Given pharma's way of doing business during the past decade, it’s become extremely difficult to identify emerging patterns that deserve an attaboy. That’s all the more reason to commend GlaxoSmithKline’s management for two steps they took last week.
The company’s CEO, Andrew Witty, announced that henceforth they would no longer include the volume of prescriptions written by physicians in a rep’s territory when calculating his/her compensation. That new policy started in GSK’s U.S. operation during 2011 and last week’s decision applies it worldwide.
At the same time, Mr. Witty announced that “the company will no longer pay health care professionals to speak on its behalf about its products or the diseases they treat [and] will also stop providing financial support directly to doctors to attend medical conferences.” (See here.)
Some industry commentators claim that GSK’s initiative represents a public relations effort, coming as it does on the heels of a $3 billion fine the company paid last year and a burgeoning bribery scandal in China. That may be true, but if so, it still doesn’t tarnish the value of these changes. If GSK's small step toward reform occurred as a result of some major scandals, that only confirms the importance of exposure by whistleblowers, plaintiffs’ attorneys and journalists as tools for rectifying corporate behavior.
Other skeptics point out that even if pharmas stop greasing physicians’ palms and quit paying reps as if they were selling hot dogs, those two practices are only a small part of the industry’s dubious business practices. Again, the doubters are right but they miss the point.
Over decades the pharmaceutical industry has built up an approach to developing and distributing drugs that appears as something from the Gilded Age of the late 19th century. In effect, pharma has developed an entire culture of corruption.
In addition to marketing drugs off-label and paying physicians to prescribe and promote them, pharmas routinely hide the results of studies that associate their brands with ineffective or harmful results.
Companies also publish “ghostwritten” articles by paying agents to conduct research and write up the results with a favorable slant. Then they pay outside, esteemed researchers to attach their names as authors.
Some pharmas report false prices so as to charge Medicaid appreciably more than their best prices. The list of dirty tricks and violations could fill up this page and the next.
So no, GSK’s policy changes won’t turn pharma’s ocean liner around and make everything right, but a culture of rampant corruption in a multibillion dollar industry cannot be thoroughly reformed by just one company stepping forward. The effort must be sustained and extensive, but at least GSK deserves a callout for taking two steps in the right direction.
An important message for consumers is that useful reforms such as GSK's last week should not lull them into complacency. Making pharma and other health care institutions responsive to the public's needs and well being cannot rest on expectations or hopes that enlightened, public-minded CEOs in those companies will proceed with useful reforms.
The very fact that someone holds a CEO position at a Big Pharma suggests that he or she is more concerned with stock price than with developing medicine to improve the length and quality of life. In order to boost stock price and earnings growth, some CEOs and their fellow officers will use any corrupt means they can without getting caught. For this substantial segment of managers, the well being of patients ranks low on their priority list. As with most things in life, there are exceptions, but that’s the general condition.
These realities demand that the push for creating wider, deeper reforms in pharma must come from everyday patients/consumers.
One way the public can do this is by pressuring pharma's customers — physicians and insurers.
For example, the Affordable Care Act requires that pharma companies, starting next fall, must disclose all payments they make to physicians. Until then, patients should go online to ProPublica's website (see here) and see whether any pharmas paid their physicians through 2012. Then if, say, one's endocrinologist/diabetologist has received tens of thousands of dollars in speaking fees from Merck or Eli Lilly, patients should refuse prescriptions for anti-diabetes products from those companies because the doctor's position as a paid advocate compromises his objectivity. In place of brands from companies that paid him, patients can request prescriptions for a competing product from another company. If the doc offers any pushback, it may not be necessary to use words such as "shill" and "whore," just so long as he perceives that the patient has those terms in mind. Once physicians start getting that message from even a couple of their patients, some of them will see the light.
There's something else that patients/consumers can do to help advance reform in the pharmaceutical industry. That involves exercising some rights of citizenship. Writing and calling one's Congressman and Senator represent one of those important rights.
In that regard, the "Antibiotic Development to Advance Patient Treatment Act of 2013" (HR.3742) is working its way through Congress. Everyone knows that the frequency and tenacity of resistant bacteria are becoming more common because antibiotics are overused, yet pharmas rate antibiotics as one of the less profitable categories. For that reason, few companies are trying to develop new antibiotics to combat increasingly virulent pathogens. The proposed legislation tries to encourage new antibiotic development, partly by lowering the current standards needed to win regulatory approval in that class. Some Washington observers note that if the Antibiotic Development Act passes, pharma's Congressional lobby will use it as a fulcrum to weaken approval standards in every other therapeutic class. Residents of the Delaware Valley can write to their Congressmen and Senators and ask them to strike the lower approval standards from the Antibiotic Development Act.
Sometimes advancing reform involves preventing the erosion of existing standards. A barrage of mail to Congress may check pharma from prevailing over an indifferent public.
So if anyone wants to broaden and accelerate the pace of last week's actions by GlaxoSmithKline, he/she shouldn't wait on the good graces of pharma's CEOs. As with other industries, pharma will reflexively take the road of increased profit. If the public wants more reform to avoid endangering its health or getting its pocket fleeced, citizens must take the initiative and push pharma in the right direction.
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