Big pharma: Kickbacks to politicians, health officials

 

I was surprised by the remark of Progressive Democratic Party president Tiong King Sing that health minister Khairy Jamaluddin seemed to have an “inseparable relationship” with the Pfizer-BioNTech vaccine manufacturer.

The prime minister’s special envoy to China said this on Feb 7 when asking why Khairy was still refusing to allow the public to choose the type of vaccine they preferred.

“If not (inseparable relationship), why refuse to offer Sinovac and Sinopharm vaccines to the people? Is this an effective way to encourage people to be vaccinated?” he had asked.

Khairy has since allowed people to be inoculated with whatever brand of vaccine they like.

I want to take this at face value and don’t wish to impute any wrongdoing or motive to anyone, but the pharmaceutical industry has a reputation for using unsavoury methods to push its products.

Studies by Georgetown University Medical Center (GUMC) in the US show that pharmaceutical companies spend far more on marketing than on research and development. It says that the 12 largest pharmaceutical companies spent more than US$120 billion on marketing in 2016 and only US$75 billion on research and development.

Firms recruit key opinion leaders – medical experts, usually physicians, who are respected and influential in their fields – to influence peers as part of a marketing strategy. According to GUMC, 15-25% of marketing budgets go towards paying opinion leaders in the US.

Last week, I spoke to a former executive of several multinational pharmaceutical firms who said gifts, dining out and conferences were some ways in which drug firms would attempt to influence purchases of their drugs.

In recent years, however, global pharmaceutical firms had become stricter about sales ethics, he said. There have been instances where officials have been sacked for overlooking the self-regulation measures or compliance.

Based on his experience, he said, drug firm executives or salesmen would first identify the “opinion leaders” – consultants, medical society executives, and doctors who could be key advocates or influencers in their specialised areas and who would thus be able to influence an increase in prescriptions.

In the past, they would be taken – with all expenses paid – to attend international medical conferences overseas. The attending sales executive would be at the beck and call of the doctors to ensure they had a pleasant stay.

These days, he said, overseas conferences and trips were very minimal. Conferences are now held in the country, and that too in four-star hotels, not in resorts like before. This is also because, with the advent of the internet, there is really no need to travel to another country to hear someone speak.

Doctors attend such conferences because they gain continuing professional development or CPD points which help in the renewal of their professional licence.

In Malaysia, pharmaceutical firms have to go through Bumiputera companies to sell medicine to the health ministry. In the process, the government ends up paying more as the middlemen have to make a profit.

The health ministry has a “blue book” where it lists the types of drugs that can be used in hospitals.

Pharmaceutical representatives visit specialists and others in public hospitals to convince them to purchase their brand but the hospitals have to place orders for the drugs through the Bumiputera companies.

However, tenders are called if the amount of a certain drug needed for the next two years exceeds a certain value. It was RM500,000 during his time some years ago, said the former executive.

Private sector doctors are often given free samples of products, especially new drugs launched in the market, by sales representatives. The samples come in handy as doctors prescribe them to patients needing such medication.

However, the purchase of vaccines for Covid-19 were fast tracked, which means not all regular protocols or procurement safeguards may have been followed.

And nobody really knows the details of the agreement between the government and major suppliers such as Pfizer as the government says it is part of a non-disclosure deal. We also don’t know who the middlemen are.

Why would vaccine suppliers insist on secrecy regarding terms and conditions? Many governments, including the Malaysian government, agreed to the terms because they were desperate to protect their people from the disease.

Pfizer, for instance, was accused early last year of “bullying” governments into agreeing to its terms and conditions.

According to Public Citizen, a US non-profit consumer advocacy organisation, in signing a contract with Pfizer, the Brazilian government waived sovereign immunity, imposed no penalties on Pfizer for late deliveries, agreed to resolve disputes under a secret private arbitration under the laws of New York, and broadly indemnified Pfizer of civil claims.

“The Brazilian government is prohibited from making ‘any public announcement concerning the existence, subject matter or terms of (the) agreement’ or commenting on its relationship with Pfizer without the prior written consent of the company.”

Public Citizen says: “Pfizer gained the power to silence Brazil.”

Is that also Malaysia’s situation?

According to Public Citizen, “At least four countries are required ‘to indemnify, defend and hold harmless Pfizer’ from and against any and all suits, claims, actions, demands, damages, costs, and expenses related to vaccine intellectual property. For example, if another vaccine maker sued Pfizer for patent infringement in Colombia, the contract requires the Colombian government to foot the bill.”

The advocacy group, which managed to study several of these contracts, says: “Pfizer required Brazil, Chile, Colombia, the Dominican Republic, and Peru to waive sovereign immunity.”

What this means is that the firm can “request that courts use state assets as a guarantee that Pfizer will be paid an arbitral award and/or use the assets to compensate Pfizer if the government does not pay” if a breach of contract dispute happens.

Coming back to “gifts” to doctors and health officials, a 2017 study by Georgetown University Medical Center and George Washington University Milken Institute School of Public Health found that “physicians and other health care providers who received ‘gifts’ from pharmaceutical companies were much more likely to prescribe a higher number of drugs per patient, including more costly prescriptions for branded medicines, compared to prescriptions written by medical providers who did not accept gifts”.

The findings were published in PLOS ONE a peer-reviewed open access scientific journal.

A 2009 report in The Guardian noted that Pfizer was hit with the biggest criminal fine in US history as part of a US$2.3 billion settlement for “mispromoting” the painkiller Bextra and for paying kickbacks to compliant doctors.

According to an Investopedia report last year, the pharmaceutical and health products industry spent US$4.95 billion on lobbying over the past 23 years – by far the highest expenditure on lobbying by all industries in the US.

A 2017 report, also in The Guardian, said hundreds of millions of dollars flowed to lobbyists and decision-making politicians in the US each year “to shape laws and policies that keep drug company profits growing”.

The pharmaceutical industry spent US$152 million on influencing legislation in 2016, according to the Center for Responsive Politics. Drug companies also contributed more than US$20 million directly to political campaigns in the US in 2016, The Guardian report revealed.

It added: “The impact of so much drug company money coursing through the veins of Congress is often incremental or largely unseen by the American public, such as the industry’s efforts to block competitors in India from making generic versions of HIV/Aids medicines that are more affordable to developing countries.”

A Reuters report in October 2021 said its analysis of public lobbying and campaign data showed that the industry spent over US$177 million on lobbying and campaign donations in the US in 2021.

You may ask: How does that affect me in Malaysia? You see, Malaysian authorities invariably follow the example of the Centers for Disease Control and Prevention (CDC) and regulator Food and Drug Administration of the US. So, whatever happens there impacts us.

Big pharma has been peddling its influence in the European Union, too. According to lobbyfacts.eu, the industry spent Euros 5.2-5.4 million on lobbying in 2020.

Even the World Health Organization has felt the influence of big pharma.

An investigation by the British Medical Journal and the Bureau of Investigative Journalism showed that three scientists who drew up WHO guidelines in 2004 advising governments to stockpile drugs in the event of a flu pandemic had previously been paid by drug companies which stood to profit from it.

What about Malaysian politicians? Have they received funding from big pharma? Have our senior health officials come under the influence of pharmaceutical firms or their agents? Has anyone even thought of investigating this?

I wonder if any of our health policies have been influenced by big pharma over the years. And I wonder if the Malaysian Anti-Corruption Commission is keeping an eye on this.The views expressed are those of the writer and do not necessarily reflect those of FMT