PillPushersTheBook

High Price of Gas???

2008-05-28T19:41:00.000-07:00

You haven't seen anything yet! Interesting contribution from a government employee in the Dept. of Commerce.

Shop your prescriptions and keep the pressure on Big Pharma to reduce unnecessary expenses!!

For those who has prescribed medication and are not aware, Costco is sooooo much cheaper. Read below for additional information.

This is worth reading.Be sure to read to the end. You will be amazed.
This is worth reading.

Let's hear it for Costco! (This is just mind-boggling!)

Make sure you re ad all the way past the list of the drugs. The woman that signed below is a Budget Analyst out of federal Washington, DC offices.

Did you ever wonder how much it costs a drug company for the active ingredient in prescription medications? Some people think it must cost a lot, since many drugs sell for more than $2.00 per tablet. We did a search of offshore chemical synthesizers that supply the active ingredients found in drugs approved by the FDA. As we have revealed in past issues of Life Extension a significant percentage of drugs sold in the United States contain active ingredients made in other countries. In our independent investigation of how much profit drug companies really make, we obtained the actual price of active ingredients used in some of the most popular dr ugs sold in America .

Celebrex:100 mg
Consumer price (100 tablets): $130.27
Cost of general active ingredients: $0.60
Percent markup: 21,712%

Claritin:10 mg
Consumer Price (100 tablets): $215.17
Cost of general active ingredients: $0.71
Percent markup: 30,306%

Keflex:250 mg
Consumer Price (100 tablets): $157.39
Cost of general active ingredients: $1.88
Percent markup: 8,372%

Lipitor:20 mg
Consumer Price (1 00 tablets): $272.37
Cost of general active ingredients: $5.80
Percent markup: 4,696%

Norvasc:10 mg
Consumer price (100 tablets): $188.29
Cost of general act ive ingredients: $0.14
Percent markup: 134,493%

Paxil:20 mg
Consumer price (100 tablets): $220.27
Cost of general active ingredients: $7.60
Percent markup: 2,898%

Prevacid:30 mg
Consumer price (100 tablets): $44.77
Cost of general active ingredients: $1.01
P ercent markup: 34,136%

Prilosec: 20 mg
Consumer price (100 tablets): $360.97
Cost of general active ingre dients $0.52
Percent markup: 69,417%

Prozac:20 mg
Consumer price (100 tablets) : $247.47
Cost of general active ingredients: $0.11
Percent markup: 224,973%

Tenormin:50 mg
Consumer price (100 tablets): $104.47
Cost of general active ingredients: $0.13
Percent markup: 80,362%

Vasotec:10 mg
Consumer price (100 tablets): $102.37
Cost of general active ingredients: $0.20
Percent markup: 51,185%

Xanax:1 mg
Consumer price (100 tablets) : $136.79
Cost of general active ingredients: $0.024
Percent markup: 569,958%

Zestril:20 mg
Consumer price (100 tablets) $89.89
Cost of general active ingredients $3.20
Percent markup: 2,809

Zithromax:600 mg
Consumer price (100 tablets): $1,482.19
Cost of general active ingredients: $18.78 Percent markup: 7,892%

Zocor:40 mg
Consumer price (100 tablets): $350.27
Cost of general active ingredients: $8.63
Percent markup: 4,059%

Zoloft:50 mg
Consumer price: $206.87
Cost of general active ingredients: $1.75
Percent markup: 11,821%

Since the cost of prescription drugs is so outrageous, I thought everyone should know about this.
It pays to shop around! This helps to solve the mystery as to why they can afford to put a Walgreen's on every corner. On Monday night, Steve Wilson, an investigative report er for Channel 7 News in Detroit , did a story on generic drug prices gouging by pharmacies. He found in his investigation that some of these generic drugs were marked up as much as 3,000% or more. So often we blame the drug companies for the high cost of drugs, and usually rightfully so. But in this case, the fault clearly lies with the pharmacies themselves. For example if you had to buy a prescription drug, and bought the name brand, you might pay $100 for 100 pills.

The pharmacist might t ell you that if you get the generic equivalent, they would only cost $80, making you think you are saving $20. What the pharmacist is not telling you is that those 100 generic pills may have only cost him $10!

At the end of the report, one of the anchors asked Mr. Wilson whether or not there were any pharmacies that did not adhere to this practice, and he said that Costco consistently charged little over their cost for the generic drugs.

I went to the Costco site, where you can look up any drug, and get its online price. It says that the in-store prices are consistent with the online prices. I was appalled. Just to give you one example from my own experience I had to use t he drug Compazine which helps prevent nausea in chemo patients.

I used the generic equivalent, which cost $54.99 for 60 pills at CVS. I checked the price at Costco, and I could have bought 100 pills for $19.89. For 145 of my pain pills, I paid $72.57. I could have got 150 at Costco for $28.08.

I would like to mention, that although Costco is a 'membership' type store, you do NOT have to be a member to buy prescriptions there as it is a federally regulated substance. You just tell them at the door that you wish to use the pharmacy, and they will l et you in.

I am asking each of you to please help me by copying this letter, and passing it into your own e-mail, and send it to everyone you know with an e-mail address.
http://www.snopes.com/medical/drugs/generic.aspSnopes.comconfirms this.

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Big Pharma and Pill Pushers Comments Continue to Stream In

2008-05-12T05:19:00.000-07:00

The book has picked up a little following and is gaining a fan club of sorts. Word of mouth is spreading and this comment comes from a fan's sister:

Anne -- I finished Ces' book over a week ago and keep meaning to tell you about it. I thought it was really good. I read a lot of books in that genre (Nance, Demille). I thought it was fast paced and interesting. I would have liked it to be a little longer and developed some of the other characters more. I would have liked more on the reunion of the two main characters when they testified before Congress. I looked for it on Amazon.com -- thought I'd get a copy for my friend who's a health care reporter with USA today -- but couldn't find it.

From A Houston Pill Pusher

2008-05-07T07:22:00.000-07:00

After reading the book we have another interesting commentary on Pill Pushers: A Big Pharma Battle For Market Share!

Life in the "Push" Lane

Take a front seat ride into a "day in the life" of America's pharmaceutical sales industry as this fast-paced thriller speeds you right into the front page headlines of today's major newspapers. Although admittedly a work of fiction, the shades of grey are taken to the limit as a corporate giant suffers the fallout of putting profits before people. You will be mesmerized as the lines between fact and fiction become all too blurry in this incredible work that is hard to put down as soon as you open it up.

PILL PUSHER BOOKSTORE ANNOUNCEMENT!

2008-04-28T12:20:00.000-07:00

We've officially been accepted into our FIRST bookstore!! For our friends in and around the N.O., please stop in and visit Britton Trice and the good people at The Garden District Book Shop. We're still working on a book signing there too. Please forward this e-mail to anyone and everyone you know in the N.O. area that might have some interest in a GREAT story! We'd love to cause a stampede for the book! Thanks for your support!

http://www.gardendistrictbookshop.com/NASApp/store/IndexJsp

For more info on the book, check it out on the web at: www.PillPushersTheBook.com Part of the story takes place in N.O. with scenes on campus at LSU too!

Marketing vs Research

2008-04-19T11:13:00.000-07:00

I think most of you are aware of this info posted on Mercola.com ... I'm really concerned with the push on marketing vs research though! Check it out!!

Shocking Facts About the Pharmaceutical Industry

Big drug companies have been accused of putting profits above patients, spinning false PR campaigns and more. Here are some of the most shocking facts about the pharmaceutical industry.

The price of drugs is increasing faster than anything else a patient pays for: The prices of the most heavily prescribed drugs are routinely jacked up, sometimes several times a year. Some medications have a mark-up of 1,000 percent over the cost of their ingredients.

Your doctor may have an ulterior motive behind your prescription: Drug reps often give gifts to convince doctors to prescribe the medications that they represent. These drug reps usually have no medical or science education.

Pharmaceutical companies spend more on marketing than research: Almost twice as much!

Guilty of Medicare fraud: Pharmaceutical companies are being tried in federal courts as a result of their exploitation of Medicare. AstraZeneca had to pay more than $340 million in penalties for coaching doctors to cheat Medicare.

The combined wealth of the top 5 pharmaceutical companies outweigh GNP of sub-Saharan Africa: In fact, the combined worth of the world’s top five drug companies is twice the combined GNP of that entire region.

Americans pay more for prescription meds than anyone else in the world: $200 billion in 2002 alone.

"New" Drugs aren't really new: Two-thirds of “new” prescription drugs are identical to existing drugs or modified versions of them.

Drug companies are taking advantage of underdeveloped countries to perform clinical trials: In developing countries, government oversight is more lax.

Message From Europe

2008-04-12T15:21:00.000-07:00

Pill Pushers has fans across the pond!

Laura and I met Peter and Dee in Italy last year. They ordered Pill Pushers and are now weighing in with their comments!

Just a quick email to let you know that both Peter and I have read your book and thought it was great. We both thoroughly enjoyed it and it gave us an insight into a world that neither of us knew anything about. Many thanks again for sending it to us.

ANOTHER FORMER PILL PUSHER!!!

2008-04-08T18:03:00.000-07:00

This is a column from a good website! Check it out!

Former Drug Sales Rep Tells All

Shahram Ahari, who spent two years selling Prozac and Zypraxa for Eli Lily, told a Senate Aging Committee that his job involved "rewarding physicians with gifts and attention for their allegiance to your product and company despite what may be ethically appropriate."

Ahari claims that drug companies often hire former cheerleaders and ex-models, as well as former athletes and members of the military, even if they have no background in science.

During their five-week training class, Ahari says he was taught sales tactics such as:

How to exceed spending limits for important clients
How to be generous with free samples to leverage sales
How to use friendships and personal gifts to foster a "quid pro quo" relationship
How to exploit sexual tension

Ahari claims that he's even heard stories about sales reps helping to pay the cost of a doctor's swimming pool, or taking a doctor to a nightclub where a hostess was paid to keep him company.

For this work, sales reps often earned more than researchers. On top of a base salary of $50,000 for starting reps, Ahari says, "there were four quarterly bonuses, an annual bonus, stock options, a car, 401K, great health benefits, and a $60,000 expense account."

Interest In The Book

2008-04-07T15:31:00.000-07:00

The book has been receiving quite a bit of interest recently! It is a great story that reveals the details of how the pharmaceutical industry influences your health care!

Check the book out at www. PillPushersTheBook.com

FDA On The Prowl

2008-04-07T13:28:00.000-07:00

Consumers should be aware of things the FDA is doing aside from pharmaceuticals.

Are they overstepping their bounds?

http://obrl.blogspot.com/2008/03/fda-goons-attacking-natural-raw-milk.html

OH I am so sick of the FDA. They are absolutely
over-stepping their bounds. And they do it all the
time with raw milk producers. The raw milk farmers in
Louisiana have been endlessly harassed by the FDA,
trying to shut down their livelihood, so unless you
know a farmer personally, we/anbody can't get raw
milk. Farmers used to list their farms on
realmilk.com and many have taken their names off so
the FDA doesn't harass them.

It's such a joke. Glad my tax dollars are hard at
work.

I am SO excited for what you are doing. Keep up the
NECESSARY work! People are so ignorant of what's
going on these days.

Comments From Colorado!!

2008-04-01T20:18:00.000-07:00

Thank you Donna C.! We love the honesty!

I just finished your book last night. I am a huge
reader (one book a week) and I've read maybe five
fiction books in ten years - don't like to waste my
time on fiction. HOWEVER, your book was excellent! I
know it's fiction, but I could see the truth in it and
I learned a lot.

The only part I did not care for (and you knew this
was coming :) were pages 243 and 244 detailing the
encounter between Brosnan and his mistress. We know
he's sleezy already, and I felt y'all could have made
it *much* more powerful by leaving out the raunchy,
smutty terms and left more up to the reader's
imagination. It almost ruined the whole book for me,
frankly. And to me personally, it made null and void
Jennifer's dedication in the beginning of the book. I
would not ask Jesus to read that chapter for me to see
if it was acceptable in His eyes.

I also found a few typographical errors. :)

Other than the above, though, Ces, EXECELLENT,
EXCELLENT book! You're a man of many talents!

If you ever want me to proofread your work, let me
know! I'm not too expensive! ;)

Pill Pushers In Paris!!

2008-04-01T20:16:00.001-07:00

Medicare: Present or Future?

2008-03-25T06:50:00.000-07:00

Or both? This joke puts it into perspective!

MEDICARE COVERAGE IN A NUTSHELL

The phone rings and the lady of the house answers,
"Hello."

"Mrs. Sanders, please."

"Speaking."

"Mrs. Sanders, this is Doctor Jones at Saint Agnes
Laboratory. When your doctor sent your husband's
biopsy to the lab yesterday, a biopsy from another
Mr. Sanders arrived as well, and we are now
uncertain which one is your husband's. Frankly the
results are either bad or terrible."

"What do you mean?" Mrs. Sanders asks nervously.

"Well, one of the specimens tested positive for
Alzheimer's and the other one tested positive for
AIDS. We can't tell which is your husband's."

"That's dreadful! Can't you do the test again?"
questioned Mrs. Sanders.

"Normally we can, but Medicare will only pay for
these expensive tests one time."

"Well, what am I supposed to do now?"

"The people at Medicare recommend that you drop your
husband off somewhere in the middle of town. If he
finds his way home, don't sleep with him."

Is There A Sequel In The Works????

2008-03-20T19:13:00.001-07:00

The story could really get juicy!!!

loved the suspense build-up to the finish! I definitely believe that a book sequel is in order. I’ll be the first in line to buy a copy for me and my friends.

Do It!

John C.

Another Book Comment

2008-03-18T13:33:00.000-07:00

Comes from someone that wants to be in the movie! BTW the movie is in the works!!!

I finally had extended time to read Pill Pushers. I had a great time reading it. Thanks for the nod in your book. When it is a movie I want to play “receptionist in Doctor’s office” or “waitress at Starbucks”.

Recent Review

2008-03-18T06:30:00.000-07:00

This review comes from a member of the Houston media! I'll leave her identity anonymous, but suffice it to say she is someone many of us know!

Keep the comments coming!

I read your book yesterday!
I started it about 3:30, and could hardly put it down! My bedtime, because I get up so early, is usually 9:00. I finally finished it about 10:45, and I must tell you it was worth the loss of sleep!
Fascinating!
Thank you for such a good read, and a glimpse into a world that I knew nothing about!
I will never again run dutifully from the Doctor's office to the pharmacy to fill another prescription without asking questions again.

Your Reviews

2008-01-03T19:33:00.000-08:00

We've heard many great reports about the book! Give us your first hand review!

Another "Pill Pushers" Story Comes To Life: "Dr. Drug Rep" Tells All in NY Times Most-Emailed Article

2008-01-02T22:28:00.000-08:00

November 25, 2007 - New York Times
Dr. Drug Rep
By DANIEL CARLAT

I. Faculty Development
On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”

I thought about his proposition. I had a busy private practice in psychiatry, specializing in psychopharmacology. I was quite familiar with Effexor, since I had read recent studies showing that it might be slightly more effective than S.S.R.I.’s, the most commonly prescribed antidepressants: the Prozacs, Paxils and Zolofts of the world. S.S.R.I. stands for selective serotonin reuptake inhibitor, referring to the fact that these drugs increase levels of the neurotransmitter serotonin, a chemical in the brain involved in regulating moods. Effexor, on the other hand, was being marketed as a dual reuptake inhibitor, meaning that it increases both serotonin and norepinephrine, another neurotransmitter. The theory promoted by Wyeth was that two neurotransmitters are better than one, and that Effexor was more powerful and effective than S.S.R.I.’s.

I had already prescribed Effexor to several patients, and it seemed to work as well as the S.S.R.I.’s. If I gave talks to primary-care doctors about Effexor, I reasoned, I would be doing nothing unethical. It was a perfectly effective treatment option, with some data to suggest advantages over its competitors. The Wyeth rep was simply suggesting that I discuss some of the data with other doctors. Sure, Wyeth would benefit, but so would other doctors, who would become more educated about a good medication.
A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”

She handed me a folder containing the schedule of talks, an invitation to various dinners and receptions and two tickets to a Broadway musical. “Enjoy your stay, doctor.” I had no doubt that I would, though I felt a gnawing at the edge of my conscience. This seemed like a lot of money to lavish on me just so that I could provide some education to primary-care doctors in a small town north of Boston.

The next morning, the conference began. There were a hundred or so other psychiatrists from different parts of the U.S. I recognized a couple of the attendees, including an acquaintance I hadn’t seen in a while. I’d heard that he moved to another state and was making a bundle of money, but nobody seemed to know exactly how.

I joined him at his table and asked him what he had been up to. He said he had a busy private practice and had given a lot of talks for Warner-Lambert, a company that had since been acquired by Pfizer. His talks were on Neurontin, a drug that was approved for epilepsy but that my friend had found helpful for bipolar disorder in his practice. (In 2004, Warner-Lambert pleaded guilty to illegally marketing Neurontin for unapproved uses. It is illegal for companies to pay doctors to promote so-called off-label uses.)

I knew about Neurontin and had prescribed it occasionally for bipolar disorder in my practice, though I had never found it very helpful. A recent study found that it worked no better than a placebo for this condition. I asked him if he really thought Neurontin worked for bipolar, and he said that he felt it was “great for some patients” and that he used it “all the time.” Given my clinical experiences with the drug, I wondered whether his positive opinion had been influenced by the money he was paid to give talks.

But I put those questions aside as we gulped down our coffees and took seats in a large lecture room. On the agenda were talks from some of the most esteemed academics in the field, authors of hundreds of articles in the major psychiatric journals. They included Michael Thase, of the University of Pittsburgh and the researcher who single-handedly put Effexor on the map with a meta-analysis, and Norman Sussman, a professor of psychiatry at New York University, who was master of ceremonies.

Thase strode to the lectern first in order to describe his groundbreaking work synthesizing data from more than 2,000 patients who had been enrolled in studies comparing Effexor with S.S.R.I.’s. At this time, with his Effexor study a topic of conversation in the mental-health world, Thase was one of the most well known and well respected psychiatrists in the United States. He cut a captivating figure onstage: tall and slim, dynamic, incredibly articulate and a master of the research craft.

He began by reviewing the results of the meta-analysis that had the psychiatric world abuzz. After carefully pooling and processing data from eight separate clinical trials, Thase published a truly significant finding: Effexor caused a 45 percent remission rate in patients in contrast to the S.S.R.I. rate of 35 percent and the placebo rate of 25 percent. It was the first time one antidepressant was shown to be more effective than any other. Previously, psychiatrists chose antidepressants based on a combination of guesswork, gut feeling and tailoring a drug’s side effects to a patient’s symptom profile. If Effexor was truly more effective than S.S.R.I.’s, it would amount to a revolution in psychiatric practice and a potential windfall for Wyeth.

One impressive aspect of Thase’s presentation was that he was not content to rest on his laurels; rather he raised a series of potential criticisms of his results and then rebutted them convincingly. For example, skeptics had pointed out that Thase was a paid consultant to Wyeth and that both of his co-authors were employees of the company. Thase responded that he had requested and had received all of the company’s data and had not cherry-picked from those studies most favorable for Effexor. This was a significant point, because companies sometimes withhold negative data from publication in medical journals. For example, in 2004, GlaxoSmithKline was sued by Eliot Spitzer, who was then the New York attorney general, for suppressing data hinting that Paxil causes suicidal thoughts in children. The company settled the case and agreed to make clinical-trial results public.

Another objection was that while the study was billed as comparing Effexor with S.S.R.I.’s in general, in fact most of the data compared Effexor with one specific S.S.R.I.: Prozac. Perhaps Effexor was, indeed, more effective than Prozac; this did not necessarily mean that it was more effective than the other S.S.R.I.’s in common use. But Thase announced that since the original study, he had analyzed data on Paxil and other meds and also found differences in remission rates.

For his study, Thase chose what was at that time an unusual measure of antidepressant improvement: “remission,” rather than the more standard measure, “response.” In clinical antidepressant trials, a “response” is defined as a 50 percent improvement in depressive symptoms, as measured by the Hamilton depression scale. Thus, if a patient enters a study scoring a 24 on the Hamilton (which would be a moderate degree of depression), he or she would have “responded” if the final score, after treatment, was 12 or less.

Remission, on the other hand, is defined as “complete” recovery. While you might think that a patient would have to score a 0 on the Hamilton to be in remission, in fact very few people score that low, no matter how deliriously happy they are. Instead, researchers come up with various cutoff scores for remission. Thase chose a cutoff score of 7 or below.

In his study, he emphasized the remission rates and not the response rates. As I listened to his presentation, I wondered why. Was it because he felt that remission was the only really meaningful outcome by which to compare drugs? Or was it because using remission made Effexor look more impressive than response did? Thase indirectly addressed this issue in his paper by pointing out that even when remission was defined in different ways, with different cutoff points, Effexor beat the S.S.R.I.’s every time. That struck me as a pretty convincing endorsement of Wyeth’s antidepressant.

The next speaker, Norm Sussman, took the baton from Thase and explored the concept of remission in more detail. Sussman’s job was to systematically go through the officially sanctioned “slide deck” — slides provided to us by Wyeth, which we were expected to use during our own presentations.

If Thase was the riveting academic, Sussman was the engaging populist, translating some of the drier research concepts into terms that our primary-care-physician audiences would understand. Sussman exhorted us not to be satisfied with response and encouraged us to set the bar higher. “Is the patient doing everything they were doing before they got depressed?” he asked. “Are they doing it even better? That’s remission.” To further persuade us, he highlighted a slide showing that patients who made it all the way to remission are less likely to relapse to another depressive episode than patients who merely responded. And for all its methodological limitations, it was a slide that I would become well acquainted with, as I would use it over and over again in my own talks.

When it came to side effects, Effexor’s greatest liability was that it could cause hypertension, a side effect not shared by S.S.R.I.’s. Sussman showed us some data from the clinical trials, indicating that at lower doses, about 3 percent of patients taking Effexor had hypertension as compared with about 2 percent of patients assigned to a placebo. There was only a 1 percent difference between Effexor and placebo, he commented, and pointed out that treating high blood pressure might be a small price to pay for relief from depression.
It was an accurate reading of the data, and I remember finding it a convincing defense of Effexor’s safety. As I look back at my notes now, however, I notice that another way of describing the same numbers would have been to say that Effexor leads to a 50 percent greater rate of hypertension than a placebo. Framed this way, Effexor looks more hazardous.
And so it went for the rest of the afternoon.

Was I swallowing the message whole? Certainly not. I knew that this was hardly impartial medical education, and that we were being fed a marketing line. But when you are treated like the anointed, wined and dined in Manhattan and placed among the leaders of the field, you inevitably put some of your critical faculties on hold. I was truly impressed with Effexor’s remission numbers, and like any physician, I was hopeful that something new and different had been introduced to my quiver of therapeutic options.

At the end of the last lecture, we were all handed envelopes as we left the conference room. Inside were checks for $750. It was time to enjoy ourselves in the city.

II. The Art and Science of Detailing
Pharmaceutical “detailing” is the term used to describe those sales visits in which drug reps go to doctors’ offices to describe the benefits of a specific drug. Once I returned to my Newburyport office from New York, a couple of voice-mail messages from local Wyeth reps were already waiting for me, inviting me to give some presentations at local doctors’ offices. I was about to begin my speaking — and detailing — career in earnest.

How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways. This meant that I was about to join some 200,000 American physicians who are being paid by companies to promote their drugs. I felt quite flattered to have been recruited, and I assumed that the rep had picked me because of some special personal or professional quality.

The first talk I gave brought me back to earth rather quickly. I distinctly remember the awkwardness of walking into my first waiting room. The receptionist slid the glass partition open and asked if I had an appointment.
“Actually, I’m here to meet with the doctor.”
“Oh, O.K. And is that a scheduled appointment?”
“I’m here to give a talk.”
A light went on. “Oh, are you part of the drug lunch?”

Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep. Eventually, with an internal wince, I began to introduce myself as “Dr. Carlat, here for the Wyeth lunch.”

The drug rep who arranged the lunch was always there, usually an attractive, vivacious woman with platters of gourmet sandwiches in tow. Hungry doctors and their staff of nurses and receptionists would filter into the lunch room, grateful for free food.

Once there was a critical mass (and crucially, once the M.D.’s arrived), I was given the go-ahead by the Wyeth reps to start. I dove into my talk, going through a handout that I created, based on the official slide deck. I discussed the importance of remission, the basics of the Thase study showing the advantage of Effexor, how to dose the drug, the side effects, and I added a quick review of the other common antidepressants.

While I still had some doubts, I continued to be impressed by the 10 percent advantage in remission rates that Effexor held over S.S.R.I.’s; that advantage seemed significant enough to overcome Effexor’s more prominent side effects. Yes, I was highlighting Effexor’s selling points and playing down its disadvantages, and I knew it. But was my salesmanship going to bring harm to anybody? It seemed unlikely. The worst case was that Effexor was no more effective than anything else; it certainly was no less effective.

During my first few talks, I worried a lot about my performance. Was I too boring? Did the doctors see me as sleazy? Did the Wyeth reps find me sufficiently persuasive? But the day after my talks, I would get a call or an e-mail message from the rep saying that I did a great job, that the doctor was impressed and that they wanted to use me more. Indeed, I started receiving more and more invitations from other reps, and I soon had talks scheduled every week. I learned later that Wyeth and other companies have speaker-evaluation systems. After my talks, the reps would fill out a questionnaire rating my performance, which quickly became available to other Wyeth reps throughout the area.

As the reps became comfortable with me, they began to see me more as a sales colleague. I received faxes before talks preparing me for particular doctors. One note informed me that the physician we’d be visiting that day was a “decile 6 doctor and is not prescribing any Effexor XR, so please tailor accordingly. There is also one more doc in the practice that we are not familiar with.” The term “decile 6” is drug-rep jargon for a doctor who prescribes a lot of medications. The higher the “decile” (in a range from 1 to 10), the higher the prescription volume, and the more potentially lucrative that doctor could be for the company.

A note from another rep reminded me of a scene from “Mission: Impossible.” “Dr. Carlat: Our main target, Dr. , is an internist. He spreads his usage among three antidepressants, Celexa, Zoloft and Paxil, at about 25-30 percent each. He is currently using about 6 percent Effexor XR. Our access is very challenging with lunches six months out.” This doctor’s schedule of lunches was filled with reps from other companies; it would be vital to make our sales visit count.+

Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors’ prescriptions every week. The process is called “prescription data-mining,” in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies. This may include deciding which physicians to aim for, as my Wyeth reps did, but it can help sales in other ways. For example, Shahram Ahari, a former drug rep for Eli Lilly (the maker of Prozac) who is now a researcher at the University of California at San Francisco’s School of Pharmacy, said in an article in The Washington Post that as a drug rep he would use this data to find out which doctors were prescribing Prozac’s competitors, like Effexor. Then he would play up specific features of Prozac that contrasted favorably with the other drug, like the ease with which patients can get off Prozac, as compared with the hard time they can have withdrawing from Effexor.

The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money.

Once drug companies have identified the doctors, they must woo them. In the April 2007 issue of the journal PLoS Medicine, Dr. Adriane Fugh-Berman of Georgetown teamed up with Ahari (the former drug rep) to describe the myriad techniques drug reps use to establish relationships with physicians, including inviting them to a speaker’s meeting. These can serve to cement a positive a relationship between the rep and the doctor. This relationship is crucial, they say, since “drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship.”

III. Uncomfortable Moments
I gave many talks over the ensuing several months, and I gradually became more comfortable with the process. Each setting was somewhat different. Sometimes I spoke to a crowded conference room with several physicians, nurses and other clinical staff. Other times, I sat at a small lunch table with only one other physician (plus the rep), having what amounted to a conversation about treating depression. My basic Effexor spiel was similar in the various settings, with the focus on remission and the Thase data.

Meanwhile, I was keeping up with new developments in the research literature related to Effexor, and not all of the news was positive. For example, as more data came out comparing Effexor with S.S.R.I.’s other than Prozac, the Effexor remission advantage became slimmer — more like 5 percent instead of the originally reported 10 percent. Statistically, this 5 percent advantage meant that only one out of 20 patients would potentially do better on Effexor than S.S.R.I.’s — much less compelling than the earlier proportion of one out of 10.

I also became aware of other critiques of the original Thase meta-analysis. For example, some patients enrolled in the original Effexor studies took S.S.R.I.’s in the past and presumably had not responded well. This meant that the study population may have been enriched with patients who were treatment-resistant to S.S.R.I.’s, giving Effexor an inherent advantage.
I didn’t mention any of this in my talks, partly because none of it had been included in official company slides, and partly because I was concerned that the reps wouldn’t invite me to give talks if I divulged any negative information. But I was beginning to struggle with the ethics of my silence.

One of my most uncomfortable moments came when I gave a presentation to a large group of psychiatrists. I was in the midst of wrapping up my talk with some information about Effexor and blood pressure. Referring to a large study paid for by Wyeth, I reported that patients are liable to develop hypertension only if they are taking Effexor at doses higher than 300 milligrams per day.

“Really?” one psychiatrist in the room said. “I’ve seen hypertension at lower doses in my patients.”
“I suppose it can happen, but it’s rare at doses that are commonly used for depression.”
He looked at me, frowned and shook his head. “That hasn’t been my experience.”
I reached into my folder where I kept some of the key Effexor studies in case such questions arose.

According to this study of 3,744 patients, the rate of high blood pressure was 2.2 percent in the placebo group, and 2.9 percent in the group of patients who had taken daily doses of Effexor no larger than 300 milligrams. Patients taking more than 300 milligrams had a 9 percent risk of hypertension. As I went through the numbers with the doctor, however, I felt unsettled. I started talking faster, a sure sign of nervousness for me.

Driving home, I went back over the talk in my mind. I knew I had not lied — I had reported the data exactly as they were reported in the paper. But still, I had spun the results of the study in the most positive way possible, and I had not talked about the limitations of the data. I had not, for example, mentioned that if you focused specifically on patients taking between 200 and 300 milligrams per day, a commonly prescribed dosage range, you found a 3.7 percent incidence of hypertension. While this was not a statistically significant higher rate than the placebo, it still hinted that such moderate doses could, indeed, cause hypertension. Nor had I mentioned the fact that since the data were derived from placebo-controlled clinical trials, the patients were probably not representative of the patients seen in most real practices. Patients who are very old or who have significant medical problems are excluded from such studies. But real-world patients may well be at higher risk to develop hypertension on Effexor. +

I realized that in my canned talks, I was blithely minimizing the hypertension risks, conveniently overlooking the fact that hypertension is a dangerous condition and not one to be trifled with. Why, I began to wonder, would anyone prescribe an antidepressant that could cause hypertension when there were many other alternatives? And why wasn’t I asking this obvious question out loud during my talks?

I felt rattled. That psychiatrist’s frown stayed with me — a mixture of skepticism and contempt. I wondered if he saw me for what I feared I had become — a drug rep with an M.D. I began to think that the money was affecting my critical judgement. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.

There was another problem: one of Effexor’s side effects. Patients who stopped the medication were calling their doctors and reporting symptoms like severe dizziness and lightheadedness, bizarre electric-shock sensations in their heads, insomnia, sadness and tearfulness. Some patients thought they were having strokes or nervous breakdowns and were showing up in emergency rooms. Gradually, however, it became clear that these were “withdrawal” symptoms. These were particularly common problems with Effexor because it has a short half-life, a measure of the time it takes the body to metabolize half of the total amount of a drug in the bloodstream. Paxil, another short half-life antidepressant, caused similar problems.

At the Wyeth meeting in New York, these withdrawal effects were mentioned in passing, though we were assured that Effexor withdrawal symptoms were uncommon and could usually be avoided by tapering down the dose very slowly. But in my practice, that strategy often did not work, and patients were having a very hard time coming off Effexor in order to start a trial of a different antidepressant.

I wrestled with how to handle this issue in my Effexor talks, since I believed it was a significant disadvantage of the drug. Psychiatrists frequently have to switch medications because of side effects or lack of effectiveness, and anticipating this potential need to change medications plays into our initial choice of a drug. Knowing that Effexor was hard to give up made me think twice about prescribing it in the first place.

During my talks, I found myself playing both sides of the issue, making sure to mention that withdrawal symptoms could be severe but assuring doctors that they could “usually” be avoided. Was I lying? Not really, since there were no solid published data, and indeed some patients had little problem coming off Effexor. But was I tweaking and pruning the truth in order to stay positive about the product? Definitely. And how did I rationalize this? I convinced myself that I had told “most” of the truth and that the potential negative consequences of this small truth “gap” were too trivial to worry about.

As the months went on, I developed more and more reservations about recommending that Effexor be used as a “first line” drug before trying the S.S.R.I.’s. Not only were the newer comparative data less impressive, but the studies were short-term, lasting only 6 to 12 weeks. It seemed entirely possible that if the clinical trials had been longer — say, six months — S.S.R.I.’s would have caught up with Effexor. Effexor was turning out to be an antidepressant that might have a very slight effectiveness advantage over S.S.R.I.’s but that caused high blood pressure and had prolonged withdrawal symptoms.

At my next Lunch and Learn, I mentioned toward the end of my presentation that data in support of Effexor were mainly short-term, and that there was a possibility that S.S.R.I.’s were just as effective. I felt reckless, but I left the office with a restored sense of integrity.
Several days later, I was visited by the same district manager who first offered me the speaking job. Pleasant as always, he said: “My reps told me that you weren’t as enthusiastic about our product at your last talk. I told them that even Dr. Carlat can’t hit a home run every time. Have you been sick?”

At that moment, I decided my career as an industry-sponsored speaker was over. The manager’s message couldn’t be clearer: I was being paid to enthusiastically endorse their drug. Once I stopped doing that, I was of little value to them, no matter how much “medical education” I provided.

IV. Life After Drug Money
A year after starting my educational talks for drug companies (I had also given two talks for Forest Pharmaceuticals, pushing the antidepressant Lexapro), I quit. I had made about $30,000 in supplemental income from these talks, a significant addition to the $140,000 or so I made from my private practice. Now I publish a medical-education newsletter for psychiatrists that is not financed by the pharmaceutical industry and that tries to critically assess drug research and marketing claims. I still see patients, and I still prescribe Effexor. I don’t prescribe it as frequently as I used to, but I have seen many patients turn their lives around because they responded to this drug and to nothing else. +

In 2002, the drug industry’s trade group adopted voluntary guidelines limiting some of the more lavish benefits to doctors. While the guidelines still allow all-expenses-paid trips for physicians to attend meetings at fancy hotels, they no longer pay for spouses to attend the dinners or hand out tickets to musicals. In an e-mail message, a Wyeth spokesman wrote that Wyeth employees must follow that code and “our own Wyeth policies, which, in some cases, exceed” the trade group’s code.

Looking back on the year I spent speaking for Wyeth, I’ve asked myself if my work as a company speaker led me to do bad things. Did I contribute to faulty medical decision making? Did my advice lead doctors to make inappropriate drug choices, and did their patients suffer needlessly?

Maybe. I’m sure I persuaded many physicians to prescribe Effexor, potentially contributing to blood-pressure problems and withdrawal symptoms. On the other hand, it’s possible that some of those patients might have gained more relief from their depression and anxiety than they would have if they had been started on an S.S.R.I. Not likely, but possible.

I still allow drug reps to visit my office and give me their pitches. While these visits are short on useful medical information, they do allow me to keep up with trends in drug marketing. Recently, a rep from Bristol-Myers Squibb came into my office and invited me to a dinner program on the antipsychotic Abilify.

“I think it will be a great program, Dr. Carlat,” he said. “Would you like to come?” I glanced at the invitation. I recognized the name of the speaker, a prominent and widely published psychiatrist flown in from another state. The restaurant was one of the finest in town.
I was tempted. The wine, the great food, the proximity to a famous researcher — why not rejoin that inner circle of the select for an evening? But then I flashed to a memory of myself five years earlier, standing at a lectern and clearing my throat at the beginning of a drug-company presentation. I vividly remembered my sensations — the careful monitoring of what I would say, the calculations of how frank I should be.
“No,” I said, as I handed the rep back the invitation. “I don’t think I can make it. But thanks anyway.”

Daniel Carlat is an assistant clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report.

Your Reviews

2008-01-02T15:44:00.000-08:00

We're really interested in your opinions! Let us know what you thought of the book!

How did the story play out for you in your mind? Favorite character? Least favorite character? Most memorable scene?

"Pill Pushers" Plot Meets Real-Life!!

2007-12-26T23:31:00.000-08:00

December 21, 2007

Data About Zetia Risks Was Not Fully Revealed

By ALEX BERENSON

New evidence shows that the drug makers Merck and Schering-Plough have conducted several studies of their popular cholesterol medicine Zetia that raise questions about its risks to the liver, but the companies have never published those results.
Partial results of the studies, alluded to in documents on the Food and Drug Administration’s Web site, raise questions about whether Zetia can cause liver damage when used long term with other cholesterol drugs called statins.
Most of the millions of people who use Zetia take it along with a statin like Lipitor, Crestor or Zocor. Or they take it in a single pill, Vytorin, that combines Zetia with Zocor.
The discovery of the unpublished research comes as Merck and Schering are already under criticism for not yet releasing data from an important Zetia study, called Enhance, that they completed early last year.
The Enhance data may also contain important information about Zetia’s liver risks. At least some patients were dropped from the Enhance study after testing revealed that they had elevated liver enzymes, a Schering-Plough spokesman confirmed this week.
But a full report on that trial, including the number of patients who had liver problems, will not be available until March.
Doctors say that by failing to disclose promptly all their research, Merck and Schering-Plough may be leaving the public with a misleadingly favorable view of Zetia’s safety and benefits.
“You don’t want to have data missing,” said Dr. Bruce Psaty, a professor of medicine and epidemiology at the University of Washington. “When there have been adverse effects, when the benefits don’t look impressive, those are the trials that historically don’t make it to press.”
A Schering executive, when asked by a reporter about the unpublished studies, confirmed their existence. But the executive, Dr. Robert J. Spiegel, said the companies had not considered the studies scientifically important enough to publish their findings. Some may eventually be published, he said.
“We’re pretty comfortable that people don’t have trouble tolerating Zetia,” said Dr. Spiegel, the chief medical officer of the Schering-Plough Research Institute, Kenilworth, N.J.
Schering also said that the F.D.A. had reviewed the data from the unpublished studies and had approved Zetia for use alongside statins. But experts on drug safety say that the agency has been slow to issue warnings about many widely used drugs that have turned out to carry serious risks, including the painkiller Vioxx, the diabetes medicine Avandia and the anti-psychotic drug Zyprexa.
Even doctors critical of Zetia generally say it is safe for most patients. But before the drug was approved in 2002, one F.D.A. reviewer said it should not be cleared for use with statins because the combination had caused liver damage in animals. And in the last two years, scattered case reports of severe liver damage in patients taking Zetia in combination with statins have appeared in medical journals.
In the United States, the product label for Zetia contains only mild warnings about the drug’s potential for liver damage.
But in Australia and Canada, regulators have been more cautious. Since 2005, they have issued a series of warnings about Zetia’s potential to cause hepatitis, pancreatitis and depression — warnings that have largely gone unnoticed in the United States.
All drugs have potential risks and side effects, of course, and doctors and patients must weigh those against a drug’s medical benefits. But in the case of Zetia, despite its widespread use, there is no evidence proving that Zetia can reduce heart attacks and strokes, as cholesterol drugs are meant to do. There is extensive medical evidence showing that Lipitor and other statins provide such protection.
The unpublished Zetia studies, devised as safety tests, would not prove the drug’s effectiveness. But they would give the public more information about Zetia’s potential risks. All the unpublished studies covered periods at least one year in length and were intended to show whether long-term use of Zetia might pose dangers that short-term use did not.
Most of the studies about Zetia in which Merck and Schering have published the results covered periods of only 12 weeks — not enough time for liver problems to develop in most patients.
The unpublished studies, conducted from 2000 to 2003 according to the F.D.A. documents, were not listed on the industry Web sites where companies are supposed to register the results of all drug trials that were ongoing after October 2002. The New York Times discovered references to the studies in briefing papers on the F.D.A. Web site.
“We keep telling people we want to practice evidence-based medicine, and what we keep finding out is that much of the evidence is obscured,” said Dr. Harlan Krumholz, a cardiologist at Yale, when told about the previously undisclosed studies. “There is important evidence, but it’s not in public view. It’s hidden from investigators.”
Schering and Merck — which are on track to earn $5 billion this year from sales of Zetia — had already been criticized for not promptly releasing results of the Enhance trial, which was completed in April 2006. Under pressure from Congress and prominent cardiologists, the companies said recently that they would release the full results of the Enhance trial by March.
In response to questions from The Times, the Schering spokesman, Lee Davies, disclosed this week that some patients in the Enhance trial had been dropped from it after tests showed that they had elevated liver enzymes — a potential sign of organ damage. But Mr. Davies said he could not disclose how many, and said the companies did not even know if the patients who had been dropped were taking Zetia and a statin, or just a statin. The delay in releasing the Enhance trial data is unrelated to the patients who were discontinued, Mr. Davies said.
The Enhance data are expected to provide the clearest picture yet of Zetia’s long-term affects. But the F.D.A.’s documents show that Merck and Schering conducted several other long-term trials of Zetia without releasing their findings.
Together those studies cover several thousand patients who took Zetia along with statins for one to two years. The statins include Lipitor and Crestor, as well as Zocor, which is usually prescribed generically as simvastatin and is the statin used in the Vytorin pill. Doctors often add Zetia to a low dosage of a statin, because Zetia reduces cholesterol in a different way than the statins do and leads to deeper overall cholesterol reductions.
One open question is whether Zetia’s method of lowering cholesterol provides the same medical benefits as fighting cholesterol with a higher-dose statin by itself. Last year, Merck and Schering began a separate study — a 10,000-patient clinical trial to prove that Zetia’s ability to lower cholesterol will translate into fewer heart attacks and strokes in patients. But data from that trial will not be available until at least 2011.
In the meantime, some doctors say, they must essentially take on faith that Zetia’s cholesterol-lowering ability will translate into real-world benefits and that its long-term use with statins does not have major risks.
Dr. Eric J. Topol, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, Calif., said that he had asked Merck and Schering more than four years ago to conduct a large, long-term trial to prove that Zetia could reduce heart attacks and strokes. But the companies had little interest, he said.
“They looked at me like I was an alien,” Dr. Topol said.
Two months ago, President Bush signed a new law intended to strengthen penalties for companies that do not release information promptly. And in 2004, the drug industry promised to improve disclosure of research results.
But the new law applies only to new trials, meaning the unpublished Zetia trials are not covered by those new rules and guidelines.
The F.D.A. has reviewed the unpublished studies, according to the agency’s briefing papers.
The companies’ own published studies have generally played down the risk of liver problems. But Dr. Mark Stolk, a gastroenterologist in the Netherlands, last year reported two cases of patients who had developed hepatitis, a liver disease, after taking Zetia alongside Lipitor. One of the patients has since died, Dr. Stolk said in an interview last month. While Zetia is safe for most patients, doctors should carefully monitor patients for liver damage, he said.
“I think other cases will emerge,” he said.
When the F.D.A. approved Zetia in 2002, it relied on trials that covered only 3,900 patients and lasted no more than 12 weeks. Still, the data from even those trials contained signals that Zetia might be dangerous in some patients when it is taken alongside statins, as it usually is.
In those trials, 11 times as many people who took Zetia along with a statin subsequently had serious health problems, compared with those who took a statin alone. Nearly all the serious problems were liver-related. Still the F.D.A. regarded the risks as relatively minor and approved Zetia without asking the companies to conduct longer trials.
The agency did not respond to requests for comment.
All drugs have risks, of course. Doctors who prescribe Zetia say that while they would prefer to see long-term trial data, they are comfortable using it because decades of evidence demonstrated that lowering LDL, or so-called bad cholesterol, is good for patients.
But Dr. Beatrice A. Golomb, an associate professor at the University of California, San Diego, said doctors have lost sight of the purpose of prescribing drugs like Zetia.
The goal of prescribing cholesterol-lowering drugs is not reducing cholesterol, Dr. Golomb said. It is reducing the number of deaths and heart attacks in patients, he said. And without data to prove that Zetia actually reduces heart attacks, doctors cannot be sure they are helping patients when they prescribe the drug, she said.

Pill Pushers Fact or Fiction??? Discuss

2007-12-20T07:00:00.000-08:00

Pfizer Is Sued Over Lipitor Marketing

By DAVID ARMSTRONG
December 20, 2007; Page B5

A former Pfizer Inc. official in a lawsuit accused the company of illegally boosting sales of its top-selling drug Lipitor through an elaborate campaign of misleading educational programs for doctors.

Jesse Polansky, claims that the educational campaign was a key part of a marketing strategy that "led thousands of physicians to prescribe Lipitor for millions of patients who did not need medication" and could be harmed by overly aggressive treatment.

The lawsuit was filed in U.S. District Court for the Eastern District of New York in February 2004. It was immediately sealed to allow federal prosecutors time to decide if they wanted to intervene in the case. In August, the government said it wouldn't intervene, lifting the seal. Pfizer was served a copy of the suit yesterday, according to Dr. Polansky's lawyer, Steve Berman of Hagens Berman Sobol Shapiro.

The failure of the government to intervene may signal that prosecutors are skeptical about the merits of the case. The government hasn't intervened in other cases which led to huge fines against drug companies. One example is another case involving Pfizer, this one for the off-label marketing of Neurontin.

Pfizer said, "We believe this case has no merit. Furthermore, after reviewing the allegations in this complaint, the government declined to intervene in this action... . Pfizer does not condone the off-label promotion of our products. We believe that our sales and marketing practices are solely based on our prescription information as approved by the U.S. Food and Drug Administration."

Early Reviews

2007-12-19T18:07:00.000-08:00

Let's hear from you early readers of the most exciting Big Pharma novel out there! What do you think of the story? Which characters do you like? Does it seem real to you?

Give us your best shot!

Pill Pushers Pushin' Books!!

2007-12-17T13:25:00.000-08:00

Jennifer and Ces getting writer's cramps from signing books!

Book Signing

2007-12-17T13:20:00.000-08:00

The authors are busy signing books at local events ...

Radio Interview

2007-12-12T15:46:00.000-08:00

Pill Pushers getting some air time ....

You can catch the authors on www.ArtistFirst.com on two occasions - - -

Monday Dec17th at 7:00 p.m.

and

Monday Dec 31st at 7:00 p.m.

Big Pharma Faces Grim Prognosis

2007-12-11T14:57:00.000-08:00

This is just an excerpt from an article in last Thursday's Wall Street Journal... Pill Pushers the book is right on target!!!!

Big Pharma Faces Grim Prognosis

Industry Fails to Find
New Drugs to Replace
Wonders Like Lipitor

By BARBARA MARTINEZ and JACOB GOLDSTEIN
December 6, 2007; Page A1

Over the next few years, the pharmaceutical business will hit a wall.

Some of the top-selling drugs in industry history will become history as patent protections expire, allowing generics to rush in at much-lower prices. Generic competition is expected to wipe $67 billion from top companies' annual U.S. sales between 2007 and 2012 as more than three dozen drugs lose patent protection. That is roughly half of the companies' combined 2007 U.S. sales.

GOING OFF PATENT

Sortable Chart: Starting in 2010, the pharmaceutical industry faces one of the biggest waves of patent expirations.

At the same time, the industry's science engine has stalled. The century-old approach of finding chemicals to treat diseases is producing fewer and fewer drugs. Especially lacking are new blockbusters to replace old ones like Lipitor, Plavix and Zyprexa.

Pharma Industry

2007-11-27T05:35:00.000-08:00

The joke posted in comments below is so real and that's where the humor comes in! I'd really be interested in your comments!!!

New Book

2007-11-26T08:20:00.001-08:00

Pill Pushers: A Big Pharma Battle For Market Share is a great read! Get your copy now through www.PillPushersTheBook.com