Why do doctors choose a $2,000 drug over a $50 one?

[jsr]

http://www.washingtonpost.com/business/economy/an-effective-eye-drug-is-available-for-50-but-many-doctors-choose-a-2000-alternative/2013/12/07/1a96628e-55e7-11e3-8304-caf30787c0a9_story.html

An effective eye drug is available for $50. But many doctors choose a $2,000 alternative.
By Peter Whoriskey and Dan Keating, Saturday, December 7, 7:25 PM

The two drugs have been declared equivalently miraculous. Tested side by side in six major trials, both prevent blindness in a common old-age affliction. Biologically, they are cousins. They’re even made by the same company.

But one holds a clear price advantage.

Avastin costs about $50 per injection. Lucentis costs about $2,000 per injection.

Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion or more annually.

[Boom Sound 416]

1. Boat payments

[HereSince1628]

13. As opposed to balloon payments, I suppose.

[valerief]

28. +1000

[MADem]

52. Sounds nicer than "kickbacks!" nt

[mother earth]

79. No, the complicity comes much cheaper, dinner and a few pens is all it takes. nt

[TheDebbieDee]

2. One word - KICKBACKS

from the pharmaceutical companies......

[pinto]

10. Your comment needs some background, citations on kickbacks. I get your point, yet

simplistic, broadbrush assumptions do little to make a case. In the well worn journalistic standard - who, what, when, where?

[Paulie]

20. Here ya go

http://www.propublica.org/article/medicare-wastes-billions-on-name-brand-drugs

[solarhydrocan]

26. Examples

Big Pharma’s Bribery Blues

Big pharmaceutical companies have a knack for getting into trouble with governments. Over the past four years, major names in big pharma - including Pfizer (NYSE: PFE), Novartis and GlaxoSmithKline (NYSE: GSK) - have been fined billions of dollars in the United States for giving physicians kickbacks and perks to promote off-label marketing.

This month, charges of bribery have surfaced in China. The Chinese government is currently investigating GlaxoSmithKline for allegedly running a “bribery web” that drew in government officials, hospitals and doctors to boost sales and prices since 2007. Other companies, like AstraZeneca (NYSE: AZN) and UCB, have also been questioned by authorities. Should investors in these companies be worried? >>more
http://beta.fool.com/leokornsun/2013/07/24/big-pharmas-bribery-and-price-fixing-blues/41373/

Johnson & Johnson agrees to settle with SEC & DOJ for $70 million
http://americannutritionassociation.org/newsletter/huge-bribery-fine

Drug Company Accused of Bribing Doctors
http://abcnews.go.com/WNT/story?id=131602

Bribery And Corruption In The Pharmaceutical Sector
http://www.financierworldwide.com/article.php?id=11025

GlaxoSmithKline fined $3bn after bribing doctors to increase drugs sales
http://www.theguardian.com/business/2012/jul/03/glaxosmithkline-fined-bribing-doctors-pharmaceuticals

Bribery 'routine' for foreign pharmaceutical firms in China
http://www.bbc.co.uk/news/world-asia-china-23662909

Teva says it may have violated bribery laws around the world
http://www.fiercepharma.com/story/teva-says-it-may-have-violated-bribery-laws-around-world/2013-11-01


That's just a few from the first page of a search- from the last year.

[JNelson6563]

58. Gosh where are those apologists?

[elias7]

71. Why don't you see post 45 before you assume you know everything

I guess the apologists were doing some research before making snap judgments

[DLnyc]

46. From the first page of the article linked by the OP

From the article:

Doctors, meanwhile, may benefit when they choose the more expensive drug. Under Medicare repayment rules for drugs given by physicians, they are reimbursed for the average price of the drug plus 6 percent. That means a drug with a higher price may be easier to sell to doctors than a cheaper one. In addition, Genentech offers rebates to doctors who use large volumes of the more expensive drug.

So if I'm a doctor and prescribe a drug which is $2,000 per injection (as in the article), I make a profit of $120 on each injection (as opposed to $3 on the $50 choice). I don't know if that meets the legal definition of "kickback", but it sure as hell serves the same function.

Sounds to me like getting rid of that 6 percent would be an excellent place to start!

[indepat]

70. We are on Medicare and my wife has the type of macular degeneration for which the

referenced $2,000 drug apparently is used. Even were the doctor to benefit by an additional 6% of the drug's cost, the total remuneration allowed by Medicare would still be but a mere pittance imo for this procedure, especially when considering all the ancillary preparation administered by a staff of three or four.

[DLnyc]

73. ???? except that the $50 treatment is just as effective ?????

The question is whether there is an unfair incentive to use the much more expensive procedure when a cheaper procedure works just as well. Of course the patient doesn't care. The question is whether it is a good idea to bankrupt the system just to make doctors and drug companies rich. But I see your point, why should you care? Honestly, I don't think I really have a good answer.

I certainly hope all goes well for your wife, and maybe the rest of us will muddle through, somehow.

[indepat]

74. No, the $50 treatment doesn't last as long and my wife requires transportation to the doctor's

office via an ambulance-type service. That said, I would guess that the $2,000 drug could be provided by big pharma for $100 to $200, but big brother regularly busts his proverbial ass to assure big pharma get theirs and then some, a la Part D to Medicare.

[DLnyc]

75. Okay, I understand that there is a reason to prefer the $2,000 treatment.

But do you think it is a good idea, in general, to give the doctor that 6% incentive to choose the more expensive treatment, regardless of which works better, or how much better?

My point is that your case is very interesting, but in general we are giving the doctors an incentive to choose a more expensive treatment all the time. And, as an example of big brother assuring that "big pharma get theirs and then some", as you point out, the 6% works very nicely to help steer big money into the pockets of the drug cartels, it seems to me.

[indepat]

78. All your points are well-taken

[merrily]

3. Rec. Single payer could stop abuses like this.

[grahamhgreen]

65. +1

[Enthusiast]

67. Yes it could.

We must insist on single payer. It would only be the right thing to do. Anyone that poo poos single payer should be derided and laughed at.

[pinto]

4. One of the best tweaks for Medicare D would be taking the Veterans' Administration approach -

Negotiated pharmaceutical costs. The VA has done it. Medicare could as well. I think it's an overlooked aspect of our federal health care systems.

[Incitatus]

8. I thought it is more of a Republican blocking thing than an overlooked thing. nt

[pinto]

12. Yeah.

[slipslidingaway]

35. It WAS part of the Obama/Biden HC proposal but was dropped after ...

getting into office and the meeting with Billy Tauzin

[uppityperson]

5. For me it was ear drops after tube placement. The ordered was $80, which I didn't know

until the person I'd sent in bought it. I called the office and they said there was another that was $10 but since most ins companies paid for medicine they usually ordered the more expensive slightly better one. I asked them to please check with people because that was wrong in many cases, like mine. They did not know, people hadn't told them that.

I used 8 drops. That was all.

Not $2000 but still, $10 a drop was a bit much when it could've been less.

[Curmudgeoness]

11. I agree that the doctors just don't know the prices

although I think that part of their job should be to know it. I had a blood test done once, and it cost $500 and was not covered by insurance. It also was just diagnostic, since we would have done the same thing no matter what the results were. I told my doctor the price and how the insurance did not cover it and he was shocked. I do know that this one doctor will never do this test again unless it is really necessary. When I went to a specialist a few years later, he wanted to do the same test. I refused and told him the same reason why. He also had no idea.

Now, I tell a doctor right off the bat that I want the cheapest meds that will work....always. And it is usually what I get. When I need an antibiotic, I always ask for amoxicillin. I had one doctor try to convince me that it probably would not work and I should get another new antibiotic. I told him that we would try amoxicillin, and if it did not work, I would let him give me whatever he wanted. It worked.

[uppityperson]

16. As they get pushed to go faster and faster, they have even less time to keep up with the latest and

best medicines, tests, etc, and can fall into prescribing what they have in the past, or what they have heard of without having time to find out the details. Drug reps and ads can play into this quite a bit. Rather than being pushed to see patients every 10-15 min, they need time also to do research as well as charting, to be able to provide Good Health Care, something that is lacking more and more.

I blame in large part the commercialization of health care. Just because you CAN see someone in only 10 min does not mean is it often appropriate to do so. Taking away providers' time spent researching and keeping up with things is wrong. It seems a good facility would pay for, or even allow, a certain amount of time a month for that as it'd pay off for them in the long run.

[Curmudgeoness]

18. I agree with your points, but

I think that a good doctor would keep up with things, even if it is in his own time. Think of it as continuing education, and a doctor has to keep up to date on new things. I was a teacher at one time, and I cannot tell you how much time is spent evenings and weekends just to do the job right. And I was not paid as well as a doctor.

[uppityperson]

21. those I know try to but they have a limited amount of time to do so.

[A Simple Game]

27. But it is not just the time spent it is where the information is coming from.

We need the doctors getting information from government and consumer advisory boards; or as the Republicans call them, death panels.

I suspect too many are just getting information from the drug companies.

[Curmudgeoness]

31. Very good point.

But if you and I, who at least in my case are not capable of getting through medical school, realize that the drug companies have an agenda, don't you figure the doctors should realize that?

[A Simple Game]

51. I'm sure most do, and many may care,

but if there are time restraints do they have an alternative? And I'm sure in many cases the more expensive alternative is a better choice for some.

Like someone said the doctors don't know the prices and expect insurance to pay for it anyway. They may not realize that while it may not cost the individual it always costs the system.

[Enthusiast]

68. A huge plus one! nt

[lordsummerisle]

6. So what's your take on this? n/t

[Fridays Child]

7. Maybe because Big Pharma reps give them cruises, gifts, and boatloads of babble...

...most of which many pharmacologically-undereducated doctors have neither the time nor the inclination to verify. Those who have complex or difficult-to-treat conditions have to self-educate and self-advocate. For low income and older Americans, that's not always easy. Seniors in many states, though, may have access to area councils on aging. Case managers and others at these agencies can help.

[Douglas Carpenter]

9. Omeprazole (Prilosec) versus Esomeprazole (Nexium) for acid reflux

Omeprazole (Prilosec) you can buy over the counter without a prescription at approximately 1/5th to 1/10th the price of Esomeprazole (Nexium) which requires a prescription. Although if you can get your provider to write a prescription for Omeprazole (Prilosec) and if you have a co-pay plan for prescription pharmaceuticals - it will cost you almost nothing. Any serious pharmacist or knowledgeable healthcare provider will admit that there are only minor differences in the compound. It would be a rare and exceptional patient who would benefit any more from the more expensive Nexium.

[Curmudgeoness]

15. An interesting thing about omeprazole

I take it as a prescription. My health insurance was changed, so the pharmacy refilled it with the assumption that my coverage had lapsed, so I go to get the prescription and they said the price was $130. I just gave them the new insurance card to update my records and change the price to my copay, but I laughed at them. I take the same dosage as the over the counter Prilosec, and even if I were to buy the name brand, it would cost less than $30 for the same amount of pills. There is something fishy there.

[Douglas Carpenter]

19. that is stange - I take it as a prescription too - and I get 60 -20 mg capsules with my 80/20 Aenta

my copay is less than $2.00 - which makes the full price somewhere around $10.00 - although my particular pharmacy does very much rely on generic medications most of which I am sure are imported from India

[Curmudgeoness]

22. Wow. The price I was told of $130

was for a month's supply----30 pills. And this is a generic as well. Hell, my copay is $10 for the 30 pills.

But the point was that I could have bought the exact same drug over the counter for so much less, it was ridiculous to think that I would have paid the price for the prescription.

Do you worry about continued use of it? I do, but it has made my life normal when it was unbearable.

[Douglas Carpenter]

25. I only use it very sparingly now - at one point I had the terrible side effect of lots of diarrhea

I know this might sound a bit quacky or wooish - I myself am a very conventional healthcare worker so I don't usually put much stock in alternative medicine - but in this particular case and for me personally I found a home remedy alternative that for me works just as well - although I don't think it does for everyone -

I discussed it here in the lounge last month:

http://www.democraticunderground.com/1018495459#post43

[Curmudgeoness]

30. Thanks.

Since I have Barrett's Esophagus from years of GERD, I am not going to make any changes to home remedies. It is a little late for alternatives, besides, I have tried this one as well as a hundred others over the ten years before I was finally treated. Danged doctor just kept telling me that "everyone has indigestion". I got his attention when I started vomiting blood.

[LiberalArkie]

62. I took 40mg Nexium for many years (with corp insurance) once I retired

I found that 20mg of generic delayed release omeprazole magnesium twice a day gives me exactly the same results as the 40mg Nexium. I guess the Nexium is so slow releasing that taking 1/2 dosage in the morning and at bedtime works like Nexium. I get it at Family Dollar.

[laundry_queen]

48. Thanks I bookmarked that thread

I have mild gerd but my main issue is diagnosed as "non-ulcer dyspepsia with chronic gastritis". I've taken a bunch of them - nexium, prevacid, pariet, tecta...they all work for a few months then stop working and my stomach pain comes back. I now have issues with polyps thanks to the long term use of proton pump inhibitors and I'm looking for a way to get out of having to take them, but not suffering horrible stomach and throat pain. Since they can't find anything structurally wrong with me and they don't think my gastritis is serious (mildly inflamed is how they said) I don't see how trying something different can hurt. My mom has the same problem and we are starting to wonder if it isn't caused by the PPIs - my brother started having the same stomach issues after he started taking over the counter meds for heartburn and he got suspicious it was the meds so he stopped and started watching his diet a bit more and taking more 'home remedies'. He doesn't have any issues with his stomach anymore. Anyway...I'll have to investigate.

[hollysmom]

14. my doctor is pushing the shingles shot and I refuse

You can get it after you have shingles, you don't have to get it before. Why look for trouble?
Also I had chicken pox 4 times and this is a live virus. If I don't seem to get immune, another bout of chicken pox could kill my the last time was horrendous when I was an older teen, i wanted to die when I had it in my nose and eyelids and ears and mouth et al. he wouldn't stop talking about it, so I asked him what was in it for him that he was so insistent. He stopped at that point and we don't discuss it anymore. I am not very interested in taking flu shots either.

[Skip Intro]

24. Maybe he's just trying to help. Chicken pox and shingles are related.

Maybe he was just trying to do what he could to help you, since you've had chicken pox four times.

[hollysmom]

29. you miss the point - I had chicken pox 4 times - the shingles shot has a LIVE virus in it

Most people have chicken pox once and then the virus stays in their body to make them immune to having it again and that causes shingles. If I can't get immune, I can't get shingles. If I get Chicken pox as an elderly person I could die.

[Skip Intro]

37. Sorry. But...

I do not know the relationship between the two, but if your doctor who knows you have had chicken pox four times is recommending a shot that has no chance of helping you, then I'd definitely be looking for a new doc.

Do you think he was pushing some honestly mistaken opinion or purposely pushing drugs on you that you don't need?

[hollysmom]

43. I have been going to him for over 10 years, not the best, certainly far from the worst.

The office is half a block from my house and he takes my insurance - so I go, we have a combative relationship, ha ha . He knows I won't just take something he gives me. I have to look it up and check out the adverse effects. I can then call him and ask for something else. He is excellent with colds and flus and sends me to specialists for muscle or bone problems. But he done't recall everything. He was really pushing the shingles shot a lot, so I figure he just had a visit from his local pill pusher. Of course the CDC recommends it for people over 60, I just think it is silly if you have never had an occurrence of shingles. He wants me to take my blood pressure pills every day, but some days my blood pressure is low and I won't take it until it is at least normal, I ended up in the hospital years before I saw him because I took the pill every day and my blood pressure disappeared and I died (luckily, I didn't feel well and drove to an emergency room before I died and they brought me right back, but I didn't wake up for 3 days when they finally cleared all the excess medication out of my system.) On the other hand, when I do get ill, he always makes time in his schedule to see me in a very short time/hour.

I.e. I think he is a regular doctor who does not deal well with independent thinkers and weird health problems. I am a challenge to him, ha ha . But he is caring

[broiles]

61. My doc says no to the vaccine because it's a live virus.

My immune system is compromised from previous bouts of shingles in my eye, on my eyelid and encephalitis. So I take Valtrex daily and that does the trick.

[DesertFlower]

34. in your case i might get it, but i do

think they're pushing the shot too much. we're bombarded with tv ads saying 1 out of 3 people will get shingles. that's a crock. how many people do you know who got shingles? i've met 2 in almost 40 years.

my friend's doc keeps pushing it. It's $300 and not covered by her insurance.

[blue neen]

39. Many, many people get shingles.

It occurs most frequently in older people and those who have compromised immune systems...I don't know whether the number 1 in 3 is correct, but it happens often enough to be of concern.

The vaccine is usually recommended for those over age 60. Some insurances do pay for it; Medicare does, I believe.

Shingles is a nasty illness and very painful. For some patients, the nerve pain never goes away.

The decision to get the vaccine is a personal one. In some areas of the country, there are free shingles vaccinations for the uninsured and underinsured. If your friend is interested, maybe she could check with the county or city Board of Health.

[DesertFlower]

41. i'm 72 and haven't had it. i know it's nasty, but

i'll take my chances. i don't get flu shots either.

my doc hasn't suggested the shingles shot. he did ask me if i wanted a flu shot. i got a pneumonia shot last year. i had pneumonia 3 times in 4 years back in the late '80s early '90s. haven't had it again since getting the shot.

i take vitamins and astragalus which is good for the immune system. a few years ago dr. andrew weil recommended it instead of a flu shot.

i follow my gut feelings.

[hollysmom]

42. The thing is, after you get shingles you can get the shot -

Yes, you will suffer through the first one, but since the odds are you won't get it, why get another vaccine you most likely will not need. If 1 out of 3 get it, it means 2 out of 3 don't.

[DesertFlower]

47. i don't believe those statistics.

i think they're just trying to scare people into getting the vaccine. like i said in over 30 years i've only known 2 people who got shingles. if 1 out of 3 get it i would have met or heard about many more. by the way the 2 people i knew who got it were in their 40s.

i have no intention of getting the shot whether i get shingles or not.

why is it none of my docs have ever suggested i get it? maybe as doctors they don't believe the statistics either.

i'm going to ask my doc how many of his patients have gotten shingles.

here's an interesting article.

http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2008/October/Should_you_get_the_shingles_vaccine

[Mojorabbit]

54. I am recovering from a huge shingles outbreak

I have never had such pain and my neurologist says it may never go away. You can have some permanent damage from shingles also. I would get the vaccine.

[hollysmom]

81. I accept that and know that it must have been horrible

But if I get chicken pox again, it could kill me. I have avoided all people and children who have been exposed to chicken pox for most of my adult life.
I have read they have drugs to temper the effect of Shingles, and most people find it annoying and somewhat painful, you must have had the exceptionally bad case.

[Mojorabbit]

84. I took the drugs to temper the effect

and am on drugs to try to quiet the nerves which only barely take the edge off the pain. It is excruciating. I have had shingles before and never had more than minor itching. I hope I don't get stuck with this pain for months or the rest of my life. I have had kidney stones which are supposed to be up there in pain levels but that did not compare at all with this pain. I don't know what I will do if I have to deal with this forever. I hope you avoid getting it.

[hollysmom]

85. AHm, but you had other attacks before.

If I ever get shingles, I will take the vaccine, but I want to wait until I know I will have it, i.e. after the first attack I have no problem. I just don't want to take it before I know I have it. You could have had the vaccine after the first attack, it works if you take it in between attacks.

I am so sorry you have it so tough. I wish I had something that could sooth you. Tough it out and then you can get the vaccine before the next attack. When I was a teen and had chicken pox in my eyes and ears and mouth et al, I just wanted someone to kill me. My mother duck taped kitchen mittens on my hands so I could not scratch. and my hands were so hot all the time it just about killed me. I hate hot hands and feet. always did always will, have to hang feet and hands out of covers in the winter. I kept trying to chew the tape off. The doctor said crying w s good for my eyes to keep the scabs from scratching my corneas and I cried a lot. That was the worst and the last time I had chicken pox, thanks to my little brothers.

[mnhtnbb]

87. I have a friend who has had a terrible bout with shingles--still gets flare ups two years

after her first outbreak. She is miserable.

We happen to go to the same doc. He has written me an Rx for the shingles shot (I'm 62)
but I'm really hesitant to get it.

OTOH, I've resisted getting flu shots until this year. Last year I had the worst
flu--went on for weeks--and am sure I got it from a passenger sitting behind
me on an airline flight who was sneezing, coughing, for two hours. Full plane, nowhere
to move. I was stuck. Sure enough, came down with it several days later.

This year I got a flu shot. We were on a 3 week trip to Europe earlier this fall--and I was sure
several times I was going to get sick when people sneezed or coughed right
on me on the metro or in a museum. Did not get sick.

[KamaAina]

76. You had dchicken pox four times?

How is that possible?

[hollysmom]

80. I just had it, I don't know why.

The doctor thought it was an inability to get immune but that was a long long time ago, last time was over 50 years ago.

[unblock]

17. big pharma spends millions sending reps to visit doctors. that tells you all you need to know.

[Hoyt]

55. Have to admit, I enjoy sitting in doc's office and seeing the pretty drug reps. But, that misses

your point, that is right on.

I will say, that docs don't usually profit directly from pills (although they can invest in the companies that develop them).

[unblock]

64. interesting how, yes, drug reps often do seem to fit a certain profile....

here's an interesting article about their tactics:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876413/

[curlyred]

23. My father did the research and demanded Avastin

The doctor was surprised that he cared. Ended up changing doctors.

[mckara]

32. Not Everyone is Playing for Our Team

[doc03]

33. They get tickets to football, baseball, golf outings etc. n/t

[JimboBillyBubbaBob]

36. Commission in some form or the other,

or they are dumb assess. I'd vote for commissions! Yet, on second thought, they must be the other at the same time.

[DeSwiss]

38. Answer: ''What are Kickbacks?''

- K&R

[Lex]

40. Because of all the swag that Big Pharma gives doctors and their offices. nt

[Aristus]

44. I'm a Physician Assistant, not a doctor. But I always prescribe the most effective/least expensive

medication available. Big Pharma isn't getting a dime more out of my patients than necessary. I get a lot of free medications donated by the pharmaceutical companies that I can pass along to my homeless patients. But Big Pharma isn't doing that out of the goodness of their hearts, but for the tax break. So I'm not going to boost their profits if I can help it.

The company I used to work for permitted drug reps to come in, buy lunch for the staff, and then pitch their new product. I'd eat their lunch, and then bug out of there. The company I work for now doesn't permit drug reps to visit the clinics, and its just as well...

If lunch can be considered a 'kickback', well, I never made good on the implied trade...

[Sgent]

45. In this case there are multiple reasons

Keep in mind this is a physician administered drug and injected into the eye -- not one that is filled by a drugstore.

1) The $2,000 is safer due to packaging. The $50 drug is only available in $1,500 dollar vials, which means the doctor must throw out the remainder of the drug and take a $1450 loss on reimbursement, or do multiple injections (to multiple people) from the same vial. Multiple dose vials aren't a problem usually, but the $50 drug has no preservatives built in, so once the package is opened it needs to be used quickly or risk contamination. This problem is even worse because the drugs in question are injected directly into the eye.

2) The $50 drug is not approved for use in the eye, and is not labeled for ophthalmic use the $2,000 is.

3) Doctors make more money (since they usually make about a 6% markup) on selling a $2,000 drug than a $50 one. Especially since the malpractice risks are lower (see #1 and #2), this is an added bonus.

For this particular drug #1 is the big reason ophthalmologists prefer the $2,000 drug. This is a drug company decision, not doctor's.

[FarCenter]

59. Use of Avastin for macular degeneration would be an "off-label" use not approved by the FDA

So doctors may not wish to risk a malpractice lawsuit if there is a bad outcome.

Avastin and Lucentis are equivalent in treating age-related macular degeneration

At two years, Avastin (bevacizumab) and Lucentis (ranibizumab injection), two widely used drugs to treat age-related macular degeneration (AMD), improve vision when administered monthly or on an as needed basis, although greater improvements in vision were seen with monthly administration for this common, debilitating eye disease, according to researchers supported by the National Institutes of Health.

Of the two drugs, Avastin is most frequently used to treat AMD.However, prior to the Comparison of AMD Treatments Trials (CATT), a two-year clinical trial, the two drugs had never been compared head-to-head. Second year results were published today in the journal Ophthalmology External Web Site Policy. First year results were published in the May 19, 2011 issue of the New England Journal of Medicine External Web Site Policy.

...

Avastin and Lucentis block growth of abnormal blood vessels and leakage of fluid from the vessels. Lucentis was approved by the U.S. Food and Drug Administration (FDA) in 2006 for the treatment of AMD. Avastin is very similar to Lucentis but is not approved by the FDA for this purpose. Avastin is approved for other indications. Most clinicians use these drugs on an as-needed basis when there is evidence of active disease, such as fluid leakage. However, in the original clinical trials for AMD, Lucentis was administered monthly. It was unknown if as-needed dosing would produce the same long-term visual improvements achieved with monthly administration.

http://www.nih.gov/news/health/apr2012/nei-30a.htm

Compounding Pharmacy Crackdown Continues With Avastin Recall

Ophthalmologists use bevacizumab — FDA-approved for various forms of cancer — on an off-label basis to treat neovascular or "wet" age-related macular degeneration (AMD). Bevacizumab is far less expensive than an FDA-approved drug for AMD called ranibizumab (Lucentis, Genentech) that costs 40 times as much.

The threat posed by contaminated bevacizumab used for AMD is one the FDA has encountered before. In 2011, the agency warned clinicians that repackaged intravitreal injections of the drug caused a cluster of serious Streptococcus endophthalmitis infections and blindness in Miami, Florida. Similar cases emerged in Tennessee among patients treated for AMD at a Veterans Affairs hospital.

Yesterday's bevacizumab recall involves a compounding pharmacy called Clinical Specialties. The pharmacy stated in a press release that it has received 5 reports of intraocular infections. The 79 recalled lots of the drug have expiration dates ranging from February 24, 2013, to June 5, 2013. The syringes were distributed to physicians in Georgia, Louisiana, South Carolina, and Indiana from December 18, 2012, to the present.

http://www.medscape.com/viewarticle/781039

[Victor_c3]

49. Perhaps it's as simple as perception?

When you go shopping for a DVD player, which one do you think is better? The $30 one or the $300 one? Without even looking at the details of the two devices, I bet that nearly everyone would say that the $300 one is substantially better quality.

People naturally think that the more expensive something is, the better it must be. I'm willing to bet that doctors are no different.

[elias7]

50. Thank you for this comment

As a physician, I suffer through reading these threads that carelessly throw around accusations of corruption-- taking bribes, lining pockets, being in bed with big pharma, etc.

Usually, I don't know how to start to dispel these strongly held opinions, so I don't even try. Maybe I'm naive, but Almost every doctor I've ever met or worked with works their ass off helping patients and are stand up people, who would have gone into other fields if they wanted to get rich or be crooks.

Unfortunately, it is really easy for people to cast unfounded aspersions and accusations when they don't know what they're talking about, and when they assume it's all us vs them and there's only us' on this site.

[solarhydrocan]

56. Some are taking bribes or all these stories may qualify for libel suits

I believe you when you say you work your ass off and are a stand up person. I don't think you yourself are taking bribes. I'm sure many if not maybe most Doctors are the same.

But these fines are getting paid for some reason. Likely the fact that some Doctors are not as ethical as you. The main point is that the Pharma companies have done many unethical things.

This needs to stop now. Especially now that we are all tied together by mandatory insurance payments.

Big Pharma’s Bribery Blues

Big pharmaceutical companies have a knack for getting into trouble with governments. Over the past four years, major names in big pharma - including Pfizer (NYSE: PFE), Novartis and GlaxoSmithKline (NYSE: GSK) - have been fined billions of dollars in the United States for giving physicians kickbacks and perks to promote off-label marketing.

This month, charges of bribery have surfaced in China. The Chinese government is currently investigating GlaxoSmithKline for allegedly running a “bribery web” that drew in government officials, hospitals and doctors to boost sales and prices since 2007. Other companies, like AstraZeneca (NYSE: AZN) and UCB, have also been questioned by authorities. Should investors in these companies be worried? >>more
http://beta.fool.com/leokornsun/2013/07/24/big-pharmas-bribery-and-price-fixing-blues/41373/

Johnson & Johnson agrees to settle with SEC & DOJ for $70 million
http://americannutritionassociation.org/newsletter/huge-bribery-fine

Drug Company Accused of Bribing Doctors
http://abcnews.go.com/WNT/story?id=131602

Bribery And Corruption In The Pharmaceutical Sector
http://www.financierworldwide.com/article.php?id=11025

GlaxoSmithKline fined $3bn after bribing doctors to increase drugs sales
http://www.theguardian.com/business/2012/jul/03/glaxosmithkline-fined-bribing-doctors-pharmaceuticals

Bribery 'routine' for foreign pharmaceutical firms in China
http://www.bbc.co.uk/news/world-asia-china-23662909

Teva says it may have violated bribery laws around the world
http://www.fiercepharma.com/story/teva-says-it-may-have-violated-bribery-laws-around-world/2013-11-01

Do these stories- by reputable news sources- not indicate that there is a MAJOR problem with *Pharmaceutical companies* and how they do business?

[elias7]

60. I'm not talking about pharmaceutical companies

They are big business, and big business, I would argue has a problem with ethics.

I'm talking about when a few individuals give a whole group a bad name.

If a democratic congressman took a bribe, we bend over backwards to see this as an aberration, an exception, a mistake.

If a republican did the same, we see that as evidence of systemic corruption in that party.

Many people see doctors as part of the privileged class, which they are really not. They have worked their asses off to get where they are. They weren't necessarily born into money. They are not wealthy in the sense of millionaire or billionaire money. Many people project their own fears and frustrations onto physicians-- I get that all the time in the ED. And if people do not get a clear cut diagnosis, they say that no one knows or no one is telling me what is wrong with me, with the tacit blame on the medical community.

The blanket biases against doctors, lawyers, police, etc is very frustrating. The blanket biases for certain groups is equally frustrating.

[Sgent]

66. I almost certainly agree with most of your statement

and I completely agree that the idea of "kickbacks" from drug companies never really happened on a significant level.

That being said, drug companies marketing budget for a long time included everything from free dinners at some of the most expensive restaurants in town, to fully paid attendance to various drug sponsored medical conferences. Those were marketing expenditures rather than "kickbacks" because they never required physicians to use / prescribe their product to receive those benefits (ie all neurologists would be invited to this conference, etc.), but they led to the appearance of kickbacks and the distinction isn't necessarily well known.

In addition, reimbursement does play a role in decision making. For instance one physician group I'm aware of used a very inexpensive (1$ per injection) steroid when providing injections in their sliding fee clinic, and another more expensive steroid ($10) in their regular clinic. The reason for this was that the $1 steroid was reimbursed at about 25 cents, and the $10 was reimbursed by third party payers (including Medicare) at $50. When the reimbursements got back to normal the physicians switched to the cheaper drug for all patients.

[Hoyt]

53. I know this will not be popular, but that is one problem with traditional Medicare.

Under traditional Medicare, a doc is pretty free to prescribe whatever he/she wants once it has FDA approval.

However, Medicare Advantage Plans can control costs by having drug formularies that say "Nope" to situations like Avastin vs. Lucentis without some pretty conclusive evidence that latter is needed.

Obviously for-profit cost controls can work against the patient, but so can allowing health care providers to profit from situation like in the OP. But, folks would raise holy hell if the government said No to Lucentis.

There are some stiff laws under Medicare/Medicaid for direct kickbacks, but the situation in the OP probably wouldn't fall in that category.

[Autumn]

57. They push what the pharmaceutical reps want them to push.

I remember seeing a Doctor and the nurse puts me in an exam room and didn't close the door all the way. I sat there for over half an hour listening to the pharmaceutical rep talking to the Dr. in his office about prescribing their drugs. It was very illuminating. My appointment was at 10:30 and the rep and I walked through the door at the same time. The Dr. finally walked in into my exam room at 11:20. I never went back to his office.

[Enthusiast]

69. What you witnessed is nearly universal.

Of course even DU has deniers.

[bluestate10]

83. By chance, I met a woman who was a surgical equipment rep. After finding out what she

did, I started asking technical questions, none of which she could answer. But, man oh man, was she drop dead gorgeous. She flew all over the east coast "talking" to Doctors about her company's products.

[Enthusiast]

86. I see them when I wait to see my Doc.

I know one Pharm rep, a very handsome young man. My very attractive niece was a pharm rep. I bet they're all good looking. Just a guess.

[Egalitarian Thug]

63. An entrenched system of graft built and protected by the AMA and associated industries.

Big Pharma has been wholly evil since its came to be, and we haven't even started on the parasites of medical device industry.

[moondust]

72. An ophthalmologist explains:

http://www.reddit.com/r/politics/comments/1sdxz6/an_effective_eye_drug_is_available_for_50_but/cdwoh5j

[B Calm]

77. For totally free vacations in Hawaii ?

[bluestate10]

82. The Doctor may be getting a kickback. Health care reform in my state removed that

route, my Insurance company pays for part of any prescriptions that I need, there is an incentive to find the most inexpensive, effective medicine.