According to MM&M-online, here are the top 10 product-related Web sites doctors visit, according to a study by Manhattan Research:

1.Pfizer‘s Lipitor.

2. Merck‘s Fosamax.

3.Shire‘s Adderall XR.

4.GlaxoSmithKline‘s Advair.

5.Bristol-Myers Squibb and Sanofi-Aventis‘ Plavix.

6.Johnson & Johnson‘s Concerta.

7.Merck‘s Singulair.

8.Forest‘s Lexapro.

9.AstraZeneca‘s Crestor.

10. Merck and Schering-Plough‘s Zetia.



Mark Bard, president of Manhattan Research, said, “Although prescription volume is certainly an important ingredient in driving most physician traffic to a product site, the data show ‘top‘ sites typically include those with a direct-to-consumer advertising component as well as new products on the market.

Conflict of interest problem endemic: specialist:

Professor Martin Tattersall has a big job — the committee he heads decides which medical drugs are allowed into Australia. For that, he needs experts to help him evaluate the dozens of medications submitted each year.



Professor Tattersall, a cancer specialist, also has a big problem. He says that finding experts to sit on the committee is now all but impossible because so many doctors have “huge conflicts of interest” with drug companies.

Drug companies ‘manipulating trials’:

One of Australia’s most senior cancer specialists has accused pharmaceutical companies of manipulating some clinical trials of medicines for commercial reasons, including deliberately delaying the release of negative findings and being reluctant to fund research into the toxicity of their drugs.

Who pays when a doctor accepts a free lunch?:

Fifteen per cent of 823 specialists surveyed by the University of NSW in a recent study published online in the Internal Medicine Journal admitted they asked drug companies for gifts, money and travel, while 52 per cent were offered travel to conferences (two-thirds accepted). The study’s lead author, associate professor of ethics and law in medicine, Paul McNeill, has recommended the end of direct payments from drug companies for travel and says industry funds for travel should be distributed through an independent group. The suggestion is in line with overseas practice: in the US direct payments for travel are discouraged, while the British have ruled out business class travel for doctors.

Mental health takes industry pills:

The so-called “Pharma Collaboration”, unreported in the Australian media, linked the Mental Health Council of Australia directly to global pharmaceutical giants Pfizer, Eli Lilly, Glaxo SmithKline, Bristol Myers Squibb, Lundbeck, Wyeth and Astra Zeneca.



It has been a good deal for the non-profit council, which promotes itself as Australia’s peak mental health group, providing 8 per cent of its total income. It also seems to have benefited the drug companies, which have a strong financial interest in selling medication to treat mental illness, especially the “new epidemic” of depression.

Thanks to Deb for today’s issues-down-under report!

According to this article from The Age (Australia), docs often demand gifts from pharma. A snip:

THE biggest investigation into gifts to medical specialists has found they actively ask for gifts from companies worth between $50 and $100,000.



The requests extend to money for nurses’ salaries, donations to their departments, computers, microwaves, journals, textbooks, CDs — even funds for a Christmas party.

It also says:

Of the one in two specialists offered travel to conferences, two-thirds accepted and most attended the meetings as audience members, not speakers. The authors — who included ethics and medical professors from the University of Sydney and the University of Newcastle — recommended in their report the end of direct payments from drug companies for travel. Industry funds for travel should be distributed through an independent group, the report said.

This reminds me of an editorial I wrote a while back for Medical Meetings about how docs sometimes try to “extort” commercial support for their CME programs. The blame goes both ways.

The writer of this editorial in the New York Times thinks so:

The doctors always insist that they can‘t be bought. But a former sales representative for two drug companies said the lunches were “incredibly effective” in lifting the number of prescriptions from practices that got the free food, and a medical school doctor who is examining the issue believes the lunches do influence prescribing. Some doctors seem to rely on free lunches as a fringe benefit for their staffs.

This article in the New York Times takes a look at how docs should be trained on medical devices—and who should do the training. A snip:

Last summer, rival cardiologists in Rock Hill, S.C., decided to learn how to perform a lucrative new procedure, implanting a defibrillator, a device that protects against fatal heart rhythms. Piedmont Medical Center in Rock Hill, S.C., has set its own standards for implanting defibrillators. One doctor attended weekend classroom sessions sponsored by a professional medical organization, passed a daylong written test given by that group and implanted defibrillators in 10 patients while an expert observed.



But by then, four other doctors at a competing practice had left him in the dust, implanting 75 devices. They chose a separate training program, provided free and tailored to their liking by a little-known device maker named Biotronik. Only one of the four doctors so far has taken the recommended daylong competency test. The training also apparently had unorthodox elements: two doctors sometimes trained together on one patient, a technique that experts called highly unusual.

Then there’s always the issue of conflict of interest and bias when the company does the training, which the article goes into at some length. Definitely worth a read.

Check out this article from the Amherst Times. It explores whether or not it’s enough to keep the per-doc lunches on the cheap side in return for allowing pharma reps access to give their pitches. One quote:

“It was almost a game, and it was unbelievable the animosity they would show if you did not bring the right kind of food, or if it was the third time they had pizza that week.”

One more:

“I‘d say that lunches are going to be one of the last things to go,” Dr. Goodman said. “The interesting thing is that it‘s generally not something doctors are ashamed about. That‘s why I find this thing so fascinating. They don‘t think they‘re doing anything wrong.”

Are they?

I love this one:

Minnesota Governor Tim Pawlenty called for a two-year moratorium on DTC drug ads so the FDA can toughen their oversight, the Associated Press reported.



“These advertisements in many instances are really ridiculous — in my opinion silly,” Pawlenty said during a news conference held in the Minnesota capitol of St. Paul.




The Republican governor said the ads contain little useful information and lead consumers to misguided self-diagnosis. He blamed the ads for rising prescription drug costs, stating he would support an outright ban if it would hold up in court.

From MM&M News.

Peter Gleason, MD, found himself in handcuffs recently for promoting an off-label use of a drug, according to this article in the New York Times. He is charged with promoting Xyrem, a narcolepsy drug from Jazz Pharmaceuticals, for depression and pain relief, and getting paid by the company to do it. The doc says he’s covered by FDA rules and the First Amendment, the prosecuter says “he conspired with the drug manufacturer to recommend it for potentially dangerous uses.”

This is one to keep an eye on. If I were the CME provider involved in this, I would be sweating bullets—could they not also be accused of misconduct on this one?

Roche pharmaceuticals has been accused of violating Australia’s pharmaceutical code of conduct by taking 200 docs out to swanky dinners that cost up to $200 a head (see story here. A snip:

Confronted with detailed evidence of the meals, a Roche spokeswoman admitted funding the events in July last year but argued they were in line with the industry code.



The largesse, which will be raised in an article in today’s British Medical Journal, was part of a Roche-sponsored meeting for doctors specialising in blood disorders and cancers.




The Roche spokeswoman said such dinners were organised because the “educational content was rigorous and the days were long, it seems reasonable to us that a dinner of this type was on offer at the end of such an educational day”.

Thanks to the PharmaGossip for the tip.

According to Outsourcing-Pharma.com:

The US Food and Drug Administration (FDA) has signalled it will soon allow a new “adaptive” approach to clinical trials in order to streamline drug testing and speed drugs to market.



The changes are designed to help the pharmaceutical industry save millions of dollars in drug development costs - which are currently skyrocketing - by saving time, preventing the number of study failures, and reducing the number of study participants required by over 30 per cent.

Among the proposed changes are allowing clinical trial sponsors to check results halfway through and modify the design of the trial to better their odds of getting better results, or cancelling the study if the results aren’t looking so good. Of course, some are concerned that this approach could lead to trouble, saying the current guidelines are there to decrease the chance of bias. The FDA is looking to address those concerns, according to the article.