Meet A Primary Care Doc Who Speaks For Glaxo
27 CommentsBy Ed Silverman // March 15th, 2010 // 7:28 am
As more universities restrict interactions between their docs and drugmakers, more primary care physicians are becoming paid speakers. Take Tara Dall, who entered private practice in 2001 and was paid $45,000 for three months of speaking last year by GlaxoSmithKline, which ranked her among the most highly paid among 3,600 speakers for the drugmaker, The Milwaukee Journal-Sentinel reports.
Critics say the trend is troublesome, because the talks can be biased and contribute to rising health care costs by promoting expensive brand-name drugs, but there are no restrictions on private docs. “There are no skids on them,” Jerome Kassirer, a former editor of the New England Journal of Medicine, tells the paper. “There is no way to control their participation.”
You may recall that one Harvard Medical School instructor recently resigned his position at Brigham and Women’s Hospital in Boston after its owner imposed a new conflict of interest policy. Lawrence DuBuske, was Glaxo’s highest-paid speaker during a three-month period last year, making $99,375 for giving 40 talks to other docs (back story here).
Dall hedged when asked if she fully disclosed her ties to Glaxo to all patients for whom she prescribes the drugmaker’s high-priced Lovaza fish oil product. “I think I would (disclose) if I was going to do anything off-label,” she tells the paper. “Whether I tell every single patient, I’m not sure.” The next day she called back and made a short statement, but hung up without answering questions, the paper writes. “It is absolutely disclosed to patients that I am a speaker and that I speak for pharmaceutical companies, and it is listed on my Web site,” she adds.
Dall speaks for five other companies and gives community talks, including an unpaid speech on heart disease she gave to General Electric employees in Wisconsin last August. What did she say? “As soon as we identify what puts you at risk, we can absolutely fix it,” Dall assured them in the talk (watch the video here). “We can totally prevent cardiovascular disease from happening. We can completely trump genetics.”
Steve Nissen of the Cleveland Clinic says that’s wrong and, at best, statins reduce heart attacks and strokes by about one-third. “We cannot trump genetics,” Nissen tells the paper. “If she was right, we could wipe this disease out just by giving drugs to people. Even if we put statins in the water supply, cardiovascular disease would still be the leading cause of death.”
A Glaxo spokesperson tells the paper that Dall brings a unique perspective as the medical director of one of the few lipid clinics in the country, although the doc says she travels around the country and gives speeches two to three days a week. While many doctors boast of articles in medical journals, Dall’s site notes she was featured in an ad in the Journal of Clinical Lipidology.
But Dall doesn’t list much in the way of published studies in peer-reviewed medical journals, the paper writes, noting Dall is listed as the lead author in a positive 2009 review article involving Lovaza. However, manuscript preparation was supported by Glaxo and editorial assistance for the article, which was published in the peer-reviewed Southern Medical Journal, was provided by DesignWrite, a medical communications firm that has been linked to ghostwriting (see this).
The Glaxo spokesperson adds the article was initiated in 2007 when Lovaza was marketed as Omacor by Reliant Pharmaceuticals, which was bought by Glaxo in 2007, and the article was reviewed only for accuracy. Though Glaxo and DesignWrite were involved, Dall tells the paper, she and her co-author put hundreds of hours of work into the article.
Lisa Van Syckel
“The next day she called back, with a short statement”
Hmmm, no doubt GSK drafted it for her!.. The woman lacks Integrity,.. yes?
Lisa Van Syckel
If she wasnt under the Grassley Radar before,.. Im sure she is now. Gotta luv those pesky reporters. “lol”
doc
There are many primary care docs that speak for pharma. I recently had a discussion with a local manager about a high volume prescriber who speaks for diabetes meds, lipid meds, mental health meds, and countless other categories. Why? The manager told me that this doc would really sell your product for you and would even go to high volume offices to do breakfast or lunch. This is a major problem with these speakers.
MedEthix
Given that some pharma reps make more than a primary care doc, is it any wonder that PCP’s are hopping on the pharma bandwagon. Also, when a doc is carrying hundreds of thousands of dollars in med school debt, those pharma dollars look mighty attractive. I am not trying to make excuses for those that pander to pharma, but I am left to wonder if the financial remuneration was better for PCP’s would so many of them be speaking for pharma?
pharmavet
I recommend Lovaza, as it is the only product of its kind that goes through a rigorous purification process to remove all traces of environmental toxins, i.e. mercury. I should think that those who post on these boards about the dangers of contaminants in drug products would also advocate this product, although it is more expensive than dietary supplements (since it’s not a supplement).
http://www.lovaza.com/benefits-of-lovaza/prescription.html
Lisa Van Syckel
It seems that GSK is keeping her quite busy, so when does she find the time to see patients, let alone give those patients quality time.
SteveM
Re: pharmavet
Here’s a 1,200 mg fish oil supplement that delivers 360 mg EPA and 240 mg DHA per capsule:
http://www.puritan.com/omega-3-products-128/triple-omega-3-6-9-010157?NewPage=1
And the product is treated to remove Mercury. Current price: $26.78 for 300 capsules. The distributor has other omega-3 products that are even cheaper.
Lovaza claims an assay of 465 mg EPA/375 mg DHA. So in other words, 5 capsules per day of the supplement would be almost equivalent to the recommended 4 capsules of Lovaza. Heck, make it 6, because the stuff is cheap. Then it beats Lovaza.
But see this page on the cost analysis that indicates Lovaza is a huge rip-off:
http://heartscanblog.blogspot.com/2008/12/lovaza-rip-off.html
THOUSANDS of dollars per year for Lovaza!
BTW: given the numbers, Tara Dall is Reptile-Physician.
pharmavet
Thanks, Steve. As to Dr. Dall herself, she is a member of the prestigious National Lipid Association, Midwest Chapter. The NLA contains a number of the of the most prestigious researchers in the field of cholesterol and lipidology, some of whom I knew from my grad school days, and some of whom I worked with in Pharma. In terms of credentials, she is among excellent company.
SteveM
pharmavet, appreciate the details on Dall. But her medical credentials are separate from her business oiliness. The marginal benefit/cost ratio of Lovaza stinks.
Big credentialed docs who are blatantly corrupt like Joseph Biedermann and Charles Nemeroff are a dime a dozen. Just look at all the pimps doing biased CME presentations.
That’s the company that Dall is in that’s the most important to take note of.
Salmon
But Lovaza was developed by Reliant Pharmaceuticals which GSK paid $1.65 Billion for. Not only that but Reliant was founded by Ernest Mario, Ph.D. who was GSK’s ex-CEO and CEO of PPD Pharmaco, the contract company which was involved in the fraudulant safety studies with Ketek. I also believe that some of the funding for reliant came from VC firms that were started with private money from GSK execs. We certainly wouldn’t want to minimize any profits to Reliant by using a nonprescription product.
Salmon
M Helm, MD
P-vet,
I’m confused - Omega-3 fatty acids don’t provide any proven long-term benefit. They can (or at least the branded product has been shown to) rejigger lipid profiles, but then again, cerivastatin did too, and ezetimibe and others do still. Frankly eating oatmeal can do the same - throw in a little cinnamon, and there may be a benefit in insulin response.
The point of treating cardiovascular disease risk factors (lipid profiles being only a small set of these) is to lower risks of heart attack/stroke. Is there evidence that shows convencingly that ANY omega-3 fatty acid can do this?
If (as I suspect - though I confess that I have not conducted a rigorous search) there is not evidence, why would anyone recommend spending any money on them (other than profit motive)?
There is evidence that multiple dietary interventions (less fried food/saturated fats, more fiber, etc.), weight-loss, exercise and a select number of medications for specific conditions (mostly available now for not much money) are effective at lowering CV risk. This means that these things WILL reduce your risk of heart attack or stroke. However, producing statistically significant changes (but not necessarily clinically important differences) in lipid profile may be the biomedical equivalent of “cooking the books.”
Reading the prescribing information for the branded Omega-3 fatty acid and particularly examing the two tables presented (focusing on both what they show, and what they don’t show) makes this stuff look more like snake oil than just fishy.
If I can find Omega-3 fatty acids in nature (which I do) why would I want to buy only that single component of my possible diet - whether or not it comes from a special factory process? There is a possibility that the long-term benefits (if any) ascribed to Omega-3 fatty acids are due other things which come from eating a diet naturally rich these fatty acids, and not one which is rich in other types of fats. The supposed benefits may be entirely unrelated to the diet or the specific fatty acids, but may be a factor of the lifestyle (or genetics) of people who eat a diet rich in Omega-3 fatty acids - though I’m not advocating moving to Greenland to live among the Inuit.
I am at a loss to understand why this product would be recommended? Can you or anyone provide a reference (preferrably peer-reviewed original research) which validates a desirable real-life benefit, not just an improvment of a lab marker?
Like anything, if this product were so obviously beneficial, GSK would not have to use Dr. Dall or others to sell it. It seems that the push here is to foster belief despite (or in the absence of) evidence. To find and sponsor a young, attractive, bright and well-credentialled spokeperson would seem to be consistent with goal of gaining converts. This is apparently also how Scientology works.
pharmavet
Salmon, just to clarify the record. Reliant Pharmaceuticals was not founded by Dr. Mario. Dr. Mario was brought on board in 2003, which was three years after the company was founded. Furthermore, Dr. Mario left Reliant prior to its sale to GSK. At the time of the sale, the CEO of Reliant was Dr. Bradley Sheares, formerly of Merck. Dr. Mario’s fingerprints were no where near the transaction. Finally, GSK executives had nothing to do with the start-up capital for Reliant or in further rounds of financing. Initial funding was primarily provided by the Pritzker Family Interests and Bay City Capital.
You are usually pretty accurate, but in this case your facts are wrong. How do I know? I worked for Reliant and left prior to the sale to GSK.
Justice in MI
re: Doc Helm’s post, here is an abstract from a meta-analysis in Clinical Cardiology, July 2009. The link didn’t work, so, with reget, I paste in the abstract. I believe this is one of the better studies that shows an actual M&M benefit, at least for high-risk pts (secondary prevention), via fish oil supplementation.
Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review.
Marik PE, Varon J.
Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA. paul.marik@jefferson.edu
BACKGROUND: Epidemiologic data suggest that omega-3 fatty acids derived from fish oil reduce cardiovascular disease. The clinical benefit of dietary fish oil supplementation in preventing cardiovascular events in both high and low risk patients is unclear. OBJECTIVE: To assess whether dietary supplements of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) decrease cardiovascular events across a spectrum of patients. DATA SOURCES: MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and citation review of relevant primary and review articles. STUDY SELECTION: Prospective, randomized, placebo-controlled clinical trials that evaluated clinical cardiovascular end points (cardiovascular death, sudden death, and nonfatal cardiovascular events) and all-cause mortality in patients randomized to EPA/DHA or placebo. We only included studies that used dietary supplements of EPA/DHA which were administered for at least 1 year. DATA EXTRACTION: Data were abstracted on study design, study size, type and dose of omega-3 supplement, cardiovascular events, all-cause mortality, and duration of follow-up. Studies were grouped according to the risk of cardiovascular events (high risk and moderate risk). Meta-analytic techniques were used to analyze the data. DATA SYNTHESIS: We identified 11 studies that included a total of 39 044 patients. The studies included patients after recent myocardial infarction, those with an implanted cardioverter defibrillator, and patients with heart failure, peripheral vascular disease, and hypercholesterolemia. The average dose of EPA/DHA was 1.8 +/- 1.2 g/day and the mean duration of follow-up was 2.2 +/- 1.2 years. Dietary supplementation with omega-3 fatty acids significantly reduced the risk of cardiovascular deaths (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.79-0.95, p = 0.002), sudden cardiac death (OR: 0.87, 95% CI: 0.76-0.99, p = 0.04), all-cause mortality (OR: 0.92, 95% CI: 0.85-0.99, p = 0.02), and nonfatal cardiovascular events (OR: 0.92, 95% CI: 0.85-0.99, p = 0.02). The mortality benefit was largely due to the studies which enrolled high risk patients, while the reduction in nonfatal cardiovascular events was noted in the moderate risk patients (secondary prevention only). Meta-regression failed to demonstrate a relationship between the daily dose of omega-3 fatty acid and clinical outcome. CONCLUSIONS: Dietary supplementation with omega-3 fatty acids should be considered in the secondary prevention of cardiovascular events.
PMID: 19609891 [PubMed - indexed for MEDLINE]
SteveM
Re: Justice in MI
And there is other suggestive evidence that Omega-3 may be helpful for cognitive disorders like ADD and some other stuff.
The benefit/cost assessment of a basic omega-3 supplement is that at pennies a capsule, “Yeah, why not? Can’t hurt.” But when a doctor is shilling Lovaza at a COUPLE OF HUNDRED $$, then “Yeah, why not?” doesn’t work.
First of all, by recommending Lovaza, Dall is stiffing the nameless insurance companies and indirectly the rest of us who pay premiums. And imagine the economic damage she does to her patients who pay for Lovaza out of pocket. When they could buy Rite-Aid omega-3 for 10% of the cost and get the same effective bio-equivalence.
Forget Dall’s pedigree and her looks. She’s part of the problem. She’s a mess…
pharmavet
My prescription plan offers a month’s supply of Lovaza with a $20 copay. This is half of what I would pay for an equivalent number of purified fish oil capsules at GNC. Now you tell me what is a better bargain.
pharmavet
BTW, Dall’s practice is well situated geographically with respect to diet. I-94 is loaded with cheese shops up and down the road, and Wisconsin ice cream has a higher butterfat content than most others (which is why it tastes so good). I would bet that a large percentage of the population of Wisconsin would be a candidate for lipid lowering therapy.
SteveM
Re: pharmavet “My prescription plan offers a month’s supply of Lovaza with a $20 copay.”
Thanks for the comparison info. The ethical perversity of the Tara Dall’s of medicine is only matched by the economic perversity of insurance compensation.
This country is a mess.
P.S. OTC, generic Omeprazole (Prilosec) will work for what, 95% of patients with acid reflux? But the co-pay for no value added Nexium or Aciphex is less than the Rite-Aid price for Omeprazole?
Pardon me while I withdraw the fork of pathological illogic from my eye…
doc
Credentials and payola go together in this industry like peanut butter and jelly.
Justice in MI
Re: Steve M–Yeah, I was certainly not recommending Lovaza, just calling attention to this study.
Personally, I am happy with a brand that costs $8/month and has been screened for impurities to my satisfaction.
My question: Any comparative “purity” studies of Lovaza to leading OTC brands?
Anyway, I’m sure TD is a smart cookie but her use of adverbs –”totally,” “absolutely,” “completely”– rings of the valley.
Whatever.
john
what a total mess this is
Former Pharma Marketing Director
But now that people know about her they can do what they should do with all primary care Dr’s who dance too closely with industry - find another doctor…
It doesn’t matter how good the credentials seem, a line has been crossed.
On the other hand, this country is more messed up when we consider that we put people into neat bankruptcy to become educated in the first place. Of course they will do anything possible to start earning the big bucks. Then again, one has to wonder what was the real motivator going into the profession anyway…
Lisa Van Syckel
FPMD,
So glad you addressed the real issue here!!
JediMindTrick
just finished checking my beard for ticks
Lisa Van Syckel
Good Job Jedi,.. You wouldnt want to get Lyme Disease. Get a Lymerix Vaccine. Ooops, Forget GSK had to remove it from the market, due to bad side effects I hear..
Greg T
Well she is certainly a looker. There may not be much behind the exterior though. She has exactly one publication in pubmed and it’s the Clin Lipidol one. That’s a thin resume for someone who is a national speaker.
As Phamavet says, the National Lipid Association, Midwest Chapter has many distinguished members, but you can become a member just by paying the dues. My guess is that’s her qualification.
Dietrich
My doctor prescribed lovaza to increase my HDL. My triglycerides are OK. Has anyone heard of this “off-label” use?
Urgent health care in Florida
Yes,It seems that GSK is keeping her quite busy, so when does she find the time to see patients, let alone give those patients quality time.
Instantmedicalcare.com