EPO Kickbacks

They're perfectly legal, but let's not mince words. When physicians derive income from prescribing drugs, it's a kickback. And that's what the New York Times documents today in its eye-opening front-page story on oncologist payments from Amgen and Johnson & Johnson, which market anti-anemia drugs for cancer patients.

It's an old story, frankly. Some Congressmen have been complaining for years about excess EPO payments in the dialysis market, where Amgen's marketing department holds sway. I will never forget my first meeting with a high-ranking aide to Rep. Pete Stark (it was in 1998, as I recall; he remains a trusted source and colleague), who fumed about the "kickbacks" that the dialysis clinics got from over-prescribing the drug. A year ago, I broke a story in a now defunct publication, The Bay Area Oncology News, about alleged illegal bundling in the cancer market. Amgen, the story alleged, was tying rebates to physicians for its white blood cell factor drug to increased purchases of its red blood cell factor drug. It has since been reported that federal authorities in San Francisco are investigating the situation, a fact that I did not see in this morning's Times story, which focused only on the rebates.

Anyway, there's probably more to be found. Next up should be the last bastion of EPO over-marketing, the AIDS market. I'd love to hear some personal stories from doctors willing to spill the beans on what's going on in that field.

Today's Times story was timed to land just before a meeting of the Food and Drug Administration's Oncologic Drugs Advisory Committee. Thursday, that group will hear evidence that overuse of the drugs actually shorten cancer patients' lives. To read more about the studies that triggered this meeting, see my posts here, here, here, and here.

This FDA committee will probably recommend tighter warnings to avoid overusing the drugs by keeping patients within the narrow red blood-cell counts specified on the FDA label. Will it do any good in the face of pervasive kickbacks that are not illegal? The National Kidney Foundation's anemia management committee, which has a majority of its doctors on Amgen's payroll, recently issued a cautious warning prefaced by a statement that doctors can use their own judgment when it comes to treating individual patients.

The latest Health Affairs just crossed my desk with an article by former FDA deputy commissioner Scott Gottlieb attacking elements of the FDA reform legislation now moving through the Senate. He complains that the "risk management plans" called for in the bill would restrict physicians' ability to practice medicine the way they see fit. Is this the kind of freedom he means?