Journalism in the Public Interest

Top Medicare Prescribers Rake In Speaking Fees From Drugmakers

Pay-to-prescribe is illegal, but doctors
say they haven’t been influenced by the money they get for promoting
drugs they also prescribe to large
numbers of their patients.


A screen shot of Bystolic's website.

This story was co-published with NPR.

When the blood pressure drug Bystolic hit the market in 2008, it faced a crowded field of cheap generics.

So its maker, Forest Laboratories, launched a promotional assault on the group in the best position to determine Bystolic's success: those in control of prescription pads. It flooded the offices of health professionals with drug reps, and it hired doctors to persuade their peers to choose Bystolic — even though the drug hadn't proved more effective than competitors.

The strategy worked. In the 2012 fiscal year, sales of Bystolic reached $348 million, almost double its total from two years earlier, the company reported.

Now, data obtained and analyzed by ProPublica suggest another factor in Bystolic's rapid success: Many of the drug's top prescribers have financial ties to Forest.

At least 17 of the top 20 Bystolic prescribers in Medicare's prescription drug program in 2010 have been paid by Forest to deliver promotional talks. In 2012, they together received $283,450 for speeches and more than $20,000 in meals.

Nearly all those doctors were again among the highest prescribers in 2011, the most recent year for which Medicare data are available. Forest began disclosing its payments only last year; the company didn't specify which drugs doctors spoke about.

Dr. Bernard Lo, who was chairman of a national panel examining conflicts of interest in medicine, said he doesn't believe the findings are coincidental.

Top Bystolic Prescribers

Below are the top 20 prescribers of the blood pressure drug Bystolic in the Medicare prescription drug program in 2010, as well as the speaking fees they received from maker Forest Laboratories in 2012. Forest only began reporting such information last year. Some of the prescribers below also may have received meals, educational items or travel expenses from the company.

Name City, State Bystolic prescriptions
in 2010
2012 speaking fees
Mark Barats West Hollywood, CA 652 $3,750
Antonio V. Baute Marietta, GA 598 $85,750
Michael Dao Garden Grove, CA 864 $2,000
Shawn Dhillon Baltimore, MD 621 $2,000 and $18,500
Tao Duong Westminster, CA 716
Eleonora Fedonenko Los Angeles, CA 598 $3,750 and $1,250
Jinesh Gandhi Phillipsburg, NJ 672 $36,700
Dannis Hood Ringgold, GA 682
Moses Hyun (Deceased) Los Angeles, CA 865
David Kavtaradze Cordele, GA 965 $51,250
Yousif Mansour Southfield, MI 1,941 $1,000 and $12,750
Sima Muster Brooklyn, NY 681 $20,000
Thanh Nguyen Garden Grove, CA 622 $4,750
Zhaoyang Pan Los Angeles, CA 818 $6,000
Hew Quon Los Angeles, CA 1,990* $3,750
Gary Reznik Los Angeles, CA 2,525 $3,750
Alexander Salerno East Orange, NJ 715 $1,250 and $11,250
Adel Sidky Boynton Beach, FL 873 $9,000
Steve Tam New York, NY 711 $1,250
Henry Yee Alhambra, CA 534 $5,000

* The prescriptions attributed to Hew Wah Quon include 1,396 attributed to the doctor himself and 594 credited to his medical practice.

When there's no evidence a drug is better, "You have to question: Why are doctors prescribing this?" said Lo, president of the Greenwall Foundation, a New York City nonprofit that funds bioethics research. "What your evidence suggests is that there is a financial incentive for doctors who receive payments from drug companies" for pitching their products.

Until now, doctors' prescribing habits have been secret from all but pharmaceutical companies, which pay millions of dollars for such information from other firms that collect it.

ProPublica's analysis marks the first time anyone has matched payment data made public by drug companies with physician prescribing records from the Medicare drug program, which covers about 1 out of every 4 prescriptions in the U.S.

(Readers can search for Medicare prescribers in our Prescriber Checkup news app and for drug company payments to doctors and other health professionals in Dollars for Docs.)

Reporters identified the drugs that were most actively promoted to doctors in 2010 and 2011 using rankings from Cegedim Strategic Data, a company that tracks marketing expenses.

The top prescribers of some of these drugs, in addition to Bystolic, also received speaking payments from the companies that made them. As a group, these heavily marketed drugs were new or had new uses, were expensive and often showed little benefit over existing medications or generics.

For example, 9 of the top 10 prescribers of the Alzheimer's drug Exelon received money from Novartis, the drug's maker. Eight of the top 10 for Johnson & Johnson painkiller Nucynta were paid speakers, as were 6 of the top 10 for Pfizer's antidepressant Pristiq.

The same was true for 7 of the 10 top prescribers of the asthma drug Advair Diskus, made by GlaxoSmithKline. One doctor made more than $100,000 from 2009 to 2012.

Many of the physicians spoke for several drug companies.

If financial relationships influence physicians to choose pricier brand-name drugs that have little benefit over generics, everyone pays the cost – particularly taxpayers, who spent $62 billion last year subsidizing Medicare Part D.

"I've never heard a doctor that said they were influenced, but obviously the companies are interested in doing it because the evidence overwhelmingly suggests that doctors are influenced," said Rita Redberg, a cardiologist at the University of California, San Francisco, and editor of the journal JAMA-Internal Medicine.

Companies are "not doing it for any reason except it improves their bottom line," she said.

survey published in the Archives of Internal Medicine in 2010 found that physicians with industry relationships said they were more likely to prescribe a brand-name drug when a generic was available. And federal whistle-blower lawsuits against several pharmaceutical companies have alleged that payments are little more than thinly veiled kickbacks, which are illegal. Companies have paid billions of dollars to settle the cases.

Each of the top 20 prescribers of Bystolic wrote at least 530 prescriptions in Part D in 2010. ProPublica attempted to contact all those who also received money from Forest. Only a handful responded to phone calls, emails and faxed letters requesting comment.

The No. 1 prescriber of Bystolic, Los Angeles cardiologist Gary Reznik, said that if patients have blood pressure under control with another beta blocker, he doesn't switch them. But he believes Bystolic is more effective at lowering blood pressure and doesn't cause the slower heart rate and erectile dysfunction of other drugs in the class.

"If you don't have to be on a beta blocker, I would not start you on a beta blocker," said Reznik, who was paid $3,750 to give talks by Forest in 2012. "If you have to have a beta blocker, Bystolic would be my choice." Reznik prescribed the drug more than 2,500 times in 2010 and more than 2,900 in 2011, including refills dispensed, Medicare records show.

"I have never felt that there were any expectations or pressure on the part of the company that I would prescribe it more or at all," he said.

Another top prescriber, internist Mark Barats, of West Hollywood, Calif., said he uses smaller doses of Bystolic to achieve the same effects as higher doses of generic medications. "It has much less side effects, particularly much less side effects on the respiratory system," he said.

"I've never seen anything that contradicts what Forest said about Bystolic," said Barats, who was paid $3,750 to speak for Forest in 2012.

Dr. Henry Yee, who was paid $5,000 by Forest, said he chooses the drug for many of the same reasons as Reznik and Barats. The cardiologist, whose office is in the Los Angeles suburb of Alhambra, said he learned about the drug from company sales reps and from reading studies. He started prescribing it "even before I started speaking for the company," he added.

Yee said he believes drug companies ask him to speak for their products because is an influential specialist in his community. "I think it is most likely because a lot of doctors listen to me," he said.

Among the 17 top prescribers with Forest ties, speaking payments ranged from $1,250 to $85,750. Seven doctors also received at least $1,000 in Forest-paid meals.

But several prominent cardiologists say no studies have proved that the benefits cited by Bystolic's top prescribers are real. Dr. Steve Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said he understands why doctors would like to believe that the beta blocker has additional benefits. "Wishing it to happen isn't the same as proving it," he said.

In 2008, the U.S. Food and Drug Administration rebuked Forest for an ad claiming the drug was "novel" and superior to other products. The FDA said the claim wasn't factual.

"I don't see any purpose for Bystolic whatsoever," said Eric Topol, a cardiologist and chief academic officer of Scripps Health, a San Diego-based health system. Topol said he doesn't use the drug because it is expensive with no added benefit. "I have no idea how you could come up with a storyline for use of that drug."

Bystolic costs about $80 per month, compared with less than $10 for a generic cousin, according to Costco's pharmacy website. (Patient copays vary by drug plan.)

In an email, a Forest representative called Bystolic "an important treatment option" because it is effective and well-tolerated but didn't assert that the drug was superior.

Forest also defended its spending on physician speakers. The company "believes that patients benefit" from paid talks and other initiatives that "enable health care professionals to stay abreast of the latest treatment options available," a representative wrote.

Three years ago, Forest paid the government $313 million to settle civil and criminal allegations about its marketing of drugs, among other things. In its lawsuit, the government alleged that Forest made "cash payments disguised as grants or consulting fees, expensive meals and lavish entertainment, and other valuable goods and services" to doctors.

Forest denied those allegations despite settling the case.

More recently, in a lawsuit unsealed in April against the drug company Novartis, the U.S. government alleged the company's "own internal analyses showed that speaker programs had a high return on investment in terms of the additional prescriptions for its drugs written by the doctors who participated in the programs, both as speakers and attendees, with the highest return arising from payments to doctors as 'honoraria' for speaking."

Novartis disputed the allegations. In 2010, the firm pleaded guilty to a misdemeanor and paid $422.5 million to settle allegations that it illegally promoted Trileptal, an antiseizure drug, and paid kickbacks for prescribing it and other drugs. Trileptal isn't frequently used in the Medicare population.

Forest, Novartis and other drugmakers said they choose speakers based on their expertise and credentials.

Pfizer "explicitly prohibits the selection of speakers based on their prescribing behavior ... any inference to the contrary is misleading," a spokesman wrote in an email. Glaxo and Johnson & Johnson also said they don't choose speakers based on prescribing.

The spending by pharmaceutical companies on speaking and consulting fluctuates based on whether they have new drugs or are marketing older ones for new uses.

To date, only 16 companies have publicly reported their payments to physicians. All companies will be required to report such payments next year under the Physician Payment Sunshine Act, a part of the broader 2010 health overhaul law.

Boehringer Ingelheim Pharmaceuticals, the maker of the blood thinner Pradaxa, began reporting its payments just last month. Pradaxa, introduced in 2010, accounted for more spending on local promotional events than any other drug in 2011, according to Cegedim Strategic Data. Of the top 20 prescribers in 2011, six received speaking fees in the first quarter of this year.

Boehringer said it doesn't pay speakers based on prescribing.

The physician prescription tallies in this story are from Medicare Part D records in 2010. Recently obtained data for 2011 show similar patterns, however. The prescription counts don't include drugs paid for by other parts of Medicare or for patients with private insurance, on Medicaid or in the Veterans Health Administration system.

Some doctors say the drug company money can undermine patients' trust.

Nissen of the Cleveland Clinic said: "I don't want the patient sitting opposite to me in the exam room to have to worry about whether I am prescribing a drug because I am being paid by the company that makes the drug."

Correction, July 3: The original version of this story incorrectly said the blood thinner Pradaxa accounted for more spending on promotional speakers than any other drug in 2011 and attributed that to Cegedim Strategic Data. Pradaxa actually ranked first for spending on local promotional events, including meeting venue, speakers fees and catering, according to the company, which doesn’t track spending on speakers alone.

I think it’s pretty unfair to automatically assume that a doctor that prescribes a medicine only does it because they pay him to speak. What if the doctor used the medication for a patient and found it to be good and then spoke for the company? I workin healthcare and although some generics are just as good there are some brand name drugs that patients respond better too. There are also some drugs that should not be given as generics as they affect patients health such as Coumadin or birth control

Alex Wilkinson

June 25, 2013, 9:11 a.m.

The issue to my mind is not generic vs. brand, but preferring to prescribe brand over generic because doctors are being paid to do so. Any good doctor would explore the potential side effects and health complications arising from any particular drug—sometimes a generic will be better, other times a brand will be. But if some doctors are truly being paid to prescribe not for the patient but for the pharmaceuticals, then how can that inspire full patient confidence? Not like this is happening with all doctors obviously, but the fact that it is happening at all is a problem.

Meghan Fitzpatrick

June 25, 2013, 11:59 a.m.

A physician’s job is to advocate for his or her patient, not drug companies. Since there is an inherent conflict of interest between healing and dealing, doctors who take payments from pharmaceutical companies should expect their motives for prescribing one drug over another to be called into question.
Drug companies have fiduciary obligations to their shareholders, but physicians have ethical obligations to their patients. It is in the best interest of drug companies to dispatch their armies of pharmaceutical sales representatives to doctor’s offices all over the country to offer them incentives to earn, for instance, by speaking. The data that drug companies provide these physician speakers, however, is not regulated, and in some cases it is deliberately misleading. When doctors, who are supposed to represent people we should trust, give speeches to other doctors in which they knowingly or unknowingly spread misleading data, they contribute to a change in the prescribing practices of their audiences over time that benefits the drug companies.
As patients, we should not have to worry about whether our doctors are being tempted by offers of cash payments, extravagant dining, etc. We should be able to rest well at night feeling like we know that our doctors are prescribing us the medications that are in our best interests, not theirs, and certainly not those of the drug companies’.

April, as Meghan points out very well, it’s a conflict of interest, whether or not it’s an explicit wrongdoing.  A lawyer, for example, isn’t allowed to take your case against a company that employed her.  It shouldn’t be too much to ask that a doctor not be beholden to anybody but the patient.  Nobody should have to question whether his doctor is trying to protect an investment.

I would be interested to see what percentage of these same prescriptions were actually filled with the brand vs a therapeutically equivalent generic.  With many states having legislation that requires or allows the dispensing pharmacy to switch Rx unless expressly forbidden by provider this may actually be less an issue than it might appear.
I would bet that if you were to ask your Dr for the name of a therapeutic for heart disease or UTI or ED they can give you a couple names, then ask them if they know the name for a generic equivalent, I wouldn’t be surprised if they come up blank…but they probably know you’ll get the generic even if they write the brand.
So is it really wrong/conflict of interest for a Dr to take $$ from a pharmaceutical company if they know writing the brand on the Rx really doesn’t matter?

It is absolutely a conflict of interest, I was married to a prescriber and the “unknown” incentives he received was mind blowing to include having boxes and boxes of meds delivered to his home address, this practice is shameful and only serves the drug company and the persons getting the incentives, definitely not in the interest of the patient.

Meghan Fitzpatrick

June 25, 2013, 2:52 p.m.

Yes, it is a conflict of interest. Pharmaceutical companies purchase data from pharmacies so that they can analyze the prescribing behavior of physicians. Drug reps then initiate contact with physicians and work to manipulate prescribing behavior for the sole purpose of profit maximization.
Drug reps specialize in sales, not medicine. They are trained to sell product; they receive performance-based bonuses. If I am in the market to buy a car I’m not going to do my research at the dealership and simply take the word of the person who is trying to sell it to me in order to put food on his table; he or she doesn’t have my best interest at heart. I’m going to read Consumer Reports, compare different makes and models, and generally know the facts before I go shopping so as to make an informed decision. Likewise, doctors can and should consult peer-reviewed journals for input on efficacy of medications before prescribing them. They needn’t and shouldn’t be influenced by salespeople to do their jobs effectively.

Charley James

June 25, 2013, 4:36 p.m.

My doctor has a simple solution: He refuses to meet the “detailers,” which is what drug companies call their sales people. And when he reads articles in medical publications about drugs, he will write to the author to find out if they receive payments from drug companies. Finally, when writing a prescription he always checks the “generic equiv.” box on his pad.

Thank you Meghan for your regurgitation of a host of tired arguments.  Just because a doctor gets information from a drug rep doesn’t mean it is his/ her only source of information.  However, time is tight for most clinicians and it is often easier to initially hear about a product from a drug rep who is paid to tout their latest wares.  The information they receive is some of the most highly regulated in the world (FDA applies the same balance standards to drug rep-doctor encounters as it does to labeling).  It is far superior to anything you could get from a car salesman, unless they were suddenly required to give you the “CarFax” report when buying a used car, and even then it really isn’t comparable to FDA labels and off-label liability.

They are very restricted in what they can say.  Now, April certainly has a point about the chicken and egg question regarding speaking and the drug in question.  Lance also raises a good point about the important role of generic substitution by pharmacies.  However, at the end of the day we need to put things in perspective.  These are the top 20 prescribers out of millions.  They are an extreme case and cannot be assumed to represent a larger pattern.  This is just inflammatory table thumping.  Perhaps these doctors did something wrong, perhaps they just relied heavily on generic prescribing.  Such a superficial analysis tells us very little.  You would have to audit their patient charts to get real information.  In the big picture though, it doesn’t matter what the top 20 prescribers do, they are just 20 of millions of prescribers.  Their actions are necessarily limited in scope. 

The other point worth mentioning is that people tend to prescribe what they are most familiar with, this is a simple availability bias.  They may then rely on generic substitution for many of their patients.  The basic facts are that most prescribers rely on an outdated prescribing core dating from around the time of their residency, they change relatively few drugs over time because their “clinical inertia"leads them to avoid prescribing unfamiliar products, rightfully so, however, after a point this becomes a ridiculous practice as many docs end up prescribing woefully out of date medications.  Many more would invariably do so if detailing did not exist to let them know, conveniently, about new products.  They can then opt to be as aggressive or conservative as they want in trying these new products.  The benefit here is that they actually hear about them.  If you just leave them with medical journals and the amazingly scarce academic detailing, most of them will never learn about new products because they are too absorbed in the practice of medicine.  Detailing and speakers bureaus are a good way to break that inertia.

The information they receive is some of the most highly regulated in the world (FDA applies the same balance standards to drug rep-doctor encounters as it does to labeling)

right ;-)

Interesting to peruse the list of uber-prescribing doctors in this article.

Anyone notice the plethora of foreign-named doctors?  Evidently they have learnednthe American way of getting rich.  Since we don’t do open bribes as readily as they would in their home countries, they adapt.

This article speaks nothing about what % of the time they use a particular product. So what if a doctor used a product 234 times if this represented only 3% of all prescriptions he/she prescribed. The % of utilization of a specificproduct within a drug class would tell you whether there is true influence of prescribing. Based on numerous studies and articles I have read, 85% of all prescriptions filled in the US are for generics and pharmaceuticals account for just $.13-18 of every health care dollar spent. If we truly want lower health care costs and better value for our health care dollar it seems like we are looking in the wrong direction.

I only have my doctor order me generic medications.

Opinions: Doctors should not receive any money from drug companies, for any reason? When people pay this type of money, they are expecting favors? Doctors need to make careful diagnoses, without any outside influences? Thank you.

As long as they are not harming the patienets, it does not matter. Any way Dr. and Drug maker relation is no different than the relationship between Congressmen and Special Interest Group. At least in case of Doctors and drug maker the relationship is transperent but not so when it comes to the lawmakers and the special interest group.

The whole pharmaceutical industry is based upon manipulated clinical trials. It is scary to think about how many people owe their jobs to fraud.

Maryann Klaue

June 26, 2013, 1:19 a.m.

How extensive is this problem, in reality?
  As a Senior Citizen who has multiple pain issues, and is outraged at the new Federal bureaucratic requirement that chronic pain patients, like myself, MUST participate in a pain management group in order to continue receiving opiate pain medications, I find myself comparing this issue to Gun Control: “Let’s outlaw guns, then: only outlaws will carry guns!”
  Because of the new Federal pain medication management requirement, my primary care physician will NOT prescribe an opiate pain medication unless I participate in one of these groups. Ironically, I’m an individual who is medication-aversive, and am continually reminded by my husband to take my meds: “You’re getting irritable, honey….”
  How many physicians (like mine) are now actually quite conservative about writing pain med. prescriptions because of extant federal mandates—compared to the few who are illegally profiteering? Let’s not tar-and-feather (and possibly professionally hamstring?) all physicians for the abuses perpetrated by a relatively minuscule few.
  And finally, last but not least: what might be the possible negative consequences for the unfortunate Medicare consumer—like me—of any universal policy changes, and/or actions taken against possibly, and I emphasize “possibly,” inappropriate “Medicare Prescribers”?

MS drugs have got to be the worst ever.  Many are very dangerous indeed and pharmas for decades have made trillions   from.  Its so easy to work out whats going on and no one is brave enough   to investigate   and   write up on the real truths

David, presumably, you’re also OK, then, with lobbyists contributing millions to reelection campaigns, sending politicians on vacations, and giving them high-paying jobs when they’re out of office, since it’s entirely possible that they’ll accept all these things and still vote in the interests of the constituents.

If the drug companies weren’t getting a benefit, they’d eliminate the programs.  Therefore, if the drug companies continue the program, the doctors are biased by it.  You can claim that it’s harmless fun and marketing, but the math doesn’t add up to that conclusion.

Maryann, nobody in their right mind advocates getting rid of drugs.  Drugs, when prescribed correctly to the right people, are invaluable.  The objection this story raises is that doctors are being paid to “know about” some drugs more than others.  If you’re not the only one paying your doctor, how do you know he’s looking after your interests first?

Keep in mind that Pfizer, when their Lipitor patent was running out last year (year before?), tried to convince the chain pharmacies to fill generic prescriptions with Lipitor anyway (over the doctor’s instruction) in exchange for letting them pocket some of the difference.  To their credit, most pharmacies refused, and the publicity seems to have killed the “promotion.”

But that’s the sort of thinking we’re dealing with.  Whether their drugs help anybody isn’t the issue, it’s whether the right drugs are being prescribed or if some doctors are more interested in keeping the “marketing” going than healing the patient.

If   someone was brave enough to investigate all the MS drugs and see all the ones that have killed many with MS at very young ages they would be alarmed .So many have made profits , shares and commissions on   aswell as very high salarys for promoting many MS drugs .  100s of thousands in the UK alone are part of

I’ve noticed the label on some of my meds recording my primary care physician who has prescribed the drug but also the name of the drug rep. From a family member physician I learned that it is common for drug reps to pay for catered lunches for their client physicians and office staffs. In fact, according to the family physician, so much food was left over from the catering and the food was so good (expensive) that she and her husband usually had to prepare dinner only on weekends.

I suspect, therefore, that what is reported here in the article is only the tip of medical payola. What about paid trips for physicians to Hawaii to hear papers on various products? And then there is the related matter of physicians relying upon the recommendations of various prominent med school professors who are paid great sums by PHARMA.

Dr. Daniel Subach

June 26, 2013, 1:52 p.m.

So, in the twilight of my years I have come to see the corruption and criminality of too many physicians who derive more pleasure and self-worth from garnishing ill-begotten dollars on the backs of their patients, then the permanent satisfaction of performing a service to humanity.  I have lived to see NPD (Narcissistic Personality Disorder) run rampant among too many physicians and healthcare providers, and have also lived to read in the daily media physicians being charged with multiple Medicare criminal violations. So much for ethics. I am going to propose to the AMA that the oath be changed to an oath to ‘money’ and the achievement of wealth over proper health care.

How do you spell “whores”?
As a physician, I find the ethics of some of my colleagues abominable!

Our facility accepts NO incentives from drug companies but we still prescribe some of these meds generics are NOT better do u know what generic birth control did to me I got pregnant twice on it generics have a lot of filers and in any medication where therapeutic levels are required it can be dangerous to use. In a warfarin patients generics are extremely dangerous I am a pristine nurse and have seen generic Coumadin cause unnecessary up and downs in pro times that have put patients in danger. Another example simvastin vs Crestor simvastin a common generic cholesterol med can cause dangerous elevations in lfts Crestor does not but many insurance companies refuse to pay for it. I look at this as yes there are prescribers abusing this but should we say that all prescribers who frequently use specific drugs are corrupt ? To me it makes sense that drs that have has good success with a drug should be those that talk about the drug.

Mary Ann I think that a lot of the reason that many drs do not give opioids is due to reputation. No one wants to be labeled as that dr that everyone goes to for pain meds. Also opioids are very addictive and not really all that effective for long term pain management. Often unless there is physical evidence of a need for opioids such as surgery or fracture drs refuse to prescribe opioids. They also have nasty side effects as someone who has worked in health care for years I can safely say that most patients are better off if they are never given these drugs.

Amazing marketing strategy. So it is basically still more about business rather than releasing the most effective drug out there to help people in need. The lives of people are somehow just being played with those pharmaceutical companies who are just in for the profits.

@ Alma….Yes it is about making money, how do you think drug developers pay for innovation?  Yes, there are grants, angel investors and venture capital dollars to be had but that is a very small percentage of what gets spent annually on development.  Try to remember that most drug companies are for profit business entities, they have investors/shareholders that expect a return on investment.
@Stan…so you never accept a rep lunch-n-learn or free CE at trade shows or a sponsored event?  You always write generic to avoid evil big pharma right…well doesn’t that make you beholding to the generic companies?  You call your colleagues “whores” for what they do, aren’t you being pimped by the generic companies?  And truthfully given your comment I doubt you are a physician.
@Scott Miller…“The whole pharmaceutical industry is based upon manipulated clinical trials. It is scary to think about how many people owe their jobs to fraud. ”  You sir are clueless as to the amount of oversight that occurs in clinical trials.
@John H…I would agree if the Rx a Dr wrote was filled exactly as a Dr wrote it however in most states the brand name drug a Dr writes will be switched to generic without even a call to the Dr and the Dr knows that.
@Meghan Fitzpatrick….Pharma companies don’t purchase Rx data from pharmacies…there is an entire industry built around that function and pharma purchases the data from them (google IMS Health for an example).  As I mentioned earlier in this post big pharma is for profit. And yes the drug reps are sales people with the best interest of the company paying them at heart…Do you not trust your Dr to be intelligent enough to differentiate between “good” drugs and “bad” drugs regardless of what a salesperson tells him/her, if not, shouldn’t you consider a change to a dr you do trust?
@Tess…Unless the prescriber you were married to ran a home office, I’m surprised he/she rec’d samples at home as there are a couple law enforcement agencies that frown on that practice
The part of this equation that should concern everyone is why does insurance reimbursement decide your health care treatment?  If you pay cash for your Rx you will get the brand, if you use insurance you will most likely get the generic.  I have nothing against generics in most cases, however I know in some cases they may be therapeutically equivalent but not “the same” (I can speak to the unfortunate difference between Branded Birth Control and Generic equivalent),
So the next time you go see your healthcare provider ask them who they believe has a bigger impact on your healthcare, the drug rep or the insurance company.

Mark Moulliet

July 2, 2013, 12:12 a.m.


If you had any idea of the fraud in drug trials and promotion of drugs.  You need to read Professor Emeritus of Organic Chemistry Joel Kauffman, Ph.D., MIT, 14 drug patents and 100 peer reviewed publications.  Professor Kauffman spent many years in drug development and clinical trials.  Stat-wise, the absolute risk of having a heart attack in one year is 0.2 percent.  On mammograms, Professor Kauffman: 

“The pain of mammograms is not accompanied by the gain of any lifespan. Undergoing annual mammography does not improve all-cause mortality after a diagnosis of breast cancer. The most careful examination of mammography trials does not even support a lower breast cancer mortality. If there is a lower breast cancer mortality, some of it may be attributed to the hormetic effect of the Xrays used in mammography. Another reasonable explanation is that aggressive treatment of the many false positives from mammography ... is replacing cancer deaths with deaths from treatment.” (pp. 216-7)

@mark tell that to my friend who had a very aggressive form of breast cancer that was detected on a routine mammogram. Not all lumps are detectable by palpating. I work in a primary care setting and I can’t tell you the number of times we have detected breast cancer on a routine mammo only to save the patients life. To me it’s worth it to save even one person.

I spent several years working in the dental industry responding to patients’ questions concerning Fluoride toxicity. (Yes Fluoride in too great a quantity can be toxic, however so can water - would you also recommend discontinuing water consumption or perhaps just recommend reasonable quantities (dose)?). So I’m familiar with Dr Kauffman’s papers/books/theories, I just have less respect for his findings than he has for the FDA.

LOL “oversight”! Yea, there’s enough oversight to make sure they are properly manipulated so when they hand it to the joke FDA they can approve it. O, but according to you the FDA is probably a paragon of protecting the publics interest. Get lost shill.

@ Scott
So when will your fact based, independently verified expose showing the fraudulent clinical trial / pharma / FDA consortium be aired ? Or is media part of the conspiracy also? With manipulation so common you should have quite the stack of documented verifiable proof.  I’d zip down to Houston and talk with the Cetero Lab if I were you, I hear they have quite a fraud story to tell.  Oh that’s right, they went bankrupt and closed, reopened under a different name and closed again after they were shown to have manipulated data. (Or were they just a “fall guy”... Hey maybe you’re on to something with this conspiracy theory)...I should stop commenting before they send silent black helicopter full of strom troopers to snatch me while I’m jogging

Whatever man. This country is so criminally medicated up the wazoo from little kids to seniors it blows my mind. I can’t watch television without a drug ad or a law firm trying to get people to sue from being damaged by drugs. It’s sad and you’re sad. I’m done.

I’m re-posting this comment from June 25, because nobody seemed to notice it.

****Interesting to peruse the list of uber-prescribing doctors in this article.

Anyone notice the plethora of foreign-named doctors?  Evidently they have learned the American way of getting rich.  Since we don’t do open bribery as readily as they would in their home countries, they adapt to our way of accepting “bribes” from Big Pharma.

What does this mean to you?  As a patient, you might want to keep your eyes open.  Please don’t bother calling me “racist”.  This particular phenomenon is not limited to medical prescribing.

I’m guessing that most people involved in the conversation saw the comment; the lack of response indicates a lack of interest in the subject matter…

This article is part of an ongoing investigation:
The Prescribers

The Prescribers: Inside the Government's Drug Data

Medicare’s failure to monitor what doctors are prescribing has wasted billions of taxpayer dollars on excessive use of brand-name medication and exposed the elderly and disabled to drugs they should avoid.

Get Updates

Our Hottest Stories