"Unlimited spending! Schedule all the programs you can." That was the management directive announced at the regional business meeting I attended when I first became a pharmaceutical rep. When I heard the announcement I felt like I was on an Enron train that was roaring down the tracks, and the company expected everyone to be on board. The company was giving its sales force unlimited funds to hire physicians as paid speakers, sometimes to influence other physicians to prescribe the company's drugs, at other times to simply financially reward physicians who wrote high volumes of prescriptions every month for the company's drugs.
Former Merck regional sales manager, Gene Carbona, told the New York Times that the only thing the company considered when selecting physicians to provide presentations was "the volume or potential volume of prescribing that the doctor could do." This is true of all pharmaceutical companies. According to The Wall Street Journal (August 31, 2009), Eli Lilly alone paid physicians $22 million dollars in just the first quarter of 2009.
The higher a physician is on the influential ladder, the greater the financial rewards to be reaped. Pharmaceutical companies pay influential leaders who can sway public opinion and influence research. And the area of medicine receiving the greatest amount of pharmaceutical money is psychiatry. The American Psychiatric Association (APA) is the most drug industry financially supported medical association. In July 2008, Senator Charles Grassley's demands that the APA provide an accounting of its finances revealed that in 2006 the pharmaceutical industry accounted for about 30 percent of the APA's financing; more than $20 million dollars.
The New York Times found psychiatrists were paid more by drug companies than any other medical specialty in Minnesota, the only state requiring full reporting of financial relationships between physicians and drug companies. Between 1997 and 2005 psychiatrists in Minnesota collected $6.7 million from drug companies. The New York Times also found drug companies were not selective about psychiatrists paid to conduct clinical trials of drugs. At least 103 of the physicians had been disciplined, criticized, or had their license to practice revoked by the Minnesota state medical board. In the case of one psychiatrist, the FDA concluded he had violated the protocols of every drug study he led that the FDA had audited. The FDA found he had reported inaccurate data to the drug makers. Despite all this, drug makers continue to hire this psychiatrist.
Senator Grassley continues to investigate the strong financial ties between the pharmaceutical industry and influential physicians. His efforts have disclosed drug industry payments to individual psychiatrists in extremely influential positions. Such as former Director of the National Institute of Mental Health (NIMH) and former radio host, Dr. Frederick K. Goodwin, who was taking money from drug companies and promoting their psychiatric drugs on his weekly National Public Radio (NPR) program, "The Infinite Mind." Dr. Goodwin never warned the public about the extremely dangerous side effects of psychiatric drugs. When the head of NPR learned of Dr. Goodwin's financial relationships to pharmaceutical companies, the program was ended.
Based on his investigations, Senator Grassley accused the APA current president-elect, Alan F. Schatzberg, MD, chairman of psychiatry at Stanford University, of failing to disclose ownership of about $6 million in shares in Corcept Therapeutics. Dr. Schatzberg is listed as principal investigator of a government-funded trial of a drug Corcept is trying to commercialize.
In October 2008, Sen. Grassley discovered that Charles Nemeroff, M.D., Chairman of Psychiatry at Emory University, had earned more than $2.8 million in consulting fees from pharmaceutical companies from 2000 2007. During that time Dr. Nemeroff was researching drugs with government money in the form of NIH grants. He failed to report this income to Emory and violated federal research rules.