Doctors Should Not Market Drugs

Doctors Should Not Market Drugs

By

Leonard Zwelling

https://www.nejm.org/doi/full/10.1056/NEJMp2210637

I am sure no doctor that you know, let alone yourself, would ever market commercial pharmaceutical products to other prescribers, would you?

Of course not.

But in a recent issue of The New England Journal of Medicine (387:1631) Dr. Troyen Brennan describes the details of a settlement that Biogen reached with the federal government for $900 million, 60% of Biogen’s net income for 2021. Biogen must have done something wrong. They did.

Former Biogen employees told the federal government that Biogen was using a dubious strategy to market its pricey (list price over $50,000 per year) immune-mediated therapies for multiple sclerosis. They were paying high prescribers as consultants and using them in a speakers’ bureau to “educate” other doctors on the use of the drugs. This violates the Anti-Kickback Statute in the False Claims Act. Basically, Biogen was buying neurologists to prescribe their expensive drugs.

What Biogen did was know that among the 13,000 American neurologists, 1200 wrote 60% of the prescriptions for these pricey drugs. They paid the doctors to putatively consult for the company, but it is unclear whether the doctors’ opinions were valued by Biogen at all. Some “consultations” were all-expenses paid large meetings of the consultants. Half the doctors who wrote more than 1000 prescriptions were among the paid “consultants.”

There were also speakers’ bureaus formed where doctors were hired to “educate” other doctors on the use of the drugs, but “200 of the trained speakers never gave a presentation and more than 1000 presentations had zero or one physician in attendance.”

The lesson is obvious. As cancer drugs become ever more expensive and more targeted, it will take not a whole lot of prescribing to reap massive profits for the drugs’ makers. Beware. If one of these companies asks you to consult, be very careful that you are actually doing consulting and not just becoming another name on the company’s letterhead. If you are on a speakers’ bureau, make sure you are actually educating other physicians and not talking to an empty room.

But here’s a better idea. Don’t do it.

Don’t take money from the private sector that you can use for a boat payment. If a drug company wants to support your study or support you doing a study of the company’s design and the money comes to your institution like grant money does—fine! But, if the money goes in your pocket, make sure you are actually doing the work and that no one will construe you as having received a kickback for your prescribing patterns. And for goodness sakes, make sure you do it on your own time, if you must. And don’t do it for companies sponsoring your research or whose drugs you are testing, especially in the clinic.

Dr. Brennan concludes with this:

“Although at one time there may have been justification for physician-marketing programs, today they can be considered obsolete, at best.”

Be careful. The government is watching, but so are the people around you. The Biogen case was cracked with whistleblowers from inside Biogen.

You know what the right thing to do is. Now the hard part. Do it. And you surely know what the wrong thing to do is. Please, don’t do that.

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