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Cash, Guns, and a Lap Dancing Drug Rep

The Carlat Psychiatry Blog, Volume , Number ,

Earlier this month, five Insys Therapeutics pharmaceutical executives were found guilty of racketeering for their attempts to bribe doctors to prescribe the company’s Subsys fentanyl spray, which was approved as a pain reliever for cancer patients, to people who didn’t even need it. Their scheme included strippers, guns, cash, and even a rap video including a dancing drug bottle mascot. It’s also linked to more than 900 overdose deaths.

Publication Date: 5/20/19
Runtime: 13 mins, 21 seconds
Article Referenced: Top Executives of Insys, an Opioid Company, Are Found Guilty of Racketeering,” New York Times, 5/2/19

Partial Transcript

Welcome to The Carlat Psychiatry Podcast, a weekly podcast brought to you by The Carlat Psychiatry Report, a CME publication, keeping psychiatry honest since 2003.

I’m Kellie Newsome….

And I’m Chris Aiken….

When the FDA approved a fentanyl spray for cancer-related pain in 2012, they had no idea how badly things would get out of hand. This is the story of strippers, guns, and cash, and lengths that the pharmaceutical industry went to to promote this opioid that took the lives of over 900 patients.

The company was Insys Therapeutics. The drug was Subsys. And the chairman was John Kapoor. Last week he was found guilty of bribing physicians to prescribe high doses of Subsys, fentanyl spray that is 100 times stronger than morphine. The allegations are astonishing. Subsys was approved for pain associated with terminal cancer, but the company convinced doctors to fabricate this diagnosis in order to prescribe it to patients who did not need it. Those patients quickly became addicted to the synthetic opioid, resulting in higher doses, more profits for the company, and over 900 overdose deaths.

Doctors were paid kickbacks of up to $800,000 to prescribe the drug. To hide the kickbacks, the company created fake speakers programs, where the physicians spoke to their friends and fellow employees for large sums of money. According to CBS News, Insys made 18,000 payments to doctors in 2016 alone.

They selected attractive women to work as drug reps, and instructed the women to stroke the hand of the physician while pleading with him to prescribe higher doses to his patients. Reportedly, these women were treated poorly in the misogynistic culture the company created. Their regional sales manager, Sunrise Lee, was a former stripper who gave physicians lap dances while touting the merits of the drug. Prior to taking on the role of regional sales manager, Sunrise’s management experience involved running an escort service, prosecutors said.

Other antics included taking physicians on expense-paid outings to shooting ranges and promoting the drug with a Hip-Hop video that instructed doctors on how to raise the dose higher and higher.

The money to fund this scheme was not hard to come by. A single patient who was started on Subsys could generate over $100,000 in revenue for the company.

In 2013 Johnson and Johnson were successfully sued for improperly promoting risperdal to older adults, children and people with developmental disabilities. accusations that it paid kickbacks to doctors and pharmacists in exchange for writing more prescriptions.

They created a sales force called ElderCare to promote it as an off-label treatment for behavioral symptoms of dementia.  These symptoms resemble schizophrenia.  Kickbacks to Omnicare Inc., the nation’s largest pharmacy – pharmacists reviewed nursing home charts and recommended risperdal routinely.  These kickbacks were hidden in the form of educational grants and rebate payments.

Janssen told its sales representatives to visit child psychologists and mental health facilities that mainly focused on children, promoting the drug as a safe treatment for disorders like attention deficit hyperactivity disorder and obsessive-compulsive disorder, the government said.  Boys could develop breasts.

Zyprexa, Seroquel, Depakote,

aid speaker fees to doctors to influence them to write prescriptions for Risperdal. Sales agents allegedly told the doctors they needed to increase their Risperdal prescriptions to get the fees.

In 2010, another big pharma, Novartis, paid $237.5 million to resolve civil allegations over kickbacks to U.S. doctors to prescribe Trileptal and five other drugs. The DOJ alleged that doctors were paid “honoraria” of between $1,500 and $2,000 to speak at physician “events” about the benefits of Novartis’ drugs. Some doctors earned as much as $150,000 a year in honoraria.

Many of the doctors selected by Novartis as speakers had no publications or teaching positions, the DOJ said. And several speakers “had difficulty with English. Other speakers were simply very poor communicators,” according to the complaint.

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