All expense-paid trips to Cancun with thousand-dollar honorariums. Physicians paid $2,000 to $4,000 for enrolling patients into drug trials. Author Kassirer says pharmaceutical and medical device companies have lured doctors into becoming advocates—even paid marketers—for medical products.
One example he cites is the use of doctors to promote off-label drugs. It is legal for doctors to prescribe drugs for uses that have not been approved, but it is not legal for pharmaceutical companies to advertise a drug for off-label use. By recruiting doctors to talk about off-label uses, companies engage in a form of marketing that would be illegal if done by the company itself. These promotions are often done by doctors on the lecture circuit, sponsored and heavily subsidized by pharmaceutical companies. (One doctor's wife interviewed for the book noted how her husband's lectures became more frequent as it came time to put his children though college.) Doctors are also paid to publish articles detailing off-label uses in medical publications. In many cases, Kassirer says, these articles are actually ghostwritten by the pharmaceutical companies. He mentions other cases where doctors are paid to write articles based on summaries of data supplied by the drug maker. Kassirer illustrates his point with a pharmaceutical company memo he unearthed: "[The company] has draft completed, we just need an author."
Kassirer does a good job giving context to why physicians are vulnerable—HMOs have been pushing physician salaries lower, young doctors are graduating with massive debt, and researchers are encouraged to partner with industry players to fund their clinical research, thereby becoming part owners of patents and the products they develop.
On the Take warns against the hidden conflicts of interest in government agencies like the Food and Drug Administration and the National Institutes of Health. Kassirer urges the everyone, including professional organizations, medical schools, academic centers, and even the medical device and pharma industries themselves, to take necessary steps before compromised research and lack of trust become truly fatal for the public and the industry.
Kassirer is former editor of the New England Journal of Medicine, and currently a professor at both Tufts University and the Yale School of Medicine.—Manda Salls