[Ip-health] Medical Industry Showers US Defense Dept with Free Travel; Military Doctors, Pharmacists Took 8,700 Trips

[robert weissman]

The first item here summarizes a Center for Public Integrity study on
private interests funding free travel by US Defense Department
personnel. The medical industry is the top funder of such travel. The
item below focuses on medical industry-sponsored trips.

--

http://www.publicintegrity.org/investigations/pentagon_travel/

When Department of Defense personnel travel, it=E2=80=99s not always the fe=
deral
government that picks up the bill. Over a 10-year period, defense
employees have taken thousands of trips paid for by outside sources,
including foreign governments and private companies that conduct
business with DOD, according to a Center for Public Integrity analysis
of Pentagon travel disclosure records.

 From 1998 through 2007, sources outside the federal government paid for
more than 22,000 trips worth at least $26 million. While these trips are
generally permitted under federal regulations, military watchdogs say
the system is broken. Allowing the drug industry to send military
pharmacists to Las Vegas or letting a Saudi prince pay a top official=E2=80=
=99s
way to Riyadh, they warn, can create serious conflicts of interest.
Defense officials say these trips are thoroughly vetted to guard against
impropriety.

According to the analysis:

     * The medical industry paid for more travel than any other outside
interest =E2=80=94 more than $10 million for some 8,700 trips, or about 40
percent of all outside sponsored travel. Among the targets: military
pharmacists, doctors, and others who administer the Pentagon=E2=80=99s $6
billion-plus annual budget for prescription drugs;
     * Foreign governments paid more than $2.6 million for 1,500 trips.
The biggest sponsors: U.S. allies Australia, Singapore, and Japan, but
the list also includes China, Russia, and the United Arab Emirates;
     * Manufacturers of retail goods paid for more than 500 trips, at a
cost of about $470,000. Their targets included buyers at on-base retail
outlets, which sold more than $12 billion of merchandise in 2007. Among
the sponsors: Nike, Skechers, Mattel, and Sony;
     * Thousands of the trips were taken to popular vacation spots such
as San Diego, Las Vegas, Honolulu, San Remo and Venice, Italy, and Jeju
Island, South Korea. Among the guests were spouses, who participated in
at least 240 of the trips.

The travel disclosure records, submitted in paper form to DOD=E2=80=99s Off=
ice
of Government Ethics, were digitized and sorted in a joint project by
the Center and Northwestern University=E2=80=99s Medill School of Journalis=
m.

--

http://www.publicintegrity.org/investigations/pentagon_travel/articles/entr=
y/1409/

Medical Industry Showers DOD with Free Travel

Military Doctors, Pharmacists Took 8,700 Trips
  By M.B. Pell, Aaron Mehta |  June 09, 2009

  A trip to Paris in September 2006 cost Dr. D. Gray Heppner nothing.
GlaxoSmithKline, one of the world=E2=80=99s largest drug manufacturers, pai=
d
$7,800 for the lieutenant colonel and chief of the Walter Reed Army
Institute of Research=E2=80=99s Department of Immunology to attend the comp=
any=E2=80=99s
symposium on malaria.

It was Boston in May for John W. Szabo. Medical device manufacturer
Cardinal Health paid $5,000 for Szabo, then chief of the Pharmacy
Service at the U.S. Army Health Clinic at Schofield Barracks in Hawaii,
to attend a leadership conference in 2002. The year before, Szabo went
to a diabetes conference in Austin, Texas, and GlaxoSmithKline paid the
bill through an unrestricted grant, totaling more than $1,000.

Trips to Tampa Bay and Austin in 2000 for Peter Bulatao were paid for by
drug-makers Novartis and GlaxoSmithKline. Bulatao, then chief of the
Department of Pharmacy at Lyster Army Community Hospital, in Fort
Rucker, Ala., sat on the committee responsible for selecting drugs for
the hospital.

These were among 8,700 trips by Department of Defense personnel paid for
by the health care industry =E2=80=94 at a cost of more than $10 million =
=E2=80=94 from
1998 through 2007, according to an analysis by the Center for Public
Integrity. In a joint project with Northwestern University=E2=80=99s Medill
School of Journalism, the Center examined 22,000 travel disclosure forms
filed by DOD personnel, and found that the medical industry was by far
the biggest sponsor of free travel, accounting for about 40 percent of
all trips. The sponsors included not only drug and device makers but
also health foundations and trade groups often funded by those companies.

A $6 Billion Drug Market

Of special interest to the industry were DOD employees who prescribe,
purchase, or recommend the use of drugs or medical equipment. Drug
companies and device manufacturers spent about $1.7 million for more
than 1,400 trips taken by DOD doctors, medical researchers, pharmacists,
and other health care employees over the decade, creating relationships
that pose serious conflict of interest issues, according to medical
ethics experts. From 2000 to 2006, the DOD prescription drug budget
ballooned from $1.6 billion to more than $6 billion a year.

Click to EnlargeShahram Ahari says he is familiar with this game. While
working as a sales representative for the drug company Eli Lilly &
Company in 1999 and 2000, Ahari describes how he used free meals, trips,
and unrestricted grants to subtly seduce civilian physicians into
prescribing the firm=E2=80=99s drugs. The strategy, Ahari explains, is to m=
ake
friends with doctors and pharmacists, get them talking about a company=E2=
=80=99s
drugs or devices, and then reward them with additional perks for
prescribing their drugs. Often physicians do not even realize the
company is manipulating them.

=E2=80=9CThe return on dividends is phenomenal,=E2=80=9D Ahari says. =E2=80=
=9CIf it costs them a
thousand dollars for a dinner, that=E2=80=99s a [patient=E2=80=99s drug] pa=
yment for one
month. If they fly you on the Concord to Paris for five grand, even if
they get one patient out of it, it=E2=80=99s a lifetime of cash.=E2=80=9D

Among the top medical device manufacturers or pharmaceutical company
sponsors of trips for DOD personnel are:
=09=E2=96=AA =09Johnson & Johnson, 187 trips at a cost of more than $215,00=
0;
=09=E2=96=AA =09GlaxoSmithKline, 95 trips at a cost of more than $120,000;
=09=E2=96=AA =09Hologic Company, 37 trips at a cost of more than $102,000;
=09=E2=96=AA =09Medtronic Inc, 86 trips at a cost of more than $93,000;
=09=E2=96=AA =09Smith & Nephew, 81 trips at a cost of nearly $90,000.

Medtronic made the front page of the New York Times in May after an Army
investigation found that military surgeon Dr. Timothy R. Kuklo
overstated the benefits of Infuse, a drug sold by Medtronic and used to
treat combat-related bone injuries. The Army investigation revealed that
Kuklo, a paid Medtronic consultant, falsified information and forged the
signatures of colleagues as co-authors in a British medical journal
article. According to the Center=E2=80=99s analysis, between 2001 and 2006,
Medtronic paid for at least 15 trips taken by Dr. Kuklo, worth more than
$13,000. Among the destinations were Coral Gables, Florida, and
Scottsdale, Arizona.

Representatives of these companies say they follow the law and
government regulations closely, paying only for reasonable expenses tied
to professional trips or third-party meetings. But industry-sponsored
travel has become a hot topic in the medical community, prompting
criticism by bio-ethicists, elected officials, and professional
organizations.

Medical professionals and industry often partner to improve medical
treatment, according to Dr. Heppner, now deputy commander of the Walter
Reed Army Institute of Research. He says the institute could not create
the vaccines and diagnostic services needed to protect the health of
American military personnel without partnering with drug companies, as
the institute lacks the necessary funding and technological capabilities
to act alone. His trip to Paris, paid for by GlaxoSmithKline,
represented a critical element of this partnership by allowing the U.S.
government to receive credit for working on a malaria vaccine. =E2=80=9CIt =
is
important to me that people understand the important things we bring and
I felt that I had to represent our contributions to the world,=E2=80=9D Hep=
pner
says.

Among the most prolific travelers in the Department of Defense is Dr.
Norman Rich, a surgeon and professor at the Uniformed Services
University of the Health Sciences. The doctor, a pioneer in vascular
surgery during and after the Vietnam War, took about 80 trips valued at
more than $250,000, including about $20,000 from Johnson & Johnson.
Allowing Rich to take industry-funded travel, officials say, allows him
to share his knowledge with surgeons across the globe.

=E2=80=9CIs it normal for the faculty here? The answer is no,=E2=80=9D says=
 Bill Bester,
the school=E2=80=99s acting vice president for external affairs, said of th=
e
trips taken by Rich. =E2=80=9CBut Dr. Rich has 40 years of surgical experie=
nce.
He is known nationally and internationally. There=E2=80=99s probably no one
living who=E2=80=99s contributed more to military surgery than Dr. Rich.=E2=
=80=9D

Targeting the Pharmacy

DOD=E2=80=99s pharmacy system employees, who can influence which drugs are
selected at base pharmacies, took more than 400 trips at a cost of more
than $400,000 from medical industry sources, according to the Center=E2=80=
=99s
analysis. Drug companies paid more than $115,000 for travel to popular
destinations, including Las Vegas, Orlando, San Diego, New York City,
New Orleans, Rome, and Paris.

  Military pharmacies help administer $6 billion annually in
prescription drugs, making DOD pharmacists an attractive target for drug
companies. Source: United States Air ForceNot all pharmacy employees can
influence drug purchases directly and some lack even indirect authority,
but chief pharmacists of on-base pharmacies have the option of serving
on the board responsible for selecting drugs the facility will sell.
Moreover, the pharmaceutical industry=E2=80=99s presence is felt more broad=
ly,
says Dr. Adriane Fugh-Berman of Georgetown University School of
Medicine. Fugh-Berman, an authority on industry influence on medicine,
notes that pharmacists often seek advice from one another and that drug
companies can create a =E2=80=9Cnet of influence=E2=80=9D around the drug s=
election process.

These companies are not trying to curry favor, according to Szabo, the
former chief of Pharmacy Service at the U.S. Army Health Clinic at
Schofield Barracks. Szabo, while sitting on the base=E2=80=99s drug-selecti=
on
committee, took trips paid for by Cardinal Health and GlaxoSmithKline,
but he insists the only motivation behind the paid travel is altruism.
=E2=80=9CThey feel it=E2=80=99s goodwill,=E2=80=9D Szabo says. =E2=80=9CI=
=E2=80=99ve never favored Glaxo
products, and Cardinal Health deals in durable things, not drugs, so
they would have no benefit by selecting me.=E2=80=9D

Conflicts of Interest

Studies in the Journal of the American Medical Association and CHEST, a
medical specialty journal, have found a link between perks bestowed on
doctors and an increased likelihood that physicians, usually
unknowingly, would prescribe a company=E2=80=99s drugs. Academic studies li=
ke
these spurred a recent movement to regulate industry gifts to medical
professionals. Since 2003, the American Medical Association=E2=80=99s guide=
lines
have prohibited physicians from accepting subsidies from industry
=E2=80=9Cdirectly or indirectly to pay for the costs of travel, lodging, or
other personal expenses of physicians attending conferences or
meetings.=E2=80=9D Senators Chuck Grassley, Republican of Iowa, and Herb Ko=
hl,
Democrat of Wisconsin, proposed legislation this year that would require
drug companies and medical device manufacturers to publicly disclose all
gifts given to doctors valued at more than $100.

Rear Admiral Thomas McGinnis, head of DOD=E2=80=99s pharmaceutical program,
banned his own staff from going on company-paid trips, but other
military pharmacy staff took about 400 trips. Source: Military Health
SystemSuch concerns have prompted Admiral Thomas McGinnis, chief of the
Pharmaceutical Operations Directorate for DOD=E2=80=99s military health car=
e
program, to prohibit his direct staff from going on company-paid trips.
Still, McGinnis is puzzled at why the medical industry would spend so
much doling out free trips to military pharmacists. =E2=80=9CI don=E2=80=99=
t really know
what the hook is, what their advantage is,=E2=80=9D McGinnis says. =E2=80=
=9CI don=E2=80=99t see
the reason why firms would do that.=E2=80=9D

Ethics experts say the reason is obvious =E2=80=94 gifts from drug companie=
s
affect the decisions of pharmacists. =E2=80=9CThey pay for them because it
works,=E2=80=9D asserts Thomas Murray, president of the Hastings Center, a
nonpartisan bioethics research institute. =E2=80=9CTrust me, their marketin=
g
departments are paying very close attention to cost benefit analysis for
these kinds of gifts.=E2=80=9D

DOD drug spending may merit that kind of attention. From fiscal year
2000 to fiscal year 2006 the Pentagon=E2=80=99s prescription drug spending =
more
than tripled from $1.6 billion to $6.2 billion, according to a
Government Accountability Office report issued in April 2008. Spending
hit $6.8 billion on drugs in 2008, says Admiral McGinnis, and the GAO
expects DOD pharmaceutical spending to reach $15 billion by 2015.
McGinnis estimates that DOD spending on drugs purchased at on-base
pharmacies alone accounts for about two percent of all drug sales
nationwide.

Despite banning his staff from accepting drug-company sponsored travel,
McGinnis nonetheless allows DOD pharmacists to attend continuing
education programs and other events paid for by drug companies, a
practice common for pharmacists in civilian practice. These trips save
DOD money and are appropriate, McGinnis says, as long as the company is
not promoting a drug at the event and as long as participants reveal
their ties with industry.

But Dr. Fugh-Berman, the principal investigator of PharmedOut, a project
to educate physicians about the influence of pharmaceutical companies on
prescribing patterns, argues that allowing medical professionals to take
industry-paid trips may actually cost more in the long run. The costs of
purchasing more expensive or unnecessary drugs, a phenomenon studies
have associated with gifts to doctors, dwarf bills for the occasional
continuing education conference, she says.

Expenses aside, Fugh-Berman says the ultimate problem is with allowing
even the appearance of doctors and others owing a debt to medical drug
and device companies. =E2=80=9CIndustry and medicine are not on the same si=
de,=E2=80=9D
Fugh-Berman insists. =E2=80=9CDoctors and other health care professionals a=
re
supposed to represent the best interests of their patients, and industry
is supposed to represent the best interests of its shareholders. These
are not the same.=E2=80=9D