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“Insane”: US Physicians Received Billions From Pharmaceutical And Medical Device Industry, New Research Finds

"Insane": US Physicians Received Billions From Pharmaceutical And Medical Device Industry, New Research Finds

Authored by Megan Redshaw via…

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"Insane": US Physicians Received Billions From Pharmaceutical And Medical Device Industry, New Research Finds

Authored by Megan Redshaw via The Epoch Times (emphasis ours),

U.S. physicians received more than $12 billion in payments from the pharmaceutical and medical device industry over a 10-year period, according to a new analysis.

(ElenaR/Shutterstock)

A research letter published on March 28 in the Journal of the American Medical Association found that the industry made over 85 million payments to more than 820,300 (57 percent) of eligible physicians across 39 specialties from 2013 to 2022. Nearly 94 percent of the payments were related to one or more marketed medical products.

Researchers examined data in the Open Payments database to determine what payments were made across different specialties and the medical products associated with the largest total payments. Data only included payments received for consulting, nonconsulting (such as speaker or faculty fees), travel, food, entertainment, education, gifts, grants, charitable contributions, and honoraria.

The Open Payments database is a federal transparency program that was established in 2013 out of concern that financial relationships between physicians and the industry were unduly influencing healthcare decision-making and costs.

The analysis found that payments varied considerably between specialties and among physicians of the same specialty. For example, the mean amount paid to the top 0.1 percent of physicians ranged from $194,933 for hospitalists to $4.8 million for orthopedic surgeons, while the payments to the median physicians ranged from zero to $2,339.

Orthopedic physicians received the greatest sum of payments, $1.4 billion, followed by neurologists and psychiatrists, $1.3 billion, cardiologists, $1.3 billion, and hematologists/oncologists, $825.8 million. Nearly 55 percent of pediatricians and 63 percent of infectious disease physicians received payments from the industry, while physicians practicing preventative medicine received the least sum of payments.

From 2013–2022, pharma paid 12 billion dollars to U.S. physicians. That’s mind-boggling. Insane. That’s how silence is bought, the minds of physicians influenced, and ultimately patient care/prescribing patterns influenced,” Dr. Manni Mohyuddin, an oncologist, hematologist, and assistant professor at the Huntsman Cancer Institute, told The Epoch Times.

Dr. Mohyuddin emphasized that the average payment received was low, but some physicians received a significant amount of money and have influence over writing guidelines, chairing committees, clinical trials, influencing opinions, and more.

Top Drugs and Devices Associated With Payments

The top three drugs associated with the most payments were Xarelto ($176.3 million), Eliquis ($102.6 million), and Humira ($100.2 million).

Xarelto, jointly developed by Johnson & Johnson’s Janssen Pharmaceuticals and Bayer, is used to prevent and treat blood clots. Janssen also created the Johnson & Johnson COVID-19 vaccine, which caused rare and sometimes fatal blood clotting disorders.

Eliquis is a multibillion-dollar blood thinner manufactured by Bristol-Myers Squibb and Pfizer. The drug in 2023 was 12 percent of Pfizer’s total revenue—second only to its Comirnaty COVID-19 vaccine. Pfizer’s COVID-19 vaccine has also been linked to blood clotting disorders.

Humira is an immunosuppressive drug manufactured by AbbVie to treat arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis. Following the top three drugs are Type 2 diabetes medications Invokana, Jardiance, and Farxiga.

According to the analysis, the three medical devices associated with the most payments were daVinci Surgical System, $307.5 million, Mako SmartRobotics, $50.1 million, and CoreValve Evolut, $44.8 million.

‘Highly Targeted to Lucrative Procedures’

Our paper is a modest analysis. It does not explain the problem of financial conflicts of interest. But it is a lot of money. And it’s highly targeted to lucrative procedures,” co-author and cardiac electrophysiologist Dr. John Mandrola wrote in a post on Substack.

Dr. Mandrola believes that the strong influence of the industry can be seen in the approval of numerous medical devices by the U.S. Food and Drug Adminsitration despite “dodgy evidence.”

“Cardiology is a technical field. We use devices. Innovation requires some collaboration. Innovation has made cardiology better. But industry influence is way too strong,” he said. Dr. Mandrola believes the payments reported in their paper are not only for physician–industry collaborations, but are for marketing and goodwill, which helps establish practice patterns among physicians.

The industry is profit-driven, and if direct payments to doctors didn’t work, the industry wouldn’t spend billions doing it, he added.

Payments Can Create Conflicts of Interest

Dr. Andrew Foy, co-author and cardiologist, told The Epoch Times in an email the analysis shows a strong relationship between physicians and industry, but there are other indicators of this relationship as well. For example, it’s not uncommon for industry ads to be featured on homepages of major medical journals or for a medical conference or meeting to bombard physicians with industry advertising.

When I experience this at conferences, I feel like industry is not only welcome at these events but that the event is built around industry and its involvement,” Dr. Foy said. “There’s certainly no attempt to hide these relationships. The main reason being, at least in my opinion, is that many physicians, perhaps even the majority, believe the physician-industry collaboration is a net benefit to patients and society.”

Dr. Foy said he doesn’t necessarily share that view, but he doesn’t believe there is strong, objective evidence to support one side or the other as it relates to the overall benefits or harms of the relationship between physicians and industry.

“At this moment in time, the profession seems only interested in transparency. ‘As long as everyone is transparent, then everything is fine.’ As if someone cannot be transparent about their conflicts and highly biased at the same time,” he said.

Dr. Foy said he worries that conflicts of interest directly related to physician–industry payments may lead to overly enthusiastic recommendations or guidelines from medical organizations to use new products, even if they have not been sufficiently tested or where the evidence is not strong enough to recommend them over an old standard, or in some cases, nothing at all.

Additionally, Dr. Foy said a “major problem” with physician–industry payments is that they “have a way of tilting physicians sympathy toward industry” and the industry’s “medical advancements” which encourage physicians to more willingly adopt new products for the sake of  “industry advancement,” even if they don’t have a direct conflict of interest with that particular product.

In a way, they become cheerleaders for industry and more open to adopting new products simply due to this attachment,” Dr. Foy told The Epoch Times.

“I think what our paper does do is provide some numbers, which some may find shocking, and hopefully it renews interest in having conversations about physician-industry payments and conflicts of interest and perhaps facilitates more research,” he added.

Tyler Durden Wed, 04/03/2024 - 19:00

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Cruising through the icebergs

Back in October 2020, in the depths of the COVID-19 pandemic, in a blog titled “why cruise lines could be worth buying again,” we proffered an investment…

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Back in October 2020, in the depths of the COVID-19 pandemic, in a blog titled “why cruise lines could be worth buying again,” we proffered an investment thesis that the sharp drops in the share prices of the major listed cruise line companies did not reflect the then fast-advancing technology that would facilitate a reopening of global activity even in the absence of a vaccine, and that pent-up demand (82 per cent of passengers are repeat cruisers) for travel would see a surge in cruising activity exceeding the expectations then implied in share prices. 

Figure 1., displays the share price charts we published in that blog post (the embedded chart references refer to the blog post of October 21, 2020). 

Figure 1. Cruising for a bruising? Share price charts as of 21 October 2020.

Figure 1. Cruising for a bruising? Share price charts as of 21 October 2020.

Today, just three and half years later, the performances of the major cruise lines’ shares haven’t fully shaken off the effects of the pandemic. While Royal Caribbean (NYSE:RCL) is up 116 per cent, Norwegian Cruise Line (NYSE:NCLH) is up only 14 per cent and the highly indebted Carnival Corporation (NYSE:CCL) is just six per cent higher. 

Given that Carnival has performed the least impressively, it’s worth examining its current circumstances to help determine whether a recovery is possible. 

It seems navigating the high seas of the stock market has been a voyage fraught with risk and relatively unimpressive returns. That is certainly the case for investors who cast their lot with Carnival, the cruise industry titan then known for its vast fleet and now known for its equally vast debt.  

Recent developments have seen the company’s shares generally register modest gains, and these follow a setback triggered by the company’s latest financial disclosures. 

Carnival’s fiscal first-quarter performance offered a beacon of hope, with strong figures and optimistic projections for the remainder of 2024. However, these forecasts hadn’t accounted for an unexpected challenge: the collapse of the Francis Scott Key Bridge in Baltimore, necessitating the rerouting of several cruises to alternative harbours along the East Coast of the United States.  

The anticipated financial impact of this event was capped at a seemingly minor “up to U.S.$10 million”, equivalent to one cent per share. The figure gains significance, however, when viewed against Carnival’s financial position, which includes the revelation that a mere one per cent fluctuation in net yields could sway its financial outlook by as much as U.S.$135 million. 

Despite the lingering shadow of the pandemic, which had once pushed Carnival’s finances to the brink and plunged its debt to sub-investment grade, the company has been charting a steady, albeit long, ‘cruise’ toward recovery. Noteworthy are the significant debt prepayments. The roadmap for 2024 and 2025 now includes manageable debt maturities, laying the groundwork for Carnival’s potential return to a more stable financial position. 

Over the horizon, Carnival’s prospects are reported to be brightening. Thanks to a resurgence in occupancy rates, helped along by compelling pricing strategies, customer deposits have surged to around U.S.$7 billion, a marked increase from the pre-pandemic figure of less than U.S.$5 billion.  

Meanwhile, travellers are booking voyages further in advance and are reported to be indulging in higher-margin onboard luxuries at a significantly higher rate than before the pandemic. This uptick in consumer spending behaviour, especially evident during the peak cruise booking season known as “wave season,” suggests a strong sales period for Carnival. 

Of course, the journey ahead remains uncertain, with Carnival’s debt levels still a critical factor. As Carnival charts a course through its financial currents, its voyage towards stability and growth continues, and as the debt continues to decline, it will inevitably capture the attention of investors. 

The timeline for Carnival to fully retire its extra debt remains uncertain. Investors currently expect it should be cleared before 2034. Carnival generated U.S.$4.3 billion in cash from operations and U.S.$2.1 billion in adjusted free cash flow in 2023, and it plans to use these cash flows to continue paying off the debt. 

With the company’s market capitalisation less than five times cash flow from operations and just ten times adjusted free cash flow, investors with a patient disposition should keep the company’s shares on their watchlist. When the market becomes confident the debt will imminently be paid down, the share price could surge. 

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Here’s the truth about how a company’s bankruptcy can affect you

Holders of a stock can be left with important decisions to make when a company they are invested in files for bankruptcy protection.

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As the global economy continues to take new shape in its recovery from the Covid-19 pandemic, many companies are still reeling from the high costs and supply shortages the health crisis triggered.

And a significant number of them are filing for bankruptcy.

Related: Another company files for bankruptcy and Dave Ramsey has words

Major bankruptcy filings in 2023 included the working space company WeWork in November, drug store retailer Rite Aid in October, and Bed, Bath & Beyond in April.

The trend has continued in 2024. In fact, telecom company Airspan Networks Holdings  (MIMO)  filed for a prepackaged Chapter 11 bankruptcy in Delaware on March 31.

A lot of the news around bankruptcies involves how companies are restructuring their debts or going out of business entirely. But if a company that files for bankruptcy has a stock that is publicly traded, the question of what happens to shareholders is worth examining. 

In Airspan's case, existing holders of stock have been given two options. One is to receive their pro rata share of $450,000. The other is to elect for warrants instead of cash. But if more than 150 shareholders decide to take the warrants, no warrants at all will be given.

A pro rata share is the cash value of a proportionate number of owned shares based on the determined total value.

A warrant is similar to an option, where the holder can purchase a security at a specific price and quantity at a future time. But unlike options, warrants are issued by a company rather than a central exchange.

What bankruptcy means for the people affected

The thought of bankruptcy is scary for companies, their employees and shareholders.

The companies themselves would enter a reality where they are forced to ponder their very survival.

Employees, naturally, wonder about the security of their jobs.

The impact on shareholders of a company filing for bankruptcy has a few layers of complexity.

In Chapter 7 bankruptcy, a company is simply going out of business. It sells its assets to pay off debts. Shareholders are left to split what's left, if there is anything remaining at all. If there is not, shareholders can get nothing.

When a company is considering filing for Chapter 11 bankruptcy, it is likely looking to restructure and stage a comeback. If shareholders are brave enough to hold onto their shares during this process, which is risky, they at least stand the chance of making some money back.

For example, car rental company Hertz  (HTZ)  filed for Chapter 11 in May 2020 as the Covid-19 pandemic wounded the travel business generally. While the stock has struggled recently, the company did come out of bankruptcy in July 2021.

Employees are pictured pondering the bankruptcy of their company, peering out the window of a building.

Shutterstock

In bankruptcy events, shareholders are last in line

When a company goes bankrupt, hanging on to its shares is dicey business. Shareholders could wind up with little or nothing, but they may be rewarded for their patience. 

In the short term, the stock is probably already down at the filing and is destined to stay that way for a while. But in the long term, there may be hope for a revival.

Shareholders are the last ones to be considered for payouts. First to get any money from liquidated assets or cash advancements are secured creditors such as banks holding mortgage or equipment loans, for example. Unsecured creditors, including banks, suppliers and bondholders are next. Then come the shareholders.

"The stock could very well become completely worthless," writes The Balance. "But there’s always a chance that the company could emerge from bankruptcy stronger and stock prices may rise. In the short-term, however, the stock price is likely to stay very low during bankruptcy and immediately after."

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Does methylene blue or mitoquinone improve skeletal aging?

“[…] long-term administration of MB or MitoQ did not have an effect on skeletal morphology during the aging process […]” Credit: 2024 Poudel et…

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“[…] long-term administration of MB or MitoQ did not have an effect on skeletal morphology during the aging process […]”

Credit: 2024 Poudel et al.

“[…] long-term administration of MB or MitoQ did not have an effect on skeletal morphology during the aging process […]”

BUFFALO, NY- April 3, 2024 – A new research paper was published in Aging (listed by MEDLINE/PubMed as “Aging (Albany NY)” and “Aging-US” by Web of Science) Volume 16, Issue 6, entitled, “Targeting mitochondrial dysfunction using methylene blue or mitoquinone to improve skeletal aging.”

Methylene blue (MB) is a well-established antioxidant that has been shown to improve mitochondrial function in both in vitro and in vivo settings. Mitoquinone (MitoQ) is a selective antioxidant that specifically targets mitochondria and effectively reduces the accumulation of reactive oxygen species. In this new study, researchers Sher Bahadur Poudel, Dorra Frikha-Benayed, Ryan R. Ruff, Gozde Yildirim, Manisha Dixit, Ron Korstanje, Laura Robinson, Richard A. Miller, David E. Harrison, John R. Strong, Mitchell B. Schaffler, and Shoshana Yakar from New York University College of Dentistry, City College of New York, The Jackson Laboratory, University of Michigan, South Texas Veterans Health Care System, and The University of Texas Health Science Center investigated the effect of long-term administration of MB or MitoQ on skeletal morphology during the aging process.

“[…] we administered MB to aged (18 months old) female C57BL/J6 mice, as well as to adult male and female mice with a genetically diverse background (UM-HET3). Additionally, we used MitoQ as an alternative approach to target mitochondrial oxidative stress during aging in adult female and male UM-HET3 mice.”

Although the researchers observed some beneficial effects of MB and MitoQ in vitro, the administration of these compounds in vivo did not alter the progression of age-induced bone loss. Specifically, treating 18-month-old female mice with MB for 6 or 12 months did not have an effect on age-related bone loss. Similarly, long-term treatment with MB from 7 to 22 months or with MitoQ from 4 to 22 months of age did not affect the morphology of cortical bone at the mid-diaphysis of the femur, trabecular bone at the distal-metaphysis of the femur, or trabecular bone at the lumbar vertebra-5 in UM-HET3 mice.

“Based on our findings, it appears that long-term treatment with MB or MitoQ alone, as a means to reduce skeletal oxidative stress, is insufficient to inhibit age-associated bone loss. This supports the notion that interventions solely with antioxidants may not provide adequate protection against skeletal aging.”

 

Read the full paper: DOI: https://doi.org/10.18632/aging.205147 

Corresponding Author: Shoshana Yakar

Corresponding Email: sy1007@nyu.edu 

Keywords: methylene blue, mitoquinone, bone, micro-CT, antioxidants

Click here to sign up for free Altmetric alerts about this article.

 

About Aging:

Aging publishes research papers in all fields of aging research including but not limited, aging from yeast to mammals, cellular senescence, age-related diseases such as cancer and Alzheimer’s diseases and their prevention and treatment, anti-aging strategies and drug development and especially the role of signal transduction pathways such as mTOR in aging and potential approaches to modulate these signaling pathways to extend lifespan. The journal aims to promote treatment of age-related diseases by slowing down aging, validation of anti-aging drugs by treating age-related diseases, prevention of cancer by inhibiting aging. Cancer and COVID-19 are age-related diseases.

Aging is indexed by PubMed/Medline (abbreviated as “Aging (Albany NY)”), PubMed Central, Web of Science: Science Citation Index Expanded (abbreviated as “Aging‐US” and listed in the Cell Biology and Geriatrics & Gerontology categories), Scopus (abbreviated as “Aging” and listed in the Cell Biology and Aging categories), Biological Abstracts, BIOSIS Previews, EMBASE, META (Chan Zuckerberg Initiative) (2018-2022), and Dimensions (Digital Science).

Please visit our website at www.Aging-US.com​​ and connect with us:

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For media inquiries, please contact media@impactjournals.com.

 

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