Stay Free! Daily

Say something nice or don't say anything at all. Or Big Pharma will threaten to sue you.

In the previous post, I said that facility with fraud is a requirement for running a pharma trial. Is that a cheap shot? Probably not.

Yesterday, Dr. John Buse testified before Congress that GlaxoSmithKline, the makers of diabetes drug Avandia, pressured him to stop questioning the drug's safety. Company representatives threatened him by saying that his "actions were scurrilous enough to attempt to hold me liable for a loss in market capitalization." In other words, they threatened a multimillion dollar lawsuit because he wouldn't simply swallow the shit Glaxo was shoveling.

Did I mention that the Congressional hearings are being held because Avandia carries an increased risk of heart attack? Avandia paid for a full page non-apology ad in today's Daily News; it wasn't much different from Panexa's. The non-apology was mere pages away from the article about Dr. Buse's testimony.

Pharma Fond of Fraud-Committing Physicians

Sunday's New York Times had a mindbending article about the way drugs are tested in this country. Apparently, doctors who have been disciplined for fraud are finding second careers running clinical trials for drug companies. One such doctor, before being hired directly by drug companies, was cited by the FDA for violating protocol in every study he managed! When a suicidal patient refused to be enrolled in one of his trials, he discharged the patient from his hospital—and the patient committed suicide shortly thereafter. It's as if facility with fraud is a bona fide occupational qualification for running a pharma trial.

Meanwhile, take a wild guess what many of the other doctors hired to run drug trials were disciplined for... if you said "overprescribing," you win!

Gene Carbona, who left Merck on good terms in 2001 as a regional sales manager after 12 years in drug sales, said the only thing the company considered when hiring doctors to give marketing lectures was “the volume or potential volume of prescribing that doctor could do.” ... Mr. Carbona, now executive director of sales for The Medical Letter, which reviews drugs, said that had he known that a doctor had a disciplinary record for excessive prescribing, “I would have been more inclined to use them as a speaker.”

Euphemism of the Week

What do you call the

agitation, anxiety, akathesia, panic attacks, irritability, aggressiveness, worsening of mood, dysphoria, crying spells or mood lability, overactivity or hyperactivity, depersonalization, decreased concentration, slowed thinking, confusion and memory/concentration difficulties

...and other symptoms suffered from getting off of SSRI antidepressants such as Prozac or Zoloft? Well, if you're in the pharmaceutical business, you don't call it “withdrawal,” you call it “Antidepressant Discontinuation Syndrome.”

In other words, the problem isn't that SSRIs are physically addictive, the problem is your decision to stop taking them.

I love how garden-variety withdrawal is now a "syndrome." Sounds like something you'd need a drug for. Imagine that.

(Via Mindhacks)

Abbott to AIDS Patients: Thank you for not dying

Abbott Laboratories has come up with an ingenius way of screwing AIDS patients. Here's how it works: Abbott sells two AIDS drugs, an older drug called Norvir, and a highly profitable newer med, Kaletra. The older Norvir works only in combination with other protease inhibitors; essentially, it boosts other drugs' effectiveness. Kalectra, however, includes Norvair and therefore works alone.

When Kaletra was the only drug of its kind on the market, it made piles of money for Abbott. But in 2003, Bristol-Myser Squibb introduced a rival drug that patients needed to take with Norvir. The suits at Abbott saw this coming and worried: if Norvir remained on the market, they were going to have competition for their real money-maker.

So what did they do? Naturally, they looked into the various ways to kill off use of Norvair: they could replace the pill form of Norvir with a liquid form that tastes like vomit, jack up the price, or remove it from the market altogether. In an instance of life imitating satire, they even proposed a plan for confronting the nagging nabobs of negativity who complained: they would tell the public that Norvair was no longer available because they had to send it to " 'the developing world (i.e. Africa)' as part of a humanitarian effort" - !

What struck me about this story is that Abbott execs knew they'd get a lot of criticism from patient groups' but figured it would die down in a year or two -- and that's exactly what happened. The company may not have predicted the lawsuits that have followed -- and the public airing of internal memos -- but the incident is still an important reminder of the need for real government oversight of pharmaceutical companies.

Merck's latest scam

Don't know if anyone caught the news last week about Merck's $1.5 billion in tax fraud. The pharma giant (makers of Vioxx) set up a subsidiary in notorious tax haven Bermuda, transferred ownership of its patents to the subsidiary, then paid cash -- which it deducted as a business expense -- to license the patents from itself. Pretty sneaky? Not sayeth Merck.

Merck says it did nothing wrong and that the deal was simply a way of raising financing for its 1993 acquisition of a pharmacy-beneifits management firm, Medco...

I love that defense. It essentially boils down to: "But Your Honor, we needed to make more money!"

And now a word from our sponsor

After moving across town and settling into new digs, we have finally gotten the new "Pranks" issue of Stay Free! out. Hooray!

Those of you in and around Brooklyn can pick up a free copy in these locations (more to follow). Subscribers should be getting your issues on Tuesday or thereabouts.

I'll post the table of contents shortly. But first, I wanted to get out this important announcement from our sponsor, Merd Pharmaceuticals, the makers of Panexa.

On the depression of mice and men

I was listening to NPR last night and caught this bit about a new study of depression drugs:

Scientists have discovered a protein in the brain called P11 that may explain how drugs like Prozac fight depression -- and why they take so long to work.

Continuing...

Researchers have been looking for an explanation by studying precisely how serotonin acts on brain cells. That's hard to do in people. So a team led by Pers Svenningsson of the Karolinska Institute in Stockholm looked at mice with signs of depression. When these mice are held by their tails, for example, they struggle less than normal mice.

Svenningsson and a group of U.S. scientists found that removing P11 from the brains of mice caused them to show signs of depression.

Granted, I'm no scientist, but how do we know that the mice were struggling because they weren't as depressed? Who knows, they may have been trying to wrap the string around their necks to kill themselves.

And isn't it quite a leap to say that not struggling is a sign of depression analogous to human depression? Charles thinks there must be a line missing in the article along the lines of: "Scientists determined the symptoms of depression in mice through a combination of tail-hanging and interviews."

This story is more promising if you look between the lines of its ridiculously reductive analogies, though: thank god researchers are looking beyond seratonin and dopamine as isolated triggers for brain functioning.

Suddenly Panexa doesn't sound so bad

It apparently isn't enough for the pharmaceutical industry to price drugs so high that people in impoverished countries can't afford them. The high prices inevitably result in the production and sale of dangerous fakes, so the drug companies actively suppress the information.

Drug companies collect information about fakes but hide their dirty laundry behind trade secrets claims and PR. The American Prospect's chilling account of Glaxo SmithKline's malfeasance in connection with the trade in counterfeit Halfan (an anti-malarial) in Africa includes more corporate double-speak, denial of responsibility, "misplacement" of records and manufactured excuses than you would think could fit in a single article. The death toll from BigPharma's refusal to publicize and prevent the sale of diluted or fake drugs may never be known but is clearly quite high.

As is often the case, I'm horrified but not surprised that this is going on in the Third World because it is going on right here. In 2002, Kansas City pharmacist Robert Courtney was sentenced to 30 years in prison for diluting the cancer drugs Taxol and Gemzar, killing 17 and injuring many more. Bristol-Myers Squibb and Eli Lilly both settled civil cases arising out of Courtney's prosecution because BMS and Lilly both had records that showed that Courtney sold three times as much of those drugs as he purchased. Both companies denied any responsibility, of course.

One more reason to hate cheerleaders

"Cheerleaders have many qualities the drug industry looks for in its sales force."

There's nothing like seeing your prejudices confirmed, so it was a joy to come across this story validating a deep, dark suspicion of mine dating back to high school: cheerleaders are products of the dark side. The proof? They're the top recruits for pharmaceutical sales rep jobs:

T. Lynn Williamson, ...cheering adviser at Kentucky, says he regularly gets calls from recruiters looking for talent, mainly from pharmaceutical companies. "They watch to see who's graduating," he said.

"They don't ask what the major is," Williamson added. Proven cheerleading skills suffice. "Exaggerated motions, exaggerated smiles, exaggerated enthusiasm — they learn those things, and they can get people to do what they want."

In fact,  so many cheerleaders move onto pharma sales that there's even a recruiting company focused on placing them: Spirited Sales Leaders.

Why cheerleaders? According to Spirited Sales Leaders, cheerleaders "possess all of the qualities you need to transform your staff into a successful sales team." In other words, they are young, buff, and jiggly.

The TAP Pharmaceutical saleswoman says it is partly her local celebrity that gives her a professional edge. On the University of Kentucky cheering squad, [she] stood out for her long dark hair and a tiny physique that landed her atop many human pyramids.

"If I have a customer who is a real big UK fan, we'll have stories to tell each other," [she] said. "If they can remember me as 'the cheerleader — she has Prevacid,' it just allows you do to so many things."