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Xarelto Sales Spike Linked to Groups, Doc Paid by Big Pharma


In an article co-authored by writers from the Milwaukee Journal Sentinel and Medpage Today, a closer look is taken at the concerns surrounding the influence of pharmaceutical companies on medical professionals who prescribe their medicines. However, it’s not just doctors who benefit from the billions of dollars spent annually by drug makers. Medical associations that create the guidelines can also influence which meds are in favor at any given time.

An investigation into these financial ties by the Milwaukee Journal Sentinel and MedPage Today uses as an example the new-gen anticoagulants that have replaced warfarin as the standard of care, even though they came on the market with no antidote for the bleeding risks that they carry. New guidelines favoring their use have been issued by a number of organizations. Using federal Open Payments data, the news groups found that the companies that make the drug often contribute handsomely to the groups whose endorsements would be important, $40 million in three years.

The article goes on to say that organizations within Europe and the U.S. that issued new guidelines received millions of dollars from several drug makers including Pfizer and Bristol-Myers Squibb, marketers of the drug Eliquis, and also Bayer and Johnson & Johnson which co-market the drug Xarelto. Also, in one case, the guidelines redefined, “who should receive the anticoagulants to prevent stroke and heart attack,” a move that surged potential patients from 3.7 million to 4.7 million Americans.

Another example found in the investigation involved The American Heart Association, which approved new guidelines last year for treating atrial fibrillation, and benefited more than $13 million in three years from anticoagulant makers. Moreover, several news groups report that from the period of August 2013 through August 2014, 9 members of guideline committees for different groups endorsing the use of this class of drugs were beneficiaries of $400,000, an average of $44,440 each, for food travel and various other things.

Doctors as well as organizations hotly deny that these payments convince them to favor or promote drugs they would have otherwise turned away. Opponents to these types of payments argue that, “the kind of money being thrown around is certain to have an influence on medical practice that might not always be good for patients.”

[Dr. Gregory] Lip has received payments from at least 12 drug-makers since 2006, including five companies that market or make the new anticoagulants, according to notations on papers and panels reviewed by the Milwaukee Journal Sentinel/MedPage Today…

Independent experts say the financial relationships highlight concerns about the influence of pharmaceutical money on medicine.

‘It seems to be a poster child for everything that is wrong with how we create guidelines,’ Dr. Jerome Hoffman, an emergency medicine physician and emeritus professor of medicine at the University of California, Los Angeles, told the Journal. Dr. Hoffman writes about conflicts of interest in treatment guidelines.

The Sunshine Act Solution?

Some argue Sunshine Act data, which was publicly posted last year, gives patients and others a way to see who gets what payments and what amount so they can decide for themselves if they feel a doctor has been influenced to push one med over another– arguably a daunting task for anyone given that includes, “$3.5 billion in payments to 546,000 doctors and 1,360 research institutions in just 5 months.”

Critics, however, point out the database doesn’t list payments to newer categories of healthcare professionals, such as nurse practitioners, that are playing a growing role in the system.

Dr. Walid Gellad, co-director of the University of Pittsburgh’s Center for Pharmaceutical Policy and Prescribing, told NPR: “If the purpose of the act is to shine a light on the relationship between industry and the healthcare sector, then you’ve left out an important component of that sector.

Finally, in addition to the article focusing primarily on the investigation into the flow of money from drug companies to doctors and medical societies who influence prescription guidelines, the Journal Sentinel published two other anticoagulant stories as part of a “Risk/Reward” series. Links to each story in the series can be found below:


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  1. Mark says:
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    This title is misleading as BMS spent the most money of all NOACs on physicians and doesn’t have the expected sales to show for it.

  2. Jeanne News says:
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    ‘Usually, people don’t know what to do with information about conflicts of interest. “So what they do is ignore it.” That’s why disclosing a bias doesn’t cancel its effects. The best way to do that, says Loewenstein, is to eliminate the bias in the first place.” P. 75, Why We Make Mistakes, Joseph T. Hallinan