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Healthy Skepticism Library item: 19191

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Electronic Source

Jewett C
Top antipsychotic prescribers also drug promoters
California Watch 2010 Dec 6

Full text:

Three San Diego County doctors who accepted five-figure payments from pharmaceutical companies have emerged on a list of the state’s top prescribers of antipsychotic drugs to the needy, according to state records.
Officials from Medi-Cal, the state program for the poor and disabled, provided a list of California’s top 10 prescribers to Sen. Charles Grassley, R-Iowa, who is reviewing prescribing rates of psychiatric and pain medications nationwide.
Three of them accepted $20,000 or more in educational or speaking fees from the company that makes the drug they prescribe to Medi-Cal patients, company disclosures show. All three practice in San Diego County.
Grassley’s investigation comes on the heels of numerous government lawsuits that have accused pharmaceutical companies of illegal marketing that has vastly broadened the market for drugs only approved for patients with rare and severe psychiatric conditions.
California authorities who provided the information to Grassley’s office warned against viewing the data as a sign of wrongdoing.
Accepting drug company payments and then prescribing the products to patients is not illegal or even unethical, in and of itself. But critics, including some industry insiders, are concerned such marketing could induce over-prescription of drugs or otherwise corrupt the process.
The drug companies say the speaking fees helps educate health care providers about the use, safety and benefits of their products.
“Physicians are selected to speak based on expertise in the area,” said Tony Jewell, AstraZeneca spokesman. “They may not be nominated or retained as speakers in exchange for or as an inducement to any past, current or future prescribing or recommendation of the use of AstraZeneca medicines.”
One of the state’s leading prescribers of antipsychotic medications is Harinder Grewal, a child psychiatrist who sees patients throughout San Diego County.
According to Medi-Cal records, she issued nearly 3,000 prescriptions for antipsychotic medications in 2009, half of them for the drug Seroquel. This year AstraZeneca, the company that sells the drug, paid her $21,600 to educate other health workers.
Grewal did not return several calls.
Grewal was also among the state’s top prescribers of the antipsychotic medication Geodon. That drug’s maker, Pfizer, spent $3,750 to compensate Grewal for leading an educational forum.
Grewal came under scrutiny by the medical board 15 years ago. According to an accusation filed by the board, Grewal claimed that she could treat premenstrual syndrome. She ordered a battery of unnecessary hormone tests and medications for three patients, records show.
The treatment added up to what the board called “excessive prescribing” and “repeated negligent acts.” Grewal was placed on five years of probation, which she completed in 2000.
Two other San Diego-area psychiatrists who share a La Mesa office also mix prescribing and promoting.
Samuel Etchie prescribed Seroquel more than 1,000 times in 2009 at a cost of $449,000 to the state, according to Medi-Cal records collected by the ProPublica news organization and provided to California Watch. The drug’s maker paid him $25,350 this year to speak to health professionals.
Etchie did not return two calls to his office.
John Allen, who shares an office with Etchie, was among the state’s top prescribers of Zyprexa, also an antipsychotic drug. Allen dispensed 418 prescriptions at a cost to the state of $346,569. This year and last, the drug’s maker, Eli Lilly and Co., paid him about $27,000 to educate other medical professionals.
Allen said he conducts speeches about Zyprexa for Lilly based on information contained in the literature that comes with doses of the drug. He said he speaks for a variety of drug makers if he has research and day-to-day experience using their medications.
“I think it’s unfortunate that there’s an implication in articles that we’re robots for drug companies,” Allen said. “We have to have our own experience with medications and find out what works best. We’re not 5-year-olds in front of TV watching cereal and toy commercials.”
Allen said the prescribing numbers reflects the many bipolar and schizophrenic patients he treats in his practice. He said he prescribes a wide variety of medications, new and old. “Whatever works for the patient is most important,” Allen said.
Medi-Cal authorities say they do not ask doctors to disclose relationships with pharmaceutical companies. However, a department spokesman said the agency prohibits health providers from accepting any “gratuitous consideration” in connection with caring for a Medi-Cal patient.
The agency analyzes data, performs audits and conducts investigations regarding any irregularities in prescriptions or other provider care.
Medi-Cal authorities said they cannot comment on audits or letters sent to doctors due to confidentiality laws. But records show that no doctor discussed in this report has been subject to a suspension from seeing Medi-Cal patients, the agency’s harshest sanction.
Medi-Cal efforts work in tandem with private and government lawsuits. Such cases have resulted in multimillion dollar settlements by pharmaceutical companies.
Such cases steps do not address the subtle but significant influence that pharmaceutical companies have on doctors, said Michael Steinman, a UC San Francisco physician who studies pharmaceutical industry marketing.
Steinman said pharmaceutical companies routinely pepper doctors with visits, phone calls and invitations to meals and events.
Research has shown that small gestures tend to influence doctors to prescribe more medications. And Steinman does not see the influence going away.
“For that reason, I think it would be best to avoid the conflict altogether,” he said. “But you’re not going to be able to do that overnight.”


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