THE

PHARMACEUTICAL
INDUSTRY
A DYSFUNCTIONAL
RELATIONSHIP

We try never to forget that medicine

is for the people. It is not for the
profits. The profits follow.
George Merck, 1950

A DYSFUNCTIONAL
RELATIONSHIP
239 US settlement payments amounting to $30.2b
have been paid
COI- 84% of doctors having a relationship with
pharmaceuticals.

ROADMAP
I.

Institutional Corruption

II. the Physician Payments Sunshine Act

(PPSA)

INSTITUTIONAL CORRUPTION

IMPROPER DEPENDENCIES

TRIAL METHODS
FDA depends on scientific data from
pharmaceuticals

Skew results to exaggerate the

efficacy. Or downplay side-effects.

PHARMACOVIGILANCE
Post clinical trial for adverse side effects.
Able to choose trial designs
Delay comparative studies
- Vioxx Gastrointestinal Outcomes
Research (VIGOR) & Weinblatt.

SOURCE OF
INFORMATION
Pharmaceutical physician relationship
Continual Medical Education (CME)Talks
Medical journals
Funding to sustain operations
Physician patient relationships
Information asymmetry more pronounced
No discretion Fiduciary duty
compromised
Exploit the unequal relationship- Incentives
to increase prescriptions.

GOVT REGULATION
Disproportionate influence over the entire
process.
Free market non-existent

Information asymmetries

Overdependencies

High Sunken costs- first mover

disadvantage
"We don't want to do anything that puts us
at a competitive disadvantage.
Novartis CEO

PHYSICIAN PAYMENTS SUNSHINE

ACT

SUNSHINE IS THE BEST DISINFECTANT?

PPSA
Payments or transfers of value of more than
$10.

Knowingly failing to report- fine up to $1m.

Aug to Dec 2013.

4.4 b transactions- $3.5b
Inaccuracies & 1.7m transactions deidentified.

PPSA
Disclosure is of limited use
I.

Onus placed on patients with limited

means
- Need to know what alternative drugs
-Second medical opinion?

II. Doesnt minimize institutional corruptionmerely results in greater transparency

REFORMS
FDA to conduct pharmacovigilance
Post trials
Separate funding for CME talks

Talks to be funded by tax

Expanding the PPSA to ban gifts
Aid vulnerable patients

SUNSHINE IS NOT THE

BEST DISINFECTANT

THE END