Comments on: Grassley: Universities Aren’t Following The Law

By: Andrew

Andrew — Mon, 13 Oct 2008 21:26:05 +0000

he’s got it right! In fact, the more prominent the university, the less the tendency to follow the law. The top dogs think that they’re above it all. The Ivies, Duke, Stanford, Baylor - they’ve been raking in bundles for years. The so called opinion leaders have gotten rich on drug company money. Not only that, but a lot ofg it’s tax-free! Let’s get all of the big shots to open up their books. What you see will no doubt surprise you!

By: Christopher

Christopher — Mon, 13 Oct 2008 03:02:11 +0000

So were you paid for your talk Doug? Just interested.

By: Doug Bremner MD

Doug Bremner MD — Mon, 13 Oct 2008 00:06:09 +0000

The return on investment for KOLs is much greater than that. And they are not doing a sales pitch, they are just showing a set of slides. The problem that I had (have) with that is that when pharma provides the slide set and insists that it not be changed, that is tantamount to a sales pitch. I got dropped several years ago because I insisted on changing the slide set. Before each talk we had this scramble to change the slides. They told me they couldn’t change them because they were FDA approved (Ha ha!), or that they had to guard against docs talking about off label usage of drugs (Ha ha ha ha ha ha ha!). They finally stopped inviting me. Ta ta. Later when I gave grand rounds at a major university I was told that I wasn’t on the ‘list’ of speakers that the pharma sponsors would pay for, so they had to scramble to get the funds to pay for my talk.

By: Thom

Thom — Sun, 12 Oct 2008 22:34:19 +0000

Doug, can’t remember where I read it, but companies pick KOLs because doctors respond better to a “sales pitch” from another doctor that from a drug sales rep. There’s even some sort of return on investment from this practice that drug companies follow. I think the return on drug reps is 2:1, but it’s 10:1 on doctors.

Can’t remember where I read that.

Also, from the way you describe it with the companies picking the doctor for the CME course….I imagine that violate ACCME guidelines. Not that I don’t doubt that your understanding is probably exactly what happens.

By: Doug Bremner MD

Doug Bremner MD — Sun, 12 Oct 2008 19:18:09 +0000

Oh, btw, Medtronics also made the TENS units, these goofy little electrical stimulators we used to put on the backs of patients with low back pain. A doc at UW did a study that showed that they didn’t work, and when they couldn’t get his funding pulled, they took the creative approach of using their influence to reduce funding for the entire NIH institute that they got funding from! He wrote about it in a book called ‘Hope or Hype.’ A good read.

By: Doug Bremner MD

Doug Bremner MD — Sun, 12 Oct 2008 18:31:32 +0000

Yes, I did go to med school, psychiatry residency too. Thank goodness I had a liberal arts education so it didn’t completely ruin my capacity for logical thought (an effect that psychiatry training can have on someone, as I was told by a PhD in epidemiology once).

So it looks like Grassley asked about the KOLs in neurosurgery too, although it has been over a year, maybe Medtronics is dragging their feet. Aren’t they the ones that were sending docs to a strip club and letting them go to the ‘VIP room’ on the expense account?

I did find his letter strange, though. Isn’t it common knowledge that companies pay for CME, select the educational material, and pay the KOLs for consulting?

Maybe I am out of the loop or something.

It is hard not to see this as a type of payola. I put the references for how early adaptors influence the ‘herd’ (i.e. docs in private practice) on my website. It is obvious that industry has figured out that the KOLs are early adaptors who have a heavy influence on the field.

I, for one, will only consult to French drug companies. They have better food, and they don’t talk about work at dinner.

By: Thom

Thom — Sun, 12 Oct 2008 16:33:47 +0000

Doug, I like you. You’ve got that clarity of vision so often found in people of high talent. Question. Did you go to med school?

By the way, two minutes on Google finds this letter that Grassley sent to Medtronic

http://preview.tinyurl.com/4zcan2

As you can see from Question 3, there are several doctors Grassley is interested. The unfortunate thing for these guys is that when Grassley finally releases this information they won’t be able to bitch moan and cry that they are being unfairly singled out.

Because the psychiatrists have taken that excuse as their own.

Grassley letter:

“Please provide the Committee with a list of all payments or other transfers of
value made to the following individuals: Lawrence G. Lenke, Jeffrey C. Wang,
Behrooz A. Akbarnia, Thomas A. Zdeblick, Rick Delamarter, David Polly, Kevin
Foley, Kenneth J. Burkus, Regis Haid, Rick Sasso, K. Daniel Riew, Steven
Garfin, Choll W. Kim, Scott Boden and Stephen Papdopoulos. For each payment
or transfer, please include the date, amount, and reason for the payment or
transfer. This request covers the period of January 2000 to the present”

By: Doug Bremner MD

Doug Bremner MD — Sat, 11 Oct 2008 23:14:29 +0000

Thom, he only sent a letter to the ACC, which by the way acted shamefully by sending faxes to every cardiology dept in the country (including ours) telling docs to continue prescribing vytorin, which they get millions in funding each year from a number of companies, including S-P. Hardly an investigation. The medtronics thing was also a letter. There is nothing involving individual academic cardiologists, or any other specialty.

By: Thom

Thom — Sat, 11 Oct 2008 14:15:17 +0000

Doug, a couple of things

1. You’re wrong. It’s the law. You can read the regulations here yourself.

http://grants.nih.gov/grants/compliance/42_CFR_50_Subpart_F.htm

2. You’re wrong. Grassley has previously sent inquiries to the American College of Cardiology and is also looking at Medtronic, which hires surgeons.

American College of Cardiology
http://www.pharmalot.com/2008/01/grassley-starts-his-own-vytorin-investigation/

Medtronic
http://www.nytimes.com/2007/09/27/business/27letter.html

In both cases, all you had to do was spend five minutes on Google. But if you are more content in making baseless charges, then have at it.

By: Gina Pera

Gina Pera — Sat, 11 Oct 2008 05:13:59 +0000

Has anyone here mentioned Grassley’s #2 campaign donor, Blue Shield, and any possible link to his fervor to de-legitimize psychiatric medications? Why else is he picking on this field, or have I missed some history?

After all, these are expensive medications, and from what I’ve seen, insurance companies are doing their darnedest to limit access to the newer formulations.