an epidemic…

Posted on Friday 23 August 2013

Reuters
Aug 22, 2013

U.S. drugmaker Eli Lilly and Co said it was "deeply concerned" about allegations published in a Chinese newspaper that it spent more than 30 million yuan ($4.90 million) to bribe doctors in China to prescribe the firm’s medicines instead of rival products. A former senior manager for the company, identified by the pseudonym Wang Wei, told the 21st Century Business Herald that bribery and illegal payments at Eli Lilly’s China operations were widespread, the paper reported on Thursday.

Eli Lilly is the third foreign drugmaker to face whistleblower accusations in the newspaper this month. The reports coincide with multiple Chinese investigations into the pharmaceutical sector, spanning alleged corruption to how drugs are priced. "In order to hit sales at rival companies and push the company’s own products, bribes and special payments of all sorts were extremely common at the company. The level of the problem was just as bad as at GlaxoSmithKline," Wang was quoted as saying…
hat tip to Pharmagossip   
I’ll bet Eli Lilly really is deeply concerned. Just as Richard Nixon was probably deeply concerned about the exposure of the White House Tapes or Al Capone was deeply concerned about those pesky I.R.S. probes. Such deep concern is something of a universal lament among those in the recently busted set. But I’m not a bit deeply surprised by these stories from China. When I read these stories, I remember once meeting a man whose chosen profession was armed robbery. He said, "You people are really lucky that we criminals are so damn dumb. We always think we’re so smart. This time, I can get away with it. This time I’ve figured all the angles. Later, I sit in jail and think up ways to do it better next time. So damned dumb!"

I doubt that pharmaceutical companies hire sales people who are like this man, criminals by design. But what they do seem to do is regularly create an atmosphere that produces this kind of criminal outcome. The way you get ahead is by meeting or exceeding sales goals that are independent of the value or need for the product. In the last post, I was talking about sitting through the Trial in Texas where a regional sales manager calmly testified about training his his reps not just to lie, but teaching them how to do it. And then they rolled out a diagram that had the "chain of command" from his level all the way to the top of the corporation [J&J], and he traced for us meetings that documented the source of this kind of training all the way up the chain. The suit was settled within a day or so of his testimony. It was a disillusioning morning.

Now, in the ChinaGate story, we have two pharmaceutical companies implicated that have recently paid huge criminal fines – GlaxoSmithKline [Biggest Deal Ever: Glaxo Pays $3B For Bad Behavior] and Lilly [Eli Lilly and Company Agrees to Pay $1.415 Billion to Resolve Allegations of Off-label Promotion of Zyprexa]. Both have signed Corporate Integrity Agreements. And now they’re embroiled in allegations that they directly bribed Chinese doctors to prescribe their drugs. While that may say something about Chinese medicine, it says a lot about these companies. The kind of money they’ve shelled out for bribes is too much to hide as simply local expenses. I hope the earlier speculations [a credible shot… ] that the Western Governments will wake up and investigate these companies and this industry from top to bottom, inside and out, are right. This is an epidemic…
  1.  
    August 23, 2013 | 10:48 PM
     

    Lilly is the worst still, in my opinion.

  2.  
    Melody
    August 24, 2013 | 7:51 AM
     

    Joel,

    Certainly agree. They learned a lot when they managed to convince doctors (and patients) that Humulin was “just like the human body makes” and that a shortage of cows was the impending death knell for natural insulins. I think they took lessons learned in their introduction of synthetic insulin and manipulation of the market (withdrawal of natural insulins), honed them well and voila!–everyone is now a candidate for a psychotropic medicine. If any of THOSE medicines lead to diabetes, they’ve created a two-fer for themselves. Whenever Mickey posts anything with Lilly in the content–red flags appear and I cannot keep my thoughts to myself.

  3.  
    Steve Lucas
    August 24, 2013 | 8:57 AM
     

    From the business perspective starting around 1980 we saw the rise of the salesman. Marketing took over almost all enterprises and product was pushed to the back, way back.

    The drug industry was the perfect embodiment of this philosophy as the WWII leaders were retiring and along with those certain restraints that maintained a basic level of truthfulness. As noted in your previous post, a lie to increase sales was the standard in sales calls. Interestingly when you speak to salespeople you will find they blame the customer for not checking their claims, much like the dumb criminal.

    Some noticed this change and cataloged it in such books as Snakes in Suits, the rise of the psychopath in business became epidemic.

    As legal settlements became common, as cataloged on Health Care Renewal, but no person was held responsible these became the cost of doing business. Remembering that salespeople and criminals will do the same thing over and over, the whole process simply gained speed.

    Today we are faced with this corporate culture not only in pharma, but in society itself, including our religious organizations that reflect this work ethic. Religious organizations speak of chain of command and rules to deter discussion while the mega churches grow due to a simple fact; If you have an issue you speak to the senior pastor and that issue is resolved. Rules and chain of command are only used when someone cannot over come a logical argument.

    Many decades ago I was taught a salesman never lies, they believe what they are saying at the time they are saying it. That may change in seconds, but at the time they truly believe what they are saying. Additionally, they were a marginal student who will internalize the goals of the company. We do not want people who will question the material they are given.

    Today business and other organizations are faced with a changing landscape. Business practices common in the US are not being tolerated in the rest of the world. People will be held accountable, not business entities.

    When we look at two cornerstones of our society, medicine and religion having become nothing more than the reflections of a marketing ethos, we do not have to wonder why the rest of society fails to function. The APA blames those old members for not seeing the light and their greatness, much like we face with many in the clergy.

    The battle cry has become; sue me, across society. Our government echo’s this, business echo’s this, and our religious organizations echo this, to the exclusion of thoughtful discussion.

    While many of us stand outside, logic in hand, we must remember; salesmen don’t lie, they believe what they are saying at the time they are saying it. This applies to government, this applies to business, this applies to medicine, and this applies to the clergy.

    Steve Lucas

  4.  
    wiley
    August 24, 2013 | 2:46 PM
     

    If the drug companies had been as successful in China as they have been in the U.S., the amount of money leaving China would have been staggering.

  5.  
    August 24, 2013 | 4:25 PM
     

    Steve,

    An amazing and thought provoking comment! Thanks…

  6.  
    CannotSay2013
    August 24, 2013 | 10:02 PM
     

    Steve,

    In psychiatry things are compounded by the lack of objective validation to psychiatric “cures”.

    If a salesman tells you that your car will give you 30 miles per gallon, but it gives you 15, well, you cannot fool a lot of people for a long time. The same is true of computers, consumer electronics, and other areas of medicine (like with meds that lower cholesterol or sugar levels).

    The intrinsic problem with psychiatry is that it lacks objective, quantifiable measures of success, so it’s a goldmine for scams. In fact, the whole psychiatric enterprise is itself a conflict of interests. Unlike other specialties of medicine, that have objective quantifiable measures of the prevalence of their conditions, psychiatry has to exaggerate the prevalence of its invented disorders to justify psychiatrists salaries. This explains why disease mongering is way more pervasive in psychiatry than in other areas of medicine.

  7.  
    CannotSay2013
    August 24, 2013 | 10:09 PM
     

    “Unlike other specialties of medicine, that have objective quantifiable measures of the prevalence of their conditions, psychiatry has to exaggerate the prevalence of its invented disorders to justify psychiatrists salaries.”

    To make it more clear what I mean by this. Suppose you are the director of a big research hospital. Each year (or each couple of years) you need to do planning on how many specialists you need to meet the needs of the hospital taking into account retirements and the needs of the population that the hospital primarily serves. To estimate the needs of oncologists, you take a look of the diagnoses of cancer in the last 5 years and you get the idea. Same with cardiologists, body trauma specialists -in which case you look at the number of car accidents and the lie-, infectious diseases, etc. When it comes to psychiatrists, you have to trust the word of psychiatrists since there are no objective ways of measuring the prevalence of psychiatry’s invented disorders. Psychiatrists face a conflict of interest that no other doctors face: if they do not diagnose people a “mad” they will not be employed and since there is no objective biological test to diagnose somebody as “mad”, they have to get as many “mad” people in the hospital as they have capacity for or else, next time there is a planning exercise they will lose both beds and staff.

    So, psychiatry is the “dream” of scam artists at Big Pharma.

  8.  
    a-non
    August 24, 2013 | 11:08 PM
     

    “The drug industry was the perfect embodiment of this philosophy as the WWII leaders were retiring and along with those certain restraints that maintained a basic level of truthfulness.” Steve Lucas

    In the geopolitical sense, a Cold War structural change that was formerly held in check by leaders like Eisenhower but now seems to have become our own petard.

  9.  
    Steve Lucas
    August 25, 2013 | 8:59 AM
     

    The reason for my comment is my wife and I attend an old line church that her family helped establish over 150 years ago that is currently facing a massive membership loss.

    The minister has stated from the pulpit that: he is not responsible for church growth, he is not responsible for a good sermon, we should not expect pastoral care from him, and in reality, it is an inconvenience for him to work Sunday’s.

    Wanting to move this situation along I contacted the next layer in our system outlining the problem. The response was unbelievable, it opened with the statement I had no standing with this level of the church; they only dealt with the minister.

    The next statement asked what life event had made me so resistant to change? I obviously had issue that I should discuss with someone. I should also encourage anyone with a similar problem to email this person so they could enlighten them about their misunderstandings.

    The whole response was demeaning psycho babble. Like most people my age I am well beyond having someone present something of this nature.

    Sadly, this church has recently dealt with another professionally diagnosed deeply flawed minister.

    When I look at society I see a hierarchy that has come to prominence based often on a salesman’s approach of tell someone anything to close the deal. Organizations only respond when faced with legal actions. Lost membership becomes a game of blame the victim and then you are pushed to name names of those who share your concerns so they can be singled out.

    Soft numbers tied to unrelated demographics allow for constant denial. We are watching government, the clergy, and medicine move to a legalist position where change is only brought by legal action. Failure is the victims fault for not understanding the greatness of the leadership, and the only measure of success is a continuing paycheck and staying out of jail.

    Pharma’s influence has moved well beyond the drug industry and medicine. Business people will repeat a behavior as long as it works and seeing it work someplace else others will mimic a behavior. The detail person is alive and well as repeating the party line over and over does not allow for questions or serious discussion.

    Currently all but one old line denomination are loosing members while the independent churches continue to grow. Like the APA, or AMA, people are finding alternative to out of touch organizations.

    Steve Lucas

  10.  
    CannotSay2013
    August 25, 2013 | 2:30 PM
     

    Steve,

    Not sure what your point is. My argument is specific to psychiatry: a medical discipline that has an intrinsic conflict of interest like no other. An oncologist cannot make up “cancerous cells”. A cardiologist cannot make up a “heart attack”. A specialist in infections diseases cannot make up the prevalence of HIV.

    A psychiatrist can absolutely make up any diagnosis he/she wants, just as he/she can make up determinations of “dangerousness” that will warrant forced commitment. So a psychiatrist, in doing its job, is serving two masters, including the worst of all: his/her own ego and economic needs.

  11.  
    a-non
    August 25, 2013 | 7:37 PM
     

    “A psychiatrist can absolutely make up any diagnosis he/she wants, just as he/she can make up determinations of “dangerousness” that will warrant forced commitment. So a psychiatrist, in doing its job, is serving two masters, including the worst of all: his/her own ego and economic needs.”
    This false diagnosis would be transferred to the patient’s HIPAA-that the state sells to anyone. The data is deindentified but can be used in all of the institutions that Steve mentioned. Instant caste system.

  12.  
    a-non
    August 25, 2013 | 7:58 PM
     

    What I’m getting at is the info is easy to re indentify.
    http://hipaa.wisc.edu/ResearchGuide/deidentification.html

  13.  
    Annonymous
    August 26, 2013 | 4:14 AM
     
  14.  
    a-non
    August 27, 2013 | 8:07 PM
     

    “Oregon doctors say no to drug companies” August 27, 2013
    Columbia Journalsim Review

    “Not well known by the public, that is. Drug companies buy prescribing information from health information companies that have purchased de-identified records from pharmacies about the drugs we all take. Drug companies then match each of our records with the doctors’ prescriber numbers sold to them by the AMA. Thus, what each doc prescribes makes its way into the sales pitches delivered in doctors’ offices.”
    http://www.cjr.org/the_second_opinion/bend_bulletin_on_oregon_doctors_saying_no_to_drug_companies.php

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