Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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Nurse Practitioners and Physician Assistants are Also Swayed by Gifts from Pharma

Nurse Practitioners and Physician Assistants are Also Swayed by Gifts from Pharma | Pharmaguy's Insights Into Drug Industry News | Scoop.it

Doctors, nurse practitioners, and physicians who were given meals, fees, grants, and other goodies by drug makers were much more likely to prescribe a larger number of medicines for each patient than health care providers who did not receive such payments, according to a new study. And often, the prescriptions were written for more-expensive, brand-name drugs.

 

The study examined $3.9 million in gifts and payments made to more than 1,100 Medicare Part D prescribers in Washington, D.C., in 2013, and found those health care providers prescribed 2.3 more claims per patient than providers who did not receive anything from drug companies. What’s more, the prescriptions cost $50 more per claim, and this trend was seen among six specialties in particular.

 

Indeed, several other studies have explored the extent to which financial ties between drug makers and doctors influence prescribing. But this latest study, which was published in PLOS One, is the first to examine prescribing trends among physician assistants and nurse practitioners in response to industry largesse, as well as all prescriptions written for Medicare recipients during a specific place and time.

 

Fugh-Berman noted nurse practitioners and physician assistants play an increasingly important role in health care because they are writing more prescriptions than ever before. The study noted this number has more than doubled over the past five years. And in 2015, these health care providers wrote 676 million, or 15.4 percent, of the 4.4 billion prescriptions in the U.S. It is worth noting that drug makers are required to report payments made to physicians, but not nurse practitioners or physician assistants, to the federal OpenPayments database.

 

Among nurse practitioners, gifts and payments were associated with a significant increase in the average cost of Medicare Part D claims — $180 versus $86. Among physician assistants, there was also a significant increase in the average cost of such claims — $213 versus $63. And gifts to physician assistants were also associated with a significantly higher portion of branded drugs – 30 percent versus 17 percent.

 

Further Reading:

  • “Senate Bill Would Bring Sunshine to #Pharma Payments to Nurses & Physician Assistants”; http://sco.lt/6Y8WDh
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Bill Would De-Stigmatize Vermont Docs and Allow Them to Partake of Pharma-Sponsored Free Ice Cream, Etc., at Medical Events

Bill Would De-Stigmatize Vermont Docs and Allow Them to Partake of Pharma-Sponsored Free Ice Cream, Etc., at Medical Events | Pharmaguy's Insights Into Drug Industry News | Scoop.it

The Vermont Senate Health and Welfare Committee has endorsed a bill designed to allow doctors who go to conferences to eat meals paid for by pharmaceutical companies.

 

The committee voted 5-0 in favor of S.45. The bill now heads to the Senate floor.

 

S.45 updates an existing Vermont law that requires pharmaceutical companies to disclose gifts they give to doctors and other health care providers.

 

The bill would drop the law’s provision that doctors who attend conferences and other large events be prohibited from consuming coffee, snacks, sit-down meals or buffets paid for by pharmaceutical companies.

 

However, doctors would still be prohibited from eating meals at events designed to promote specific drugs or devices, according to Sen. Virginia Lyons, D-Chittenden, the lead sponsor of the bill.

 

Lyons said Vermont doctors who attend conferences right now are faced with a stigma because other practitioners can eat dinners and buffets.

 

“We had all these docs and other practitioners going to conferences, and there would be a big dinner, and it would be sponsored by a pharmaceutical company (that) may not be pushing a specific drug or device …,” Lyons said.

 

“There would be signs placed outside of the dinner room at the conference that say … ‘Vermont practitioners not welcome,’” she continued. “They couldn’t come in and have the food because it was considered a gift that would influence.”

Pharma Guy's insight:

It all started with ice cream. Read “No Schering-Plough Ice Cream for You, MA VT MN Doctors!

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Dermatologists Accepted $34 Million from Pharma Companies

Dermatologists Accepted $34 Million from Pharma Companies | Pharmaguy's Insights Into Drug Industry News | Scoop.it

Dermatologists received more than $34 million from industry in 2014, and most of that money came from pharmaceutical companies, according to a new study published in JAMA Dermatology.

Researchers in the study mined the Centers for Medicare and Medicaid Services Sunshine Act Open Payment database, which lists payments that dermatologists receive from companies making products that are reimbursed by a government-run health program. In 2014, the database’s first full year of financial data, 8,333 dermatologists received more than 208,000 payments. The top 10% of dermatologists received 90% of the total payments.

“At the center of all this is [the patient’s] concern about dishonesty and selfishness,” says says Dr. Hao Feng, the study’s first author and a dermatology resident at NYU Langone Medical Center.

Most of the payments were for food and beverage, but that’s not where the big money was spent. Speaker fees, consulting fees and payments for research represented 70% of the total money spent. The top 15 companies were all pharmaceutical manufacturers. Studies on other branches of medicine reveal that receiving industry payments and meals was linked to increased prescribing of brand-name medications, the authors write.

Pharma Guy's insight:

Hmmm... Allergan sure paid for a lot of "research" compared to Abbie, which paid for "speaking" junkets! Surprising. I wonder how different pharma companies categorize their payments to physicians. Who confirms that this process is the same at each company?

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College of Family Physicians' "Do Nothing" Physician Payment Recommendation

College of Family Physicians' "Do Nothing" Physician Payment Recommendation | Pharmaguy's Insights Into Drug Industry News | Scoop.it

A report written by the College of Family Physicians in Canada about how to prevent conflicts of interest between doctors and the pharmaceutical is being criticized for weak recommendations, with none of them explicitly banning the accepting of money from the drug industry.


The report makes 20 recommendations dealing with issues such as conflict of interest, financial relationships, marketing and other relationships with the pharmaceutical and health care industries.

But they don't prevent a doctor with ties to the pharmaceutical industry from serving in leadership positions, sponsoring certain events, or even from contributing to an "unrestricted" education fund.


Alan Cassels, a drug policy researcher at the University of Victoria, is critical of the college for sitting on the report as long as it did.


University of Victoria drug policy researcher Alan Cassels says he beleives the report was held back because it is "basically recommending the status quo between physician education and the pharmaceutical industry.”

He suspects the college held it back because it's "pretty embarrassing."

"They're basically recommending the status quo between physician education and the pharmaceutical industry,"

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Has Collusion with #Pharma Caused an "Anti-psychiatry Movement?"

Has Collusion with #Pharma Caused an "Anti-psychiatry Movement?" | Pharmaguy's Insights Into Drug Industry News | Scoop.it

On February 18, the eminent psychiatrist Jeffrey Lieberman, MD, former President of the APA, published a video and transcript on Medscape.  The article was titled What Does the New York Times Have Against Psychiatry?, and was essentially a fatuous diatribe against Tanya Lurhmann, PhD, a Stanford anthropologist, who had written for the New York Times an op-ed article that was mildly critical of psychiatry.  The essence of Dr. Lieberman's rebuttal was that an anthropologist had no business expressing any criticism of psychiatry, and he extended his denunciation to the editors of the NY Times.


"Why would such a report be printed in a widely respected publication such as the New York Times? What other medical specialty would be asked to endure an anthropologist opining on the scientific validity of its diagnoses? None, except psychiatry. Psychiatry has the dubious distinction of being the only medical specialty with an anti-movement. There is an anti-psychiatry movement. You have never heard of an anti-cardiology movement, an anti-dermatology movement, or an anti-orthopedics movement."


I have already written a critique of Dr. Lieberman's paper, but my purpose today is to address the question:  why does psychiatry have an anti-movement?  In my view, there are ten reasons.



Pharma Guy's insight:


Reason #4, #5, and #6 involve pharma.

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US Sunshine Act - Coverage Confusion

US Sunshine Act - Coverage Confusion | Pharmaguy's Insights Into Drug Industry News | Scoop.it

New rules introduced in the US to make the financial relationships between pharma companies and physicians more transparent are themselves lacking in clarity, it would appear.


In February 2013, the Centers for Medicare and Medicaid Services (CMS) published its final rule requiring manufacturers of medicines and medical devices to report payments exceeding $10 or other 'transfers of value' (TOV) made to physicians and teaching hospitals, as well as physician ownership and investment interests.


Under the Act, all applicable manufacturers were required to start collecting data from August 1, 2013, and submit it to the CMS by March 31, 2014. Physicians and hospitals started the registration process on June 1, with a review process kicking off in July.


At the moment that information is still under wraps, but will become open for scrutiny by the public in September, and it is widely anticipated that journalists and other interested parties will be sifting through the data to highlight the biggest spenders and recipients.


Coverage confusion
One the face of it the situation is fairly straightforward: the CMS has set out pretty clear guidance when it comes to financial payments and an informal straw poll of pharma companies suggests they are comfortable with what is covered. However, that is not the case with transactions that come under the TOV category.


One area of confusion is support for medical writing and editorial services, such as may be provided by pharma companies to authors of clinical studies. As reported by PME recently, some pharma companies, such as Pfizer and AstraZeneca, consider this is in scope, while others, such as Shire, believe it is not reportable. 

Pharma Guy's insight:


Proposed Rules for Physician Payment Sunshine Act
Looming Challenges Cloud Implementation

Life science companies are struggling to under-stand the complex reporting requirements and compliance issues presented by existing and new regulations such as the Physician Payments Sunshine Act (PPSA), provisions of which were included in the Patient Protection and Affordable Care Act. While the looming challenge of complying with the Sunshine Act has consumed the attention of the drug and medical device industry, it has tended to obscure other issues of long-term strategic importance, such as the effect of transparency on public perception, and the need for industry to re-structure its spending practices with transparency in mind. 
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Pharma Payments to HCPs Topped $8 Billion in 2016. Allergan & Celgene Paid Out the Most!

Pharma Payments to HCPs Topped $8 Billion in 2016. Allergan & Celgene Paid Out the Most! | Pharmaguy's Insights Into Drug Industry News | Scoop.it

Payments from drug and device companies to physicians and teaching hospitals hit more than $8 billion in 2016 according to Open Payments data recently released by CMS.

All told, nearly 631,000 physicians and approximately 1,146 teaching hospitals received $8.18 billion in payments and ownership and investment interests in 2016, according to tallies compiled by the CMS. Last year's total was $7.52 billion.

About half of the overall payments were for research and $2.7 billion were in payments not related to research. A little more than $1 billion stemmed from ownership or investment interests.

Of the largest pharmaceutical companies, Allergan paid out the most in 2016 with $66 million in total payments. Dr. George Patrick Maxwell, a plastic surgeon in Nashville, is listed as the highest payment recipient from Allergan, with $4.6 million.

Celgene was the second-highest spender with a total of $54 million in payments last year. Of its recipients, Boston oncologist Dr. Kenneth C. Anderson a took in the most, with $1.9 million.

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To Fight Against Gout Treatment Guidelines, Pharma Uses Surrogates: i.e., Paid Physicians

To Fight Against Gout Treatment Guidelines, Pharma Uses Surrogates: i.e., Paid Physicians | Pharmaguy's Insights Into Drug Industry News | Scoop.it

It was once seen as the disease of kings, afflicting only the lazy and gluttonous. These days, however, gout is everywhere — and a bitter battle has broken out among physicians about how best to treat it.

 

A form of arthritis, gout is characterized by unsightly bulges under the skin and incredible pain in the joints. Typically seen in older men, the disease now increasingly afflicts women and younger adults, often accompanied by obesity, diabetes, and high blood pressure.

 

“It used to be the disease of kings, but now it’s really the disease of the people,” said Dr. Robert Terkeltaub, a professor of medicine at the University of California, San Diego.

 

Gout is a booming market and many drug companies are rushing to get a piece of it — and to win over physicians. As many as 10 novel compounds to lower uric acid levels are in various stages of testing. A recent report estimated the global market for gout drugs will grow 17 percent in coming years, with AstraZeneca, Horizon Pharma, and Takeda as leading vendors (“Gout is Serious Disease Education Website” by AstraZeneca won a Choice Award; http://sco.lt/5JZ3h3).

 

But the American College of Physicians, the nation’s largest specialty medical association, this month put out new guidelines that call for less aggressive pharmaceutical treatment. That’s angered many gout specialists, who in recent years have created two new professional groups — both backed by drug companies — to bolster gout research and promote long-term use of medication to lower uric acid.

 

In an era when many long-standing medical guidelines — such as how often to get a mammogram or how aggressively to target blood pressure — are being vigorously scrutinized, the terse disagreement highlights recurring tensions over just what constitutes scientific evidence.

 

It’s true, as the ACP says, that there’s a lack of gold-standard evidence — in the form of randomized, controlled clinical trials — to prove that patients with gout should be put on a long-term drug regimen to lower their uric acid to any specific level.

 

But rheumatologists argue that the expensive clinical trials that the ACP wants to see are unlikely to be conducted on already approved drugs and that it makes no sense to wait until a patient suffers from a painful flare-up before treating him or her (read “Only Old Drugs That Don't Need Safety Tests Get Studied & Win Monopoly Status from FDA”; http://sco.lt/7hagu9).

 

They say their own experience in the clinic and numerous observational studies — which don’t control for the placebo effect — show that lowering uric acid prevents the recurring, painful flares that bedevil 70 percent of gout patients and may also prevent permanent bone and joint damage. They recommend reducing uric acid to levels of 6 mg/dL or lower as a matter of course.

 

“Would you manage hypertension without looking at blood pressure?” Terkeltaub asked.

 

Terkeltaub, a staunch advocate for medication, has received about $35,000 in consulting fees from drug companies that make gout medications in recent years, according to the Open Payments database that tracks such payments. Many of the rheumatologists who have called for treating gout with drugs have also received money from pharmaceutical companies. Edwards, for instance, received about $27,000 in 2015.

 

Studies have shown that doctors who receive compensation (even in the form of inexpensive lunches) from pharma companies are more likely to prescribe brand-name drugs than their peers. The Institute of Medicine urges professional physicians’ groups to limit such conflicts of interest on any panel that writes up treatment guidelines. Most groups do not do that.

 

The American College of Physicians, which published the guidelines that urged less pharmaceutical intervention, does maintain a strict policy: Committee members cannot have any pharma ties. McLean, for instance, used to serve as a paid speaker for Takeda Pharmaceuticals’s gout drug Uloric; he dropped that job to join the ACP committee that was working on treatment guidelines.

Pharma Guy's insight:

Further Reading:

  • The Case of Brand Colcrys vs. Generic colchicine: Consumers Pays the Price: http://sco.lt/6MziQD
  • Branded Pharma Wages War Against Generic and OTC Medicines: COLCRYS vs. colchicine Case Study: http://bit.ly/1Ig3Tc5
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How Big Pharma Courts Physicians & Makes Them Look Like They Have a Lot of Money!

How Big Pharma Courts Physicians & Makes Them Look Like They Have a Lot of Money! | Pharmaguy's Insights Into Drug Industry News | Scoop.it

The Truth In Media Project has released Part 3 of its latest series Truth In Media: Big Pharma, The FDA & Health Propaganda. Part 3, titled How Big Pharma Manipulates Physicians and Corrupts “Best Practices,” discusses how companies in the pharmaceutical industry influence doctors’ “best practices” as well as offer funding for research and court physicians and their staff in hopes of gaining loyalty.

 

Devon Beasley, a registered nurse, has spent years in her field and told Truth In Media that she has seen representatives for pharmaceutical companies “wine and dine” an entire medical office in the midst of promoting various products. “Some of the offices that I would apply for would actually tell me ‘hey, we have catered lunches three times a week.’ That’s directly from pharmaceuticals. You also get materials for your office that make your office look really great,” said Beasley. “They will bring in supplies that make your office look like you have a lot of money.”

 

Beasley went on to say that medication samples, which are common in the doctors’ office and part of the pharmaceutical companies’ strategy to promote certain products, are highly sought after by patients and can conflict with the pursuit of proper medical care. “No one is asking which is the safest medication, which is the best for me, which is best for the patient. It’s all about ‘do you have samples, do you have coupons? Can you prescribe me something that does have a coupon? Can you prescribe me something that does have a sample?’ And it has nothing to do with which one is best, most effective or safest,” said Beasley.

 

Truth In Media’s Ben Swann also discussed the pharmaceutical industry’s impact on the medical community’s procedures known as “best practice,” which is the name for a system of policies that have been agreed upon by doctors and regulatory agencies such as the FDA. Swann explained that “the problem with best practices is how it is manipulated by big pharma. Research that best practice is based on is heavily funded by big pharma.”

Pharma Guy's insight:

“They will bring in supplies that make your office look like you have a lot of money.” LOL!

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Pharma Pays Male Docs More Than Female Docs for Same Services (& Lunch!)

Pharma Pays Male Docs More Than Female Docs for Same Services (& Lunch!) | Pharmaguy's Insights Into Drug Industry News | Scoop.it

Background


Academic literature extensively documents gender disparities in the medical profession with regard to salary, promotion, and government funded research. However, gender differences in the value of financial ties to industry have not been adequately studied despite industry’s increasing contribution to income and research funding to physicians in the U.S.


Methods & Findings


We analyzed publicly reported financial relationships among 747,603 physicians and 432 pharmaceutical, device and biomaterials companies. Demographic and payment information were analyzed using hierarchical regression models to determine if statistically significant gender differences exist in physician-industry interactions regarding financial ties, controlling for key covariates. In 2011, 432 biomedical companies made an excess of $17,991,000 in payments to 220,908 physicians. Of these physicians, 75.1% were male. Female physicians, on average, received fewer total dollars (-$3,598.63, p<0.001) per person than men. Additionally, female physicians received significantly lower amounts for meals (-$41.80, p<0.001), education (-$1,893.14, p<0.001), speaker fees (-$2,898.44, p<0.001), and sponsored research (-$15,049.62, p=0.05). For total dollars, an interaction between gender and institutional reputation was statistically significant, implying that the differences between women and men differed based on industry’s preference for an institution, with larger differences at higher reputation institutions.


Conclusions

Female physicians receive significantly lower compensation for similarly described activities than their male counterparts after controlling for key covariates. As regulations lead to increased transparency regarding these relationships, efforts to standardize compensation should be considered to promote equitable opportunities for all physicians.


Pharma Guy's insight:

The sunshine act shines light on "glass ceiling" of physician payments!

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Glitch Prompts Temporary Shutdown of Pharma Payment Verification System

Glitch Prompts Temporary Shutdown of Pharma Payment Verification System | Pharmaguy's Insights Into Drug Industry News | Scoop.it

The government had to take offline its system for doctors to verify payments from drug companies after at least one doctor had payments attributed to him that actually went to someone else.


"After an assessment of the data resulting from a complaint, we discovered that a limited number of physician payment records submitted by at least one manufacturer incorrectly contained information about other physicians," CMS spokesman Aaron Albright said in an email late Sunday. "To protect physician privacy and correct the issue, we have taken the system offline temporarily and will work with the industry to eliminate incorrect payment records."

Pharma Guy's insight:


Oh My! Not another Canadian software problem, I hope!

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