale University, the University of Melbourne, and Royal Melbourne Hospital in Australia conducted the first national survey of 1,662 practicing physicians in late 2003 and 2004 to study these relationships. They surveyed doctors in six specialties to determine the extent of their financial ties with the pharmaceutical industry—and the factors that predict those ties.
Study findings indicate drug and device manufacturers hand pick the doctors with whom they’ll form the strongest ties. In addition to direct payments, study results show cardiologists are also more likely to be paid honoraria than pediatricians, anesthesiologists or surgeons.
Study co-author Eric Campbell, Ph.D., an Associate Professor of Medicine at the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School, notes the strategic implications of these “hand-washing” practices. Campbell said “if the drug and device industry can influence cardiologists, they can likely influence the prescribing practices of other doctors.”
 Reprinted with permission of Health Resources, www.healthresources.net.