Tuesday, January 29, 2008

An Ethical Way to Make $750/hour?

Recently, I wrote about the anonymous physician, Hired Gun, M.D., who has made as much as $800,000/year giving talks for drug companies. Some were horrified, others may have been secretly envious. Here's a key question: Is there any way for "unbranded doctors" (to borrow a phrase from the National Physician's Alliance) to make that kind of dough?

Funny you should ask. Recently, I received a call from a large law firm specializing in securities litigation cases. The attorney explained that his firm was suing Eli Lilly for defrauding investors of stock value, because they had misled these shareholders about the negative side effects of Zyprexa. If Lilly had been honest, so the suit claims, investors would have unloaded Lilly stocks earlier, thereby avoiding losses as the stock price decreased in reaction to negative media attention, particularly this New York Times article.

So where do I come in? The attorney asked me to consult in writing a paper outlining the marketing points used by antipsychotic drug makers. This brief would be used as legal ammunition, in order to prove that Zyprexa's weight gain and hyperglycemia side effects led to loss of market share versus its competitors. If I accepted, I was promised $500-$750/hour.

I respectfully declined his offer, because I believed it would create an unacceptable conflict of interest. After all, in both this blog and in The Carlat Psychiatry Report, I write about antipsychotics all the time, and I was loathe to open myself up to a criticism like, "You're being paid to say bad things about Zyprexa."

While I'm comfortable with my decision, I know that there are several prominent critics of the pharmaceutical industry who accept this type of work, including David Healey and Adriane Fugh-Berman, both of whom I know personally and who are utterly ethical people. Aside from the money, I believe they do this legal work because it is fascinating, and because it contributes to our shared cause of greater transparency in the drug industry.

So, is consulting with legal firms an ethical way to make $750/hour? Probably so, but for me, having already had my own first-hand experience with the corrupting influence of money, it's just not worth the risk of it happening again.

9 comments:

Anita Barkley said...

While David Healy has spoken out against the drug companies, to say he is "utterly ethical" is ridiculous. Look at his record regarding ECT. In his new book, did he disclose his mentor, Max Fink, co-authored the book and funded the book? No, because there was an obvious COI. David Healy goes to where the money is and is doing quite well. Are you aware David Healy endorses unmodified and regressive ECT? Has yet to acknowledge ECT can and does cause premenate amnesia? Come on doctor, you lose credibility with such an endorsement of someone with such obvious COI's.

LISA EMRICH said...

Gee Whiz...I'm in the wrong field. On several occasions, I've written something regarding PhRMA and it's propaganda to have extensive visits to my blog to check out all I was saying. I even joked recently with David Williams over at Health Business Blog that the many PR firms which PhRMA employs to monitor there PR efforts really should start paying me consulting fees since they seem to find certain of my pieces helpful. (I only say this because after a recent piece which APCO, Edelman, and Gray all checked out, Ken Johnson submitted a "letter to the editor" which was a re-written version of a recent press release and the changes made omitted similar bits to the complaints I had made.)

Stephany said...

Could it be possible to author the paper and accept no fees?

Rather than decline to avoid critical commentary?

I must say this causes me to shake my head in disbelief, that medical community is supposed to be, in my opinion, humanitarians at heart.

In my work/job I teach Autistic kids, Downs, etc. the day is busy, and I enjoy the kids. I earn 13 bucks an hour.

So the 750.00 per hour is over the top, and makes me wonder where the point is any longer with regard to the medical profession.

That means for 2 hours I could write and make a house payment.

Also, yes, Max Fink is a whole other story. Informed consent is being shown a video about ECT.

Anonymous said...

I have been practicing psychiatry for about 20 years and have gotten every sort of offer imaginable. I also did the drug talks for Effexor in 2001. They quite scheduling me after the first few talks perhaps because I wouldn't endorse it as first line and made sure to discuss discontinuation syndromes. Perhaps I just wasn't that good but the rep made sure that I knew of his displeasure about those two issues.

I have learned that whenever someone offers substantially more per hour than the usual clinical rate, they are buying something other than an objective opinion. Now, I don't even allow a trickle of an interest if the dollars offered are much above where the market usually values my labor.

Suicide Malpractice said...

Dan: Did you agree or disagree with the plaintiff claim? Did the lawyer ask you to do something misleading or unethical in any way?

Daniel Carlat, M.D. said...

No, I was not being asked to say anything untruthful, nor would I have knowingly done so. However, it's likely that in the back and forth process of revising the document, I would have felt pressure to make my claims sound "stronger." At least, that's what I'm told often happens.

Suicide Malpractice said...

After the ordeal you avoided, you would have felt, $750 was not enough.

Plaintiff experts should endure through a legal wringer. A wrong statement on the resume should be treated as criminal perjury, with large fines and jail time. Any misstatement of fact should result in a mistrial. Then the judge should sanction the misleading expert with triple the legal costs from personal assets, precluding any payment from plaintiff law firm to the expert. To deter.

People complain of lack of recourse against the false testimony of plaintiff whores. There is massive recourse inside the case, but only from the judge of the case. All outside accountability is forbidden by a Supreme Court case. Only a federal law can reverse that.

Defendants should demand full accountability of opposing expert by their lawyer, on pain of a legal malpractice lawsuit defendant for losing. These defense lawyers do not want to scare the other side. The other side gave them their job.

The majority of medmal cases are weak. Only full legal accountability of plaintiff experts can improve the medmal practice. A prime example of a weak case is the Zyprexa litigation. It is garbage science.

Anonymous said...

It continues to sadden me that relatively few mental health consumers have sought redress for the damages wrought by Zyprexa. If one was to go down to a partial care program, a partial hospitalization program and/or a sheltered workshop at 3:00 and ask those taking Zyprexa if they knew of the litigation, few would say yes. (I recently tried this at a drop-in center.) In an era where virtually every provider agency asserts that it fosters consumer empowerment, here again we see the impact of learned "compliance, complacency and conformity."

Lilly is one lucky company despite the suits brought by State Attorney Generals and potentially by shareholders. Things would be much worse for Lilly if all those with standing litigated.

Anonymous said...

I am one of these Zyprexa consumers who just 4 months ago learned of it's harmful effects--and quit cold turkey. I trusted a hand full of specialists and PCPs over the last 8 years. I didn't do any research on the drug at all.

I'm amazed by my change in mental and physical health since stopping. I'm reading a book on brain chemistry and just last week learned of the legal efforts, and subsequent Zyprexa settlements, over the last few years. I was on Zyprexa on and off between 1999 and 2007. Mostly on.

Fortunately, I don't have any of the really serious side effects like diabetes or pancritis (yet). But, I do have several other health issues that quite possibly are related (obesity, high lipid counts, high blood pressure, dyspepsia, somnolence, intermittent chest pains, intermittent tremors in hand, memory loss, erectile dysfunction). I have found mention of each of these being tied to Zyprexa. Some of these are gone or lessened since I stopped taking the drug, some are not.

As a former Zyprexa patient, I would urge you to accept the assignment. But, on the condition that they lower their fee to market rates. Or better yet, you could donate the proceeds to a charity. Especially, if you feel you could do a better job on the writing than the next guy they will make the offer to. That way you can reasonably skirt the criticism.

And if any of you know of a law firm who would consider adding me to a class action suit, please post a reply here. The only firm I've spoken with so far only works with people who have developed related diabetes.