
Whistleblowers: Drug company offered 'bribes' to doctors to boost sales - aaronbrethorst
https://www.cnn.com/2019/04/30/health/mallinckrodt-whistleblower-lawsuit-acthar/index.html
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netwanderer3
It's disheartening that this med is being used to treat infants and they
wouldn't even leave those helpless babies alone. Healthcare is a $3.5 trillion
dollar per year industry and is powering 20% of U.S economy, but I think the
problem goes a lot deeper and further than just the medical field. This is a
systematic issue across all industries where profits are increasingly being
prioritized above everything else, even when it involves the most basic and
essential human values.

Is the rapid increase of population part of the cause? Overpopulation often
means the value of each individual will be decreased since anyone is now
easily replaceable and becomes irrelevant. There are no signs this trend is
going to stop anytime soon. I fear there has to be a massive catastrophic
event to happen in order to trigger any societal changes at this level.

~~~
basetop
It is pretty much every industry. The tobacco industry pushed studies and
advertising claiming smoking was doctor approved and "healthy". The food
industries/companies and their studies claiming cereal and orange juice
constitutes a healthy breakfast. The oil industry, pharma, etc.

I think the diminishing value of humans/individuals is a result of
overpopulation and industrialization. I don't remember who said it, but cities
are now industrial farms for humans and a human being is a commodity/resource.
In an industrial society, a human being is fundamentally no different than a
cow or a pig on massive industrial farms. Our value is our commoditize
productive value.

~~~
myth_drannon
That's why HR is Human RESOURCES. I believe you are correct in your
observation and your comment makes me very sad.

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stakhanov
"Drug company offered 'bribes' to doctors to boost sales": I don't see how
that headline constitutes news to anyone with even just a passing familiarity
with how this market works.

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zerogvt
My thoughts exactly. Situation in healthcare is utterly dismal. I see
prescriptions of very expensive medicine where there are alternative brands
(or generics) for a fraction of the price and when people complain (a serious
percentage of the price comes off their pockets) doctors respond with vague
mumble-mumble about that drug being a new generation.

~~~
muro
Unfortunately, there are drugs where the generics don't work as well as the
brand. Then it's tricky what to prescribe.

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friendly_chap
I am originally from Hungary, from a small town. My aunt is an assistant for a
child doctor.

Every single doctor here gets approached by multiple drug companies, being
offered expensive vacations and similar perks (if not outright money) for
prescribing the company's medications.

One particular doctor who is an absolutely disgusting and vile human being
describes antibiotics for every ailment. He essentially ruined thousands of
children's health for said perks. It got so bad the word spread in the town
and apart from the least informed families no one took their children to this
doctor if they could avoid it.

But this is just one doctor. The other 2 who practiced here also accepted
rewards, but were a bit more sensible with it, but not by much. According to
my aunt this is an incredibly widespread problem, and one that has been going
on for decades.

I can't imagine anything more atrocious than sacrificing children's health for
material gain. A person who is support to protect life and does this... I'm
not religious and I seldom wish ill fate to people, but I do hope there is a
hell for these kind of people.

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arkades
1) this is a lot more uncommon than people seem to suggest. Note from this
article, they found -288- docs. In a country with a little over 1,000,000
physicians.

2) the real problem is the legislation congress pushed through barring
Medicare from negotiating drug prices. “Many of those sales are driven by
Medicare reimbursements. A CNN investigation last year found that Medicare
spending on Acthar had risen dramatically -- more than tenfold over six years
-- to some $2 billion.” the article went ahead and glossed right over it, but
if Medicare is your prime payer and can actually push back on price jumps,
-this doesn’t happen-.

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fit2rule
I know a 'pharmaceutical representative'. She is little more than a corporate
prostitute - and I mean that sincerely.

She is paid to take doctors on dinner dates, woo them and give them 'free
samples', and ensure that they promote her product over all the others. She's
admitted to me that she regularly has sex with her clients - and that she's a
part of a larger team that covers the entire German market.

Its such a normal, accepted practice, that my surprise at her frank attitude
about it was met with a "well, duh, how do you think we stay relevant in such
a competitive market?" response ..

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neilv
Salespeople have long wined and dined customers, been charismatic, etc.

I've never heard (in the US) of a practice of salespeople having sex with
customers. I'd expect to hear a lot of lawsuits, were that a practice in the
US.

It'd be sad if people who are just doing normal sales work (e.g., talking with
the customer, understanding and communicating how product could work for them,
negotiating deals) were insulted or had their reputations harmed by a
suggestion that they were doing something else.

~~~
fit2rule
So its clear, she openly admitted to the fact of her sexual engagement, and
was kind of proud of it.

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neilv
I was speaking of the suggestion that it's a normal, accepted practice. If
people thought it was, then they might unfairly assume or suspect of it of
many salespeople who do not do that.

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DoctorOetker
you write "unfairly", but you probably mean "incorrectly"

there is nothing unfair about people assuming or suspecting things, we do not
regulate each other's thought processes.

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neilv
I see your point, and I could agree to "incorrectly", but would you agree that
assumptions and suspicions tend to affect behavior, which would be when the
"unfair" comes in?

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gingabriska
Don't want salesmen? Remove the market.

~~~
neilv
I think we can update the names of the old "salesman" tropes to be gender-
neutral. I'm pretty sure there are many women in pharma field sales, for
example.

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fredsanford
Judging by the pharma people that visit my MD's and cardiologist's office,
they're all miss america candidates less than roughly 30 years old...

MCI did the same shit back in their day. A sales visit from MCI almost always
consisted of 1 each: redhead, blond, brunette all of whom looked like models.

~~~
danieltillett
You should see the men too given how many doctors are women. Pharma sales is
the most competitive of all sales jobs and doctors one of the hardest
professions to sell to. The outcome is unless you has totally stunning and
dripping in charm you are not getting into see the doctor.

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pjc50
I'm fairly sure there were reports of this happening _in the middle of the
opioid scandal_ \- the doctors most willing to overprescribe opioids were
statistically identified and bribed by the relevant pharma company. Perhaps
someone else can find the reference to this?

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philliphaydon
First heard about this in the documentary Prescription Thug$. The way the
industry works in America is bizarre.

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mnm1
Is this a patented drug? If so Congress has the ability to step in and
invalidate the patent. Not that they will do it. Those assholes couldn't give
a fuck if infants have seizures and die. If not where's the competition? I
thought this was a free market. Surely undercutting this price should be easy
while still making money. It seems the patent should have expired by itself by
now anyway.

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aaavl2821
There's no patent. But there's no regulatory pathway for developing a
"generic" version of this drug. It's probably one of the most egregious
examples of price gouging ever and there's little anyone can do about it

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aaavl2821
This is probably the most egregious example of price gouging in the pharma
industry. But it is an outlier and not representative of the whole industry

I feel like there are ~3 groups of high priced drugs:

\- straight up profiteering: this is the questcor playbook, that also inspired
martin shkreli. companies find cheap old drugs that treat severe rare disease
where they can get away with jacking up the price. The companies do no
original r&d or new science. This is a rare practice these days and is highly
stigmatized in the industry, as this type of practice kicked off a lot of the
political debate around drug pricing

\- increasing price of "legacy" drugs: big pharma is increasingly bad at r&d.
The industry is also in a period where a lot of huge drugs are going off
patent. So pharma companies increasingly rely on price increases of mature
drugs, rather than development of new drugs, to sustain revenue growth. This
is a much bigger phenomenon in dollar terms than the aforementioned
profiteering. This is possible mostly for large molecule drugs because the
"generic" pathway isn't as mature as small molecules, so the large molecule
drugs can have exclusivity after patent expiry. Huge multi billion dollar
drugs like humira and enbrel have done this a lot. Private payers are
beginning to push back on this pretty effectively, and hopefully as the
biosimilars industry matures this will improve.

\- innovative, clinically valuable medicines. Some medicines are expensive
because they are worth it in health economic terms. The cost per QALY gain is
within the "acceptable" range. Most of the industry really does try to develop
drugs like these (with varying degrees of conviction), but it's really hard.
Companies ideally only want to develop drugs that are first in class or best
in class. When that fails (which it usually does) they resort to
aforementioned strategies. Unfortunately in many cases these innovative drugs
are priced too high. They are often developed by startups and then bought by
big pharma once the tech is derisked. Pharma is under huge pressure to grow
revenue so they often price these meds too high. Which is a shame bc a lot are
amazingly good medicines

Price isn't the only issue though, access is another, although they go hand in
hand. Price can be "fair" but access still limited by payers. Copays for drugs
are generally higher than for medical procedures, so consumers feel like drug
prices are higher than medical procedures, when in reality they are all super
high

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howard941
Stories such as this one highlight the need to address the industry's
widespread price gouging head-on. Detecting and punishing the secondary
offenses whether they're bribery or peddling off-label uses _sub rosa_ are too
unreliable in light of the stakes. We must do better.

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a_imho
The majority of patient facing medical ~professionals are pharma salespeople
anyway.

~~~
collyw
In the States maybe. Not in most developed countries.

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otabdeveloper2
> Drug company offered 'bribes' to doctors to boost sales

Oh wow, such news.

In other shocking developments: water falls from the sky when it rains, and
cigarettes are addictive.

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georgehayduke
As someone outside the U.S. I find this whole pharma-complex absolutely mind-
boggling.

~~~
Hoasi
Is it really different elsewhere though? These are the same conglomerate firms
everywhere.

~~~
pjc50
The UK bans advertising to the public for prescription drugs, and has a
standard cost-effectiveness approval process for what the NHS will prescribe
("NICE"). Drug marketing is a lot less prevalent here.

