Would you accept money “with no strings attached” from a robber who, in the act of stealing, happened to kill some of his victims? Would you accept money that has been stolen? Would you accept sponsorships from tobacco companies for a meeting about lung diseases?
Few doctors would. Why is it then that most doctors willingly accept sponsorships from drug companies that have earned much of their money illegally while being fully aware that their criminal activities have killed thousands of patients, the very people whose interests doctors are supposed to take care of?
Here is a typical example. The Scandinavian College of Neuropsychopharmacology held its 55th Annual Congress at the University of Copenhagen on 24-26 April, 2014.1 On its front page, the meeting announcement listed AstraZeneca and Janssen as meeting sponsors, with their company logos, and with the text “All sponsor grants are unrestricted,” as if there was nothing to worry about. There surely was.
In 2010, AstraZeneca was to pay $520 million to settle a fraud case. The charges were that the company illegally marketed one of its best-selling drugs, the antipsychotic quetiapine, to children, the elderly, veterans and inmates for uses not approved by the FDA, including aggression, Alzheimer’s, anger management, anxiety, attention-deficit hyperactivity disorder, dementia, depression, mood disorder, post-traumatic stress disorder and sleeplessness.2,3 Further, the company targeted its criminal activities towards doctors who do not typically treat psychotic patients and paid kickbacks to some of them. Other doctors were sent to lavish resorts to encourage them to market and prescribe the drug for unapproved uses. AstraZeneca denied wrongdoing but the US Attorney General stated:
“These were not victimless crimes – illegal acts by pharmaceutical companies and false claims … can put the public health at risk, corrupt medical decisions by healthcare providers, and take billions of dollars directly out of taxpayers’ pockets.”
In 2012, Johnson & Johnson was fined more than $1.1 billion after a jury had found that the company and its subsidiary Janssen had downplayed and hidden risks associated with its antipsychotic drug risperidone.3,4 Jurors returned a quick verdict in favour of the state, Arkansas, which had argued that Janssen lied about the life-threatening side effects of risperidone.
Janssen continued to maintain after the verdict that it didn’t break the law, but its crimes had hit hard, also on children.5 More than a quarter of risperidone’s use was in children and adolescents, including nonapproved indications, and a panel of federal drug experts concluded that the drug was used far too much. A world-renowned child psychiatrist, Joseph Biederman from Harvard, had pushed the drug heavily to children and also extorted the company.5
The same year, the US government stated in a motion that Alex Gorsky, Vice President of Marketing, who was set to become Johnson & Johnson’s next chief executive officer, was actively involved and had firsthand knowledge of alleged fraud that involved kickbacks to induce Omnicare, the nation’s largest nursing home pharmacy, to purchase and recommend risperidone and other of the company’s drugs.6 Despite the weight of federal and state investigations of the allegations, Johnson & Johnson’s board of directors rewarded Gorsky by selecting him to be the next CEO.
How Many Patients Were Killed?
The death toll of the illegal marketing of antipsychotics, which also involved olanzapine from Eli Lilly,3 has been enormous. A meta-analysis of randomised trials of antipsychotics given to patients with Alzheimer’s disease or dementia showed that 3.5% died on drug and 2.3% on placebo (P = 0.02).7 Thus, for every 100 patients treated, there was one additional death on the drug.
What Should Be Done?
It is an unfortunate psychological fact that humans can get accustomed to even the most horrible atrocities, without even noticing that there could be a problem, particularly if they benefit from the crimes. The drug industry has learned that crimes pay, even those that cost the lives of thousands of patients and lead to huge fines.3 This is why the crimes have increased, and as in the mob, the greater the crime, the greater the advancement and earnings for the criminal.3 It is extremely rare that crimes committed by those at the top of drug companies have cost them their job.
Many of the crimes would be impossible to carry out if doctors didn’t willingly contribute to them. It is also clear that their harmful consequences for patients could be considerably reduced if doctors didn’t accept industry money.3 Doctors conveniently blind themselves to what they are doing but patients see it differently. When asked about rather small gifts to physicians, half of the patients were against.8 If patients knew what some doctors earn by collaborating with the drug industry, they would be shocked. The average annual compensation for leaders of US Academic Medical Centres when they sit on pharmaceutical company boards of directors is a staggering $312,564.9
Doctors and their organisations need to consider carefully whether they find it ethically acceptable to receive money that has been partly earned by crimes that have killed patients. The answer is obvious but when will we see change?
1. Meeting Announcement. 55th Annual Congress of the SCNP. http://scnp.org/annual-meeting/2014.html (accessed 25 April 2014).
2. Khan H, Thomas P. Drug giant AstraZeneca to pay $520 million to settle fraud case. ABC News 2010 April 27.
3. Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing, 2013.
4. Ark. judge fines Johnson & Johnson more than $1.1B in Risperdal case. CBS/AP 2012 April 11.
5. Harris G. Research center tied to drug company. New York Times 2008 Nov 25.
6. Kelton E. J&J needs a cure: new CEO allegedly had links to fraud. Forbes 2012 17 April.
7. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294:1934–43.
8. Blake RL Jr, Early EK. Patients’ attitudes about gifts to physicians from pharmaceutical companies. J Am Board Fam Pract 1995;8:457-64.
9. Anderson TS, Dave S, Good CB, Gellad WF. Academic Medical Center leadership on pharmaceutical company boards of directors. JAMA 2014;311:1353-4.