Who Is the Drug Dealer?
A dealer in marijuana is arrested for selling a pound of this drug to someone who gladly paid his fee. If that transaction was in New York State, and he was caught and convicted, he could be incarcerated for up to 15 years and pay a fine of $15,000 dollars.
A professor of medicine is paid $2,000 to hawk an expensive drug at dinner and has an unwritten, but well known, quid pro quo arrangement with that pharmaceutical company to prescribe their drug as part of this well understood agreement. Some of these paid speakers will prescribe a drug that will ultimately cost the patient, or taxpayers, as much as a few thousand dollars more for each year, for each patient prescribed, when compared to its generic equivalent. A top doctor might therefore prescribe 1,000 patients a drug that could have been prescribed a generic that cost pennies. Do the math and you’ll realize that this lecture “scam” just cost the healthcare system more than a million dollars! Who is the drug dealer here? Who will penalize the sick and the elderly more?
Unlike the Marijuana dealer, the doctor’s patients did not seek out this drug, they didn’t request it, and moreover, if they realized there were alternative drugs, they would not be happy to pay for it. And yet, it is the Marijuana dealer that goes to jail and the doctor that is regarded as a compassionate caregiver.
In 2012 a cardiologist practicing in New York was arrested for allegedly selling prescription drugs in exchange for his permission to “bill their insurance providers for unnecessary tests.” Shortly after his arrest I saw two of his patients in my office, both with congestive heart failure (CHF), who were treated by this doctor before his arrest. Both of them were prescribed a drug called Bystolic as part of their therapy. Bystolic, is a drug that belongs to the beta-blocker class and is a brand name drug, marketed in the US by Forest Pharmaceuticals. It has never received FDA approval for the treatment of congestive heart failure.
The two beta-blocker drugs commonly used to treat CHF, and approved for that use, Carvedilol and Metoprolol Succinate, are available as generic drugs and cost a fraction of what Bystolic sells for. Both patients told me it was a great expense for them, paying an additional $60 dollars each month, compared to an appropriate beta blocker like Carvedilol. With the click of my pen, they received the better drug and saved almost $700 for a year’s supply.
This doctor might have been arrested for selling prescription Oxycodone to a willing participant, but will receive no penalty for defrauding patients who got the wrong drug for their heart failure; a drug that not only cost his patients money but may have cost some of his patient’s lives. Bystolic has not been established to help patients, with CHF, and so patients with that disease who were prescribed that drug not only paid more money for it but also may have paid the ultimate price. While I have no proof of whether this doctor received any form of remuneration from Forest Labs I can’t help be suspicious that he did.
This year I saw a patient whose cardiologist, a man well known in the cardiology community and a full professor of medicine at a top university, had retired. For the past ten years this patient has been treated for his hypertension with a drug named Tarka that was marketed here by Sanofi-Aventis. This drug, he told me, cost him $90 dollars in co-pay every three months (it would cost around $150 dollars every month for someone without insurance) or $3,600 dollars in total for the past ten years. It’s one of the most expensive medications marketed for hypertension and since almost every good drug used for hypertension is now generic and costs as little as $4 dollars a month without insurance (sometimes even less for those with a prescription drug plan), I’ve never prescribed it. This patient would later tell me that he paid $5 dollars for a three month supply of the generic medication I prescribed. His blood pressure remains well controlled on an inexpensive, every bit as good, generic medication.
Many of you likely read last month, that the US Department of Justice filed a complaint against Norvartis Corporation for what they believe were “kickbacks to doctors to induce them to prescribe Novartis pharmaceutical products that were reimbursed by federal health care programs… The payments and lavish dinners given to the doctors were, in reality, kickbacks to the speakers and attendees to induce them to write prescriptions for Novartis drugs,” the DOJ said in the press release.
But what about the physicians who are involved? What about some of the top doctors, the elite physicians who are professors of medicine and in charge of teaching medical students and residents, who are just as guilty as Novartis; guilty of manipulating patients into accepting costly prescription drugs? It’s time for these physicians to be held accountable for their duplicitous behavior and especially, for making medical decisions based on their own monetary gain, at the expense of their patients’ health and pocketbooks.
Dr. Evan S. Levine is a cardiologist in New York and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.