If you've ever seen Dr. Drew Pinsky on TV, you've seen the look: lips pursed, eyes narrowed, head slightly tilted to stage right. It's an expression that seems practiced in front of a mirror, designed to dispense to his troubled patients precisely the right dosage of compassion tinged with disapproval—but, instead, it makes him look like his mind is somewhere else, off golfing or figuring out where his next paycheck is going to come from.
Thanks to the Justice Department, we now know of a Dr. Drew payday large enough to trigger a reverie or two. As part of its monstrous $3 billion settlement with the pharmaceutical giant GlaxoSmithKline (GSK), the DOJ unsealed documents showing that the dear doctor had taken in at least $275,000 for "services for Wellbutrin."
Precisely how can one service an antidepressant like Wellbutrin? According to the government's complaint, Dr. Drew was hired to "deliver messages about [Wellbutrin SR] in settings where it did not appear that Dr. Pinsky was speaking for GSK." After Pinsky suggested that Wellbutrin might be responsible for increasing a woman's orgasm rate—to as many as 60 orgasms in a good night—an internal GSK memo noted approvingly that Dr. Drew had "communicated key campaign messages" about Wellbutrin to the public.
GSK got hauled into court, in part, because it is illegal for a pharmaceutical company to promote a non-FDA approved use of a drug. (FDA recognizes Wellbutrin as an antidepressant and smoking cessation aid, not as an orgasm enhancer.) But it's not illegal for a doctor to promote or prescribe such off-label uses. (Pinsky was not charged with any crime. In a statement to Forbes, he said, “My comments were consistent with my clinical experience.” And a GSK spokeswoman wrote that “The complaint does not reflect what would be allowed in GSK today … We have increased our controls to require disclosure of financial relationships.”) Off-label uses can be very lucrative to a company marketing a drug. This is one reason why so much drug-company money has been winding up in the pockets of physicians. Including, quite possibly, yours.
In Dr. Drew's case, the Justice Department isn't the first to point out that he's been taking money from pharmaceutical companies and medical device manufacturers. In January, while researching conflicts of interest caused by pharmaceutical payments, I discovered that Pinsky had taken $115,000 from Janssen Pharmaceuticals. When the news went public, Janssen was the first to defend Pinsky, stating that the money was for a program "aimed at educating teens, parents, and educators about the prevalence and serious risks of teen prescription drug abuse in the U.S. ..." And Alison Rudnick, a spokesperson for CNN’s Headline News network, home of the show Dr. Drew, emailed me to confirm that, if appropriate, "Dr. Drew would provide an on-air disclaimer if he were to do a story involving Janssen Pharmaceuticals." Be that as it may, there was no such disclaimer last week when the subject of the Dr. Drew show was gastric bypass surgery—even though the Los Angeles Times had an article in December questioning the propriety of Pinsky's role as a spokesperson for 1-800-GET-THIN, a lap-band surgery marketing firm. (A source at Headline News says that the lap-band deal had elapsed by the time the gastric bypass show aired, so no disclosure was necessary.)
It's not just celebrity doctors like Pinsky who are getting lots of attention—and cash—from big pharma. Thanks to lawsuits like the recent GSK one, we're beginning to get hints of just how much the drug industry is paying physicians in hopes of getting them to talk up and prescribe its wares. As a result of court battles, a number of big drug companies, such as Pfizer, Abbott, Eli Lilly, Novartis, and Johnson & Johnson, have been forced to disclose the money they've paid to medical providers. The nonprofit investigative journalism organization ProPublica collected all of those disclosures (along with a number of others that were voluntary) from 12 drug companies. All told, the database contains more than $760 million in payments for such services as consulting, speaking, and research. (It is probable that a large proportion of these gigs are "work" in name only, such as the lavish consulting meetings in Jamaica that the government alleges were intended to reward physicians prescribing large amounts of Wellbutrin to their patients.)
It's not surprising that some doctors would take drug company cash—even when doing so potentially runs counter to the interests of their patients. But the $760 million figure gives a sense how widespread the problem has become. Throw a few names into the ProPublica database—names of medical doctors you know—and there's a reasonable chance you'll discover that one has been suckling from Big Pharma's teat.
Worse yet, you can often catch a whiff of drug company money on the FDA, which decides which pharmaceuticals are allowed on the market, and the NIH, which funds some $30 billion of medical research annually. That controversial decision last year to screen children for cholesterol—and potentially put them on cholesterol-lowering drugs? Big Pharma was there. The decision about whether diabetes drug Avandia should be off the market? Big Pharma was there. In my own investigations, I found a number of people serving on key NIH advisory panels who were taking money from pharmaceutical firms. When I used the Freedom of Information Act to get the agency to turn over certain documents that might shed light on these payments, the agency refused to do so. (I sued. The judge ordered the NIH to turn over some of the documents I requested; the government is now deciding whether or not to appeal the decision.) This money is potentially influencing which compounds get researched, what drugs get approved, and what medicines wind up in your bathroom cabinet.
The payments to Dr. Drew are just a tiny symptom of a much bigger malaise. There are volumes of laws and regulations that are supposed to keep the public safe from ineffective or dangerous drugs. Publicly, the drug companies and their supporters say those rules threaten to stifle medical progress. But in reality, the deep pockets of the pharmaceutical industry make it relatively simple to get around mere laws and federal regulations. And when a company gets caught, it’s no biggie. GlaxoSmithKline stock didn't suffer despite the enormous fine—as I write this piece, its stock price is up more than a percent from the day before the settlement was announced. When you sell some $44 billion worth of drugs annually, even a $3 billion settlement is just the cost of doing business. A quarter of a million dollars to an unctuous TV doc isn't even a blip on the radar.