Give a Drug Talk, Go to Jail?

Just as hired guns were getting used to the fact that their fees will soon be posted on the web for the world to see, federal prosecutors have made their lives a little more stressful. According to this recent article in the New York Times, they are planning to nab some of these consultants on kickback charges.

It’s illegal to prescribe treatments in return for payments from drug companies. Of course, no physician is going to admit that they do this. But anybody who has ever been involved in the unsavory business of speakers' bureaus knows that it happens all the time.

It can be rather subtle—call it “soft kickbacks.” When I was hawking Effexor for Wyeth in 2002, there was no explicit agreement that I would get more speaking gigs if I prescribed more of their drug. Not even a wink or a smile. But I knew that the company was keeping track of my prescribing history, and that it couldn’t hurt my relationship with them if I enriched by patient population with Effexor scripts. Add to this the fact that Effexor was not significantly different from several other antidepressants, and you have the right mix of ingredients for a kickback-esque situation.

I don’t recall consciously thinking, “I’m going to prescribe Effexor rather than Zoloft for Mr. Jones so that I can make my handlers happy.” It was more like breathing an atmosphere hypersaturated with Effexor money, Effexor thoughts, and Effexor rewards. Any doctor who chooses to put him or herself in such a situation ends up treading a line, and as the amount of money increases, the incentive to think actual kickback thoughts increases as well.

Thus, for example, when orthopedic surgeons are pulling in several million per year for consultation, immorality is highly likely to happen.

According to Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, big ticket surgeons are going to be the target of most of these investigations. But doctors prescribing the same drugs that they help to market can’t be far behind.

Imagine this scenario: Dr. X gives Seroquel talks for AstraZeneca. Dr. X also writes plenty of Seroquel prescriptions. Patient Y becomes obese after a year on Dr. X’s Seroquel. On the web, Pt. Y finds out that Dr. X made $50,000 from AstraZeneca over the past year. Pt. Y is not happy, and there are plenty of attorneys around looking for business. Dr. X could get into serious legal trouble.

This scenario, which may have sounded far-fetched only a few months ago, should now strike fear into the hired gun’s heart, and will hopefully lead to a gradual end of this dodgy marketing practice.