The Medical Establishment Fat Cats
The day before the Brexit referendum a group of French people travelled to London to ask the Brits to remain. As a neighbourly gesture, the French offered free samples of croissants – real ones, not that frozen dough “baked” by petrol pump attendants or staff in supermarkets who were “butchers” the day before!
The act of friendship was not appreciated by the police who, invoking a 19th century law (The Corrupt Practises Prevention Act, 1854) forbidding people to influence voters by giving food, sent them on their way… to Europe.
It’s a pity the English pernickety love of laws and rules doesn’t apply to more serious matters.
Drug companies pay doctors £40 million for travel and expenses reported the Guardian in 2013. That’s just what British doctors received and it is more when we consider only 35 of 44 drug companies revealed the data (nine refused), according to the Association of British Pharmaceutical Industry (ABPI).
Doctors denied it influenced their judgement, yet in 2005 the Commons Health Select Committee warned in a report that the industry’s sponsorship of doctors and other medical staff had drug promotion as its motive and could lead to unsafe prescribing of drugs such as the deadly arthritis drug Vioxx.
At the moment drug companies are only required to publish their total outlay. By 2016 the European Trade body was expecting them to publish individual doctor’s names. That was in 2013; will it happen by year-end?
One doctor who does not believe such a cozy relationship between big pharma and doctors being harmless is James Le Fanu. In an article “Swine flu scientists were too close to big pharma“ he reveals the experts who advised the WHO regarding the swine flu vaccine had “done paid work for pharmaceutical companies” according to an investigation. The drug companies stood to gain from their advice.
The swine flu jab has been linked to narcolepsy after a study found children who were vaccinated were 13 times more likely to suffer from the life-changing condition.
There’s another twist to this sinister story. Le Fanu tells us “the threatened swine ‘flu ‘pandemic’ of 2009 proved something of a non-event with only 10% of the predicted number of cases and a miniscule mortality rate of 0.0005%” – one of the mildest ‘flu events of the past 100 years”! Obviously the science of predicting isn’t a science.
Further, not only had big pharma invested in a vaccine but in an anti-viral drug, Tamiflu, with the idea of shortening and reducing the complications of ‘flu, he explains.
In the meantime WHO had drafted plans on how best to manage a major “pandemic” – in collaboration with the European Scientific Working Group on influenza (an organisation sponsored by drug companies), Le Fanu says. Their advice; “surprise, surprise was to stockpile large quantities of vaccine and anti-viral drugs!
Tamiflu, was produced by Roche. Four years after that “pandemic” (Dec. 2012), the British government, who had taken the advice to stockpile the drug, MPs demanded a £500million refund the Daily Telegraph reported. Rightly so. Why the change of heart? Well, the pandemic never happened but it’s now come to light that Roche had no science behind their claims for their drug’s efficacy or safety. If they had, they would refuse to publish it.
Dr Sarah Wollaston, a Conservative MP and a member of the Health Select Committee wrote to the Public Accounts Committee demanding action. She explained, “Without this information [scientific evidence for Tamiflu] regulators and doctors can’t possibly assess the clinical benefit (if any) of Tamiflu.” She said, “Tamiflu was just one example of firms apparently concealing clinical trials data.”
At first Roche’s spokesperson said they would co-operate with the PAC. But… a leaked memo revealed a plan to combat calls by regulators to force companies to publish results. And by July 2013, the Guardian could inform us “Big pharma is mobilising patients in battle over drugs trials data.” This means the drugs industry has mobilised an army of patient groups to lobby against plans to force companies to publish secret documents on drug trials. According to the Guardian,
Under proposals being thrashed out in Europe, drugs companies would be compelled to release all of their data, including results that show drugs do not work or cause dangerous side-effects.
… The latest strategy shows how patient groups – many of which receive some or all of their funding from drugs companies – have been brought into the battle.
The strategy was devised by two large trade groups: the Pharmaceutical Research and Manufacturers of America (PhRMA) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) according to a memo from the director of EFPIA to directors and legal counsel at Roche, Merck, Pfizer, GSK, AstraZeneca, Eli Lilly, Novartis and many smaller companies. The memo was leaked by an employee.
The email outlined a four-pronged battle plan. First, the ground troops (patient lobby groups) would be sent in to raise fears that if full data from drug trials were published it would create a health scare!
As Tim Reed of Health Action International said, “the people in most need of the information are being used to fight for the drug companies.” They obviously rely on the innocence and ignorance of Joe Public to advance their cause.
The second line of defence included discussions with science organisations about the “risks” of data sharing. Thirdly, they planned to collaborate with other businesses concerned about releasing trade secrets and confidential data.
The final defence tactic against their unsuspecting customers was, for the long term, to organise academics across Europe on whom they could rely to correct false interpretations of data, which the memo states, “is deemed to be happening in any case.”
In a statement, Matt Bennett, senior vice-president of PhRMA, playing to sentiment and invoking the slippery slope fallacy along with a dose of fear, said,
EMA’s proposed policies on clinical trial information raise numerous concerns for patients. We believe it is important to engage with all stakeholders in the clinical trial ecosystem, including the patients who volunteer to participate in clinical trials, about the issue.
If enacted, the proposals could risk patient privacy, lead to fewer clinical trials, and result in fewer new medicines to meet patient needs and improve health.
The Roche story
A year later Ben Goldacre gives a detailed overview of the whole sordid history of Roche and their fraudulent claims for their dud drug Tamiflu. His conclusion in his article “What the Tamiflu saga tells us about drug trials and big pharma” is memorable for its shocking though unsurprising conclusion.
The drug wouldn’t have been good in the event of a flu epidemic, he begins. He then goes on to explain the efforts of the Cochrane Collaboration (a not-for-profit collaboration of 14,000 academics) to obtain the true data on Tamiflu from Roche.
The licensing and purchasing of the drug by governments has been a failure of the regulatory system. While Goldacre doesn’t use the word “criminal”, it does seem appropriate for Roche’s use of secrecy, evasiveness, lies and selling under false pretences, he details.
Another issue he raises is the conflicting interpretations of Roche’s initial “research” data by professional bodies such as the FDA, US Center for Disease Control and the European Medicines Agency. This illustrates the lack of scientific knowledge, governance and poor critical faculties – and perhaps the effects of lobbying and maybe other sweeteners – by the very bodies charged with protecting nations’ health.
Faulty drug trials
Goldacre lists three faults with Tamiflu – “faults more common than we may realise.” First, participants were unrepresentative of real-world patients. Second, the active and placebo pills were different colours and third, diagnosis of pneumonia was measured by patients’ self-reporting, rather than by means of a clear diagnostic algorithm such as an x-ray.
And so, taking the moral and scientific high ground, Goldacre, trying to run with the hare and the hound, tell us,
… paradoxically, after everything you have read above, with the outrage fresh in your mind, on the day when it feels harder than any other, I hope you will join me in saying: Bravo, Roche. Now let’s do better.
Come on, good children, let’s have it for the big pharma cheerleader…
Ireland’s Medical Establishment Fat Cats
Secret top-up payments
In November 2013 The Irish Times article Hospital chief receiving €30,000 allowance from shops on campus informed us some of Ireland’s hospitals pay almost €1 million in top-up payments to senior managers and consultants. Our Lady’s Hospital for Sick Children creams off €30,000 a year to-up from the tuck shops just for the chief executive. The hospital refused to comment since the information is protected under data legislation because the data was provided to the HSE audit on a confidential basis. Why the need for confidentiality?
A month late we learn of another fat cat, Dr Rhona Mahony, licking her lips – while keeping them tightly shut. Dr Mahony, Master of the National Maternity Hospital, fails to give details on €45,000 pay. She refused to provide the documentation requested by the Health Service Executive regarding her €45,000 top-up. She subsequently “felt vilified” by the media coverage. Bless! She’s not usually coy in dealing with the media. After all, it’s only €900 per week before she starts earning (see below for more).
Dr Mahony claimed the extra money came from seeing private patients, which begs the question, how does she earn the same amount from patients every year? But she was rumbled by Dr Geraldine Smith, auditor with the HSE, by saying to the Dail Public Accounts Committee that the National Maternity Hospital told her the funding came from “rents, license fees and other incomes.” The hospital never mentioned Mahony’s private patients, she said.
Tony O’Brien, head of the HSE, asked Dr Mahony for documentation to verify her account. “Following several communications between then and 6 December, Dr Mahony did not provide the documentation.”
Dr Smith had asked for similar documentation on four other staff, each creaming €30-40,000. “To date, there has been no information and I don’t think we are going to get it,” Dr Smith said, confirming their deviant defiance and arrogance.
Another fat cat was Dr Sam Coulter-Smith at the Rotunda hospital. Unlike the honourable gentleman who reformed the Rotunda, Dr Lombe Atthill, Coulter-Smith creamed two allowances of €20,000 and €40,000.
The cream thickens for Rhona Mahony. In April, the Irish Examiner, in an article titled HSE to review alleged €100k top-up, revealed the HSE had launched a specific enquiry into claims she received, not €45,000, but €100,000 a year as a top-up payment – two grand a week before she gets to work on a Monday morning.
The Irish Examiner claims Mahony and four others receive €45,000 per year for being directors of a private clinic attached to the hospital – but which they rent. They get paid for renting a clinic. Confused?
All of these top-up payments contravene the HSE guidelines on pay. You’ll notice the proletariat – nurses, porters, domestic staff etc. – don’t get paid twice.
One of the many recent scandals to hit the Irish health industry is summed up by the headline “HSE seeking repayments from pharmacies for drugs not dispensed.” RTE news reported in June 2016 that the Health Service Executive is investigating pharmacists who have claimed payment for drugs which they have not dispensed to patients. it is understood several million euro is involved. When it comes to the pharmacists, if someone doesn’t give you a top-up, abuse your position of trust and give it to yourself.
Unlike normal societies where thieves are penalised and made to reimburse their victims, we are told in Ireland, “… if agreement can be reached regarding recoupment…”! Like the comment Dr Smith, the auditor, said of Dr Mahony who wasn’t handing over the requested documentation: “I don’t think we’re going to get it,” it’s probably the same with the pharmacists. For example, this was a headline in 2011: HSE tells patients to ask for refunds from pharmacies. (In fact pharmacists had been overcharging as far back as 2009 and refused to co-operate in repaying.)
The HSE wrote to pharmacists asking them to review their operating procedures – and if you’ve ripped off the tax-payer you might kindly think about giving us (the HSE) a few euro, please…
Charity begins at home
Charity begins at home – especially if that home is that of the Kellys’ who founded and controlled the suicide support charity Console. According to reports the Kellys creamed off a million euro in the last two years alone to party. The poor oversight, governance, and unheeded warnings ten years ago facilitated what the American savings and loan commissioner William J. Crawford said, “The best way to rob a bank is to own it.” The Irish nation was first awoken to charity scandals with the revelation in 2013 that the Central Remedial Clinic had “admitted using charitable funds to top up the salaries of senior staff members.” (link)
We are very good to ourselves when we have a bit of power. As I write, more financial controversies are coming to light at the St John of God charity for similar reasons to the hospitals above. Despite threatening to withdraw valued services, we learn “HSE says St John of God not compliant with official pay policy.” The fat cats (not the proletariat but senior managers) at SJOG creamed about €1.64 million in 2013 and maintained it by secrecy (link).
Among the details reported by the Irish Mail are: 14 executives shared up to €2 million in upfront lump sum payments; each payment was between €50,000 and €250,000; the payouts were not declared in any publicly available accounts and the HSE was not informed of the payments until after the newspaper’s investigation.
Ireland’s Two-tier Medical System
When a dentist in Co. Galway contacted the head of the HSE accounts department, she was dismissed for being too dramatic and fussy, in more or less terms. She was concerned that a newly qualified dentist they had employed the previous year had overcharged the HSE by €150,000 – by charging the maximum allowable for treating patients. This required charging the HSE for work not done.
You’ll notice a difference between the UK and Irish fat cats. The Brits are a bit more noble about creaming it, they do it for something greater than themselves; the company, whereas the Irish experience shows it’s more for the benefit of the individual.
Without the power (eg, see here) and will to deal with issues, good governance or a sense of integrity, with Joe Public too emotive about medicine rather than rational and an arrogant establishment that believes it owes nobody an explanation, the elite capture, as outlined above, amounting to little less than a kleptocracy, means the privileged medical elite, Ireland’s haute bourgeoisie, can continue to exploit their power.
“The very rich, they’re different to you and me.” F. Scott Fitzgerald, The Rich Boy
” We aren’t the kind of people who make mistakes, are we?” Jeremy, in the movie The Riot Club (and BBC)
On the riot Club mentality and Oxford University elite, see a recent essay in the Guardian: “PPE: the Oxford degree that runs Britain: Oxford University graduates in philosophy, politics and economics make up an astonishing proportion of Britain’s elite. But has it produced an out-of-touch ruling class?”
Cochrane reviewer sues Roche for claiming Tamiflu could slow flu pandemic
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m314 (Published 27 January 2020)
Cite this as: BMJ 2020;368:m314
My post Unhealthy Business
Photo Credit: Wiki Commons