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All expense-paid trips to Cancun with thousand-dollar honorariums. One example he cites is the use of doctors to promote off-label drugs. It is legal for doctors to prescribe drugs for uses that have not been approved, but it is not legal for pharmaceutical companies to advertise a drug for off-label use. By recruiting doctors to talk about off-label uses, companies engage in a form of marketing that would be illegal if done by the company itself. These promotions are often done by doctors on the lecture circuit, sponsored and heavily subsidized by pharmaceutical companies.

One doctor's wife interviewed for the book noted how her husband's lectures became more frequent as it came time to put his children though college. NAMI works with drug corporations to lobby congress to create legislation that benefits the industry. The free distribution of its journals, including the Archives of General Psychiatry , and the Archives of Internal Medicine , is made possible by drug company advertising.

Before it was a truly independent organization with its own laboratory which it used to determine the effectiveness and safety of drugs. Drug corporations were not allowed to advertise in its journal, the Journal of the American Medical Association , unless their products were worthy of the AMA seal.

Gradually it removed its critical stance toward the industry, stopped publishing its books on useful drugs, and abandoned its seal of approval. MHA has since received millions in financing from drug corporations. The reason is that each doctor may write millions of dollars worth of prescriptions during their careers.

Plus, the physicians interact directly with patients and usually have their trust. Drug corporations even rank some physicians according to their lifetime prescribing potential.


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The recruitment of physicians begins in academic medical centers and hospitals where they are identified by pharmaceutical salespeople called detailers. The detailers frequently visit these facilities to aggressively promote drug products while providing meals and gifts to students. According to the New England Journal of Medicine , medical students receive a substantial amount of meals and other favors from drug corporations.

The students are often invited to what the Journal describes as quasi-social events, where they hear industry-sponsored lectures.


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All of this is done with the approval of the teaching facility. Apparently the industry capitalizes on the susceptibility of students who are usually tired, and who need encouragement, kindness, and free food. Kassirer witnessed a typical one of these put out by Pfizer, where two well-dressed detailers in their late 20s provided a buffet for a teaching conference. One was stationed at the beginning of the line, the other at the end.

After graduation, physicians are usually in debt from educational loans, which make them particularly vulnerable to the financial rewards provided by drug corporations. In addition, they often see their senior role models lavishing themselves with these gifts. So, they begin by accepting meals and gifts, then, reportedly, some even demand industry donations as their careers advance.

There is a silent progression, illustrated Dr. Kassirer, from the innocence of accepting gifts and food to a later bland and unquestioning acceptance of pharmaceutical money by physicians as their careers advance. Those not recruited during med school may later be aggressively targeted by detailers who visit practicing doctors at their offices and can be seen all over hospitals and academic medical centers They frequently deliver meals for conferences at these establishments.

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And in some cases, physicians in private practice as well as heads of departments at hospitals will directly solicit drug corporations for meals. According to Dr. There is now at least one detailer for every six physicians. Each one has an expense account that allows them to provide doctors with gifts, meals, and cash payments. Petersen cites a manual she was able to read by Tap Pharmaceuticals, which mentioned that detailers should expect hospitals and private practice doctors to ask them for cash.

The detailers would deliver the money on the condition that the doctors would write more prescriptions. Pfizer has done this. Those who are willing to give talks about the products receive additional money. In addition, free dinners sponsored by corporations are also offered, which include educational seminars about new drugs. They reportedly make tens of thousands of dollars a year from this, in addition to their regular salary. Furthermore, they may be used as expert witnesses in lawsuits against drug corporations. Loren R. Most physicians with ties to the drug corporations swear they could not be influenced by a financial conflict of interest.

They insist that, they cannot be bought, that no matter what the blandishments, they can remain objective. However, says Dr. The drug corporations are certainly convinced of this, which is why most of their marketing money is spent not on the public, but on the doctors—the agents whom the public interact with. To prove his point, Dr. Professor Cialdini discovered that reciprocation is a very powerful motivator after studying the persuasive tactics of salespeople, fund-raisers, advertisers, and PR firms.

Providing favors and gifts are important tactics used to obligate people to return favors. This has worked even when the exchanges are unequal. For instance, a small gift has been given, which influences the receiver to repay a larger amount to the giver. An effective way to place someone in debt, according to this rule, is by delivering persistent uninvited favors over a period of time. According to Petersen, almost all American doctors accept these gifts.

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Most states require physicians to take about 50 hours of instructions each year as part of their continuing education. These may occur at resorts which doctors are flown to, workshops, annual conferences, over the phone, or dinners where speeches are given. In many cases the doctors receive pay for attending.

Almost half of the refresher courses themselves are funded by drug corporations and take place at their various venues. Furthermore, many medical and psychiatric textbooks, which are used as the educational material, are written by consultants with strong ties to drug corporations.

On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

The pharmaceutical industry has become increasingly interested in funding continuing medical education, according to The Boston Globe. The lectures were to be offered at hospitals, medical schools, and educational companies, as well as teleconferences, and webcasts. Many of the psychiatrists who teach the courses are consultants for, or receive research funding from, drug corporations. As much as they prescribe these drugs, most doctors know little about them, says Dr.

And the information they receive pertaining to them is often provided in the form of advertisements funded by the industry. Jerry Avorn and his colleagues at Harvard Medical School found that when a group of doctors where asked about the properties of certain prescription drugs, their answers resembled information in drug advertisements rather than scientific literature.

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There are more than , scientific conferences and events sponsored by the industry each year. Many of them are hosted by the various professional societies which are partially or mostly funded by drug corporations. In addition to the presentation material being produced mostly by the industry, almost all of the doctors who deliver the speeches at these conferences are consultants to at least one drug corporation. For instance, at the APA conference in Atlanta Georgia, the list of psychiatrists scheduled to speak who disclosed that they were receiving payments from the industry, numbered in the hundreds.

Some speakers were consulting for as many as 25 different corporations. At some of these meetings, clusters of doctors wondering through the halls are reportedly met by pharmaceutical sales representatives who greet them with gifts and smiles. The doctors themselves sometimes become walking advertisements for drug corporations, with corporate logos looped around their necks. Attendees receive free items at display booths if they express even a minimum of interest. Some allegedly crowd and push their way through to the booths in order to get the gifts.

All gifts are marked with corporate or brand logos. Some doctors carry multiple bags which they stuff with loot, including: notepads, coffee mugs, tiny fans, rubber models of various organs, plastic trinkets of all sorts, candy, samples of drugs, baseball caps, mouse pads, small flashlights, luggage tags, etc.

At one meeting he attended, a pharmaceutical company was giving away an item the size of a book in an unmarked box. He witnessed physicians grabbing them in frenzy even though they had no idea what was inside.

Jerome P. Kassirer

Peterson recognized the same behavior at a meeting she attended, where she witnessed physicians wandering through halls, stopping at each booth to pick up a few items and stuffing them into large shopping bags, which were filled with trinkets. At some booths doctors can simply walk up and grab an item.

The questionnaires themselves are advertisements in disguise. After they have given their private information to a company, he or she is vigorously targeted for various promotions. They mentioned that the exhibit hall contained many booths run by sales representatives offering free gifts to psychiatrists. They also sponsored 50 scientific sessions throughout the conference which lasted a week. Some of the speaking sessions occur during meal times. On one day, at breakfast psychiatrists were educated about bipolar disorder at the Marriott Marquis Hotel, sponsored by Eli Lilly.

GSK funded a lecture at the Grand Hyatt at lunchtime so they could learn about maternal depression. Then Pfizer provided a lecture on generalized anxiety disorder during a dinner at the Grand Ballroom of the Roosevelt. The senior physicians who significantly influence their peers are called thought leaders in the industry. Some of them are identified by detailers and then trained by the industry. Thought leaders are used by drug corporations to perform a variety of functions: They conduct the research, write the CPGs, and publish articles in medical journals.

They create professional slide presentations and write literature. Frequently, they even write the speeches which the doctors deliver. Thought leaders are a critical part of the industry. Many of them hold positions at prestigious academic institutions while serving as consultants to the industry.

These leaders may be on the advisory boards and speaking panels of multiple drug corporations. Their lectures occur at hospitals, hotels, restaurants, medical meetings, and conferences. Kassirer, such industry leaders have been heavily corrupted by greed due to an enormous infusion of cash.

Up to three-quarters of the scientific research on prescription drugs is funded by the industry. Some of this occurs at academic institutions, which the industry has close ties with.