TOV Injury and Safety Blog

Drug payments to doctors

     Following in the footsteps of the State of Minnesota, the State of Vermont recently required drug companies to disclose payments to physicians.  Although Vermont is a small state without a significant number of specialists, some intriguing numbers came out of the Vermont data.  For example, just as in Minnesota, it turns out that Psychiatrists take home more drug company money than any other specialty.  Further, the numbers show that Psychiatrists who took the most money also tended to be more likely to prescribe dangerous, expensive and controversial antipsychotics to children--a practice which has been questioned.   The Minnesota study also found that a significant share of the psychiatrists who were highly compensated had been disciplined in the past and had impaired credibility.

          Overall,  in 2006 drug makers paid $2.25 million dollars to Vermont doctors, their universities or hospitals, for fees and travel expenses.  Payments to psychiatrists doubled from 2005 from $20,835 to $45,692 on average.  This number does NOT include the cost of free drug samples or the salaries or expenses of sales representatives.  The manufacturers' data show that they spend roughly twice as much on marketing the drugs as they spend on researching them.

          Endocrinologists earned the second largest average marketing fees from drug makers:  $33,730 per year.  The top 100 doctors who received the highest compensation included 11 psychiatrists and 5 endocrinologists.  Although we are not privy to the data and couldn't tell for certain, it appears that the averages annual payment was computed for the highest-paid specialists, not for all specialists in the state.

         It appears to be self-evident that doctors' prescribing decisions should not be influenced by drug money.  This kind of back-scratching behavior is inappropriate in any circumstance, but it is deplorable when it occurs in two wealthy professions and the health of innocent people is at issue.  "Bribing" doctors to prescribe a company's drugs should be criminalized so that there is not even the appearance of unethical behavior.  The studies in Minnesota and Vermont confirm our common sense assumption that these payments are influencing the treatment decisions of medical professionals.

China and product liability

          Issues of safety and the flat earth rose to the forefront again this week, as  an importer named Foreign Tire Sales of Union, NJ, was presented with a demand from the NHTSA to recall almost half a million radial tires it purchased in China.  The tires were manufactured without the gum strip which prevents tread separation (much the same defect that killed the Firestone Tire Company and did such damage to Ford Motor Company). 

          The defect was known to Foreign Tire Company (FTC) for almost two years, but did not become public until it was uncovered in a personal injury lawsuit arising out of the wrongful death of two construction employees killed in a rollover accident in Pennsylvania.  The Chinese manufacturer, Hangzhou Zhongce Rubber, which sells the tires under the brand names Westlake, Compass, Telluride and YKS admitted in September, 2006 that it "unilaterally decided to omit the gum strips" and was "generally unresponsive" when asked to address the problem.  The owners of Foreign Tire Sales, Inc., say that they cannot afford to mount a massive recall effort or to replace or dispose of the defective tires.  "We don't really know where to start....FTS...will have to go belly up."  NHSTA officials were officially "outraged" at FTS's dilatory response, but consumers still have no recourse beyond watching FTS's owners collapse the corporation and its debts.

          In states like Michigan where the retailer and wholesalers are not responsible for defective products, consumers will have no remedy whatsoever for product failures, since the Chinese manufacturers cannot be forced to respond to injury or death claims:  the Chinese government routinely refuses to make them available to legal process, and they do not provide insurance coverage.  Thus, Chinese companies have yet another strategic advantage over American firms, and cannot be held to account for errors made through negligence or greed, and American consumers are left to the mercy of taxpayers when dangerous products of Chinese origin cause grievous injuries.

         In the name of international corporate profit, American citizens are being fleeced of their jobs, their safety, and their legal rights. Not only our manufacturing base, but also our perspective on justice, is being transformed overseas.

Product liability in Michigan

          Have you wondered how many product liability cases are "clogging" the courts in Michigan?  Well, if you have no personal life and that issue has been troubling you, the answer is at hand.  The Michigan Supreme Court's Annual Reports' Circuit Court Statistical Supplement is now available for the years 2002 through 2006.  There were three product liability trials in 2002.  There were one hundred percent more in 2003:  that is there were six!  We had another increase in 2004 with seven cases tried.  @%$#^@&^&  This upward trend leveled off in 2005 and 2006 when Michigan citizens and their lawyers tried 5 product liability cases each year.  No wonder the courts no longer have room for divorce or criminal matters!  Every twenty years, each of the 80 counties in the state has to take a week out to try a product liability case! 

          By the way, the total number of personal injury cases tried in Michigan in 2006, in case you were wondering: 104 malpractice trials; 119 auto negligence trials and 113 other forms of injury claims tried.  A little more than three injury cases for every county in the state, average, for the entire year.  About one percent of the total filings in the Circuit Court.

Case filings and "Reform"

        In an incredible display of audacity, the Chamber of Commerce continued its war on victims' rights by asking the legislature for additional legal reforms in Michigan.  It falsely claimed that "forty percent fees" are "often" charged by attorneys, even though attorneys in Michigan are limited by law to charging a maximum one-third fee in contingent fee cases.  The Michigan Chamber must have been too lazy to investigate and simply dropped this line from the Chamber's national lobbying campaign into the Michigan literature.

          The Chamber suggested that Michigan needs contingent fee reform to protect Michigan from "frivolous cases" without documenting that frivolous cases are occurring or explaining why a limit on fees in meritorious cases would have an impact on the filing of frivolous cases.  Clearly, the Chamber has become so brazen that it no longer believes itself subject to normal rules of reasoned discourse or logic.  The Chamber also asked for "additional sanctions" for pursuing frivolous claims, but failed to mention that Michigan currently has one statute, three Court Rules and one rule of Professional Ethics which all ban and punish frivolous claims and which can lead to payment of costs, sanctions and fees by lawyers or litigants or to discipline by the courts or the State Bar.

          The Chamber suggests that too many cases are being filed, without citing the actual numbers.  Even a glance at the actual numbers will demonstrate that Michigan's role in the Chamber's national campaign is absurd and incredibly cynical.  For example, while there were 1,925 medical malpractice filings in MIchigan in 1983, and 3,629 in 1986 as legislative reforms were being implemented, only 931 cases were filed in Michigan in 2006. Michigan has averaged fewer than 100 malpractice trials per year for the years 2002 through 2006, and Michigan ranks in the bottom eight to 14 states nationally, for the median payout on malpractice claims.  In the year 2000, for example, insurers paid compensation on only 300 malpractice cases in Michigan, total.

          While the population of doctors and patients has increased substantially during this twenty years, the number of filings has been reduced by at least fifty percent, and compared with 1986 by 75 percent.  By any measure, if filings are down from 3600 to 900, the number of "frivolous filings" is no longer a problem--if it ever was.  (See Michigan Lawyers Weekly, June 25, 2007 21 Mich L.W. 940, pp. 1, 32)  These arguments have become so brazen and so detached from reality that the Michigan Defense Trial Counsel organization has joined the State Bar in repudiating the Chamber's claims.  When the organization that is directly compensated for representing your interests no longer supports your arguments, it should be an indication that you are departing from reality.  As both of these organizations explained, the Chambers claims are entirely divorced from the actual practice of law in Michigan and are clearly politically oriented:  we already have a form of "loser pays" which the Chamber is apparently unaware of; we already have two mandatory forms of settlement-inducement procedure which the Chamber ignores; there are no frivolous claims any longer; and by the Chamber's own numbers, only 19 percent of the total recovery is normally paid to Michigan lawyers--not the "forty percent" it hypes. 

        The Lawyers Weekly also made another interesting observation.  It noted that while medical malpractice reform was touted as a means of bringing physicians to Michigan, in fact, as the number of claims has come down, the increase in the number of doctors practicing in Michigan has trended downward over the two decades of "reform".  In fact, liability is only one small factor in physicians' choice of geographic location--and for the past ten years physicans have increasingly gone elsewhere despite Michigan's relatively attractive liability climate.

          By the way, even the Chamber had to admit that reducing the number of malpractice claims by between fifty and seventy-five percent didn't reduce malpractice premiums:  it claimed that as a result, premiums "stabilized".    One wonders by what percentage we would have to reduce lawsuits for the insureds to reap an actual savings in liability premiums if 75 percent wasn't enough?

          In truth, this is simply a cynical effort to trash what was the best and most consumer-oriented legal system in the world.  By making scapegoats of lawyers and courts, the Chamber can continue to assure high corporate profits.  Compare these statistics with the recently released record Michigan insurance profits discussed elsewhere in our weblog.

Product injuries and the Flat Earth

     Much has been written about the shrinking world of commerce and how the world has become "flat", enabling competition from continents away.  In the United States, this has also generated controversy as a "race to the bottom" since many good jobs, particularly in manufacturing, are being moved overseas where labor costs are low and worker's rights and safety are negligible.

     The recent controversy over toy recalls raises additional issues of safety and liability, particularly for Michigan residents.  So far in 2007, 24 toys have been recalled in the United States, including all of the "Thomas the Train" toys [in the case of Thomas, the issue is the use of lead paint].  All of these recalled toys were manufactured in China--along with 70 to 80 percent of all toys sold in the U.S. 

     A number of other Chinese products have also been recalled in the past few months, including poisonous tooth paste.  Clearly, "cheap" products from a loosely regulated economy bear additional safety risks that Americans had been accustomed to ignore.

     These products bear an additional risk for Michigan residents, since after tort "reform" the seller of the product is not legally responsible for defects or injuries they cause.  Further, the Chinese government doesn't allow its industries to be sued (particularly since most are government-owned).  As a result, when a "Thomas" occurs in Michigan, if it causes catastrophic injuries to someone, no one is responsible and has to stand behind it.

     Prior to "reform" large retailers like Wal Mart and K Mart required their suppliers to purchase substantial insurance policies to indemnify the seller and protect the consumer.  Since they are no longer amenable to suit in Michigan, they no longer add this requirement to their purchasing terms, and if the company has an insurance contract, it is not available to injured Michigan consumers.

More on money and judicial elections

     A recent report funded jointly by the Justice at Stake Campaign, the Brennan Center for Justice and the National Institute on Money in State Politics found more basis for concern over "purchasing" state judgeships.  It noted that between 2002 and 2004, the amount of money raised to support judicial elections had increased from 29 million dollars, nationwide, to 47 milllion dollars.  In 2006, it dropped to "only" 34.4 million dollars when there were fewer contested races, while the median financial contribution total, per judgeship, increased by almost 25 percent from $202,000.00 to $244,000.00.

          Spending on television advertising is one significant component in this increase.  Candidates for Alabama's elected Chief Justice seat purchased a total of 17,830 TV spots for this one election in the second-most expensive judicial race ever.  The biggest spenders in these races are not, as some would suggest, trial lawyers.  Despite their intimate familiarity with the candidates and issues, all lawyers are overwhelming out-spent by business interests:  in 2006 nationwide races, business interests contributed more than 15 million dollars, while all lawyers of every political stripe combined contributed only about 7 million dollars.

        Actually, regardless of who is identified as "buying" judges, the practice and appearance are denigrating to the court and to the image that the justices are "above" political influence.  Figures from the 2004 and 2006 elections showed that the outcome of 85 and 68 percent of judicial elections, respectively, could be accurately predicted by analyzing which candidate received more cash. 

         Our courtrooms should be the final refuge of equality in our society.  It is dangerous enough that legislators may be "purchased" and protected from campaign regulation by the argument that the First Amendment protects unlimited finanicial contributions.  No citizen should enter a courtroom in this country knowing that the elected judge has been elevated to the bench through the financial efforts of a particular industry, trade group or special interest.  When we read of judicial pronouncements and verdicts, we should have confidence that they represent the best thinking of our generation, with as little special interest influence as possible.  Judicial opinions on topics like land use, injury liability, criminal procedure and constitutional rights, medical malpractice and corporate governance are too important to be purchased in advance by special pleaders.  Perhaps if the media did not reap such a windfall every election cycle, it would be more open to supporting a campaign for judicial selection reform.

Who educates doctors?

         You may be surprised to learn that continuing medical education for doctors is not provided exclusively--or even primarily--by the medical profession or the university system.  The New York Times for June 13, 2007, reported that a sea-change has occured in continuing medical education over the past decade.  In 1998, drug-industry financing of continuing medical education amounted to 300 million dollars.  By 2007, the drug manufacturing industry was contributing 1.12 billion dollars and paying for half of all continuing medical education in the United States.

         The risk associated with this situation can be demonstrated by Vioxx, the pain-killer that was responsible for an estimated 140,000 cases of serious heart disease between 1999 and 2004, according to Dr. David Graham, safety researcher for the FDA.  When drug manufacturers sponsor physician education, they have a natural profit-incentive and cultural bias toward minimizing the potential health risk associated with a particular drug, and toward promoting drug use in general.  Education about drug use and risks tends to be entirely one-sided and unbalanced.

          To counter this common-sense problem, the organization that accredits and certifies continuing medical education forbids drug manufacturers from paying physicians who teach continuing medical education courses.  To circumvent this prohibition, the drug companies hire for-profit "medical education communication companies" to organize CME courses.  These companies launder drug company dollars that compensate physician lecturers and writers--who then present data as though it were originating from a neutral source.  A recent lawsuit against Pfizer documented that physicians were even compensated for appending their name to medical journal articles ghost-written by the industry.  In case you think that this risk is only theoretical, you should realize that Republican Charles Grassley of Iowa and Democrat Max Baucus of Montana headed a U.S. Senate Committee that recently concluded--after a two-year study--that drug companies do in fact use this educational process unethically as a marketing device.

Record Profits for Michigan Insurers

         A recent analysis of the financial reports from AAA, Allstate and State Farm (these three insurers account for about 45 percent of Michigan auto insurance premiums) documented that they have made record profits since 2002.  Even accounting  for losses caused by Hurricane Katrina, these companies have earned record profits and created record levels of reserves.  This performance is consistent with record after-tax profits in the industry generally:  the industry reported profits in 2006 of 63 billion dollars--which was fifty percent above 2005's record profit of 43 billion dollars. 

          The Auto Insurance Report, a respected industry commentator, explained that the Michigan insurers are "significantly" more profitable than their reported loss ratios would indicate; and other industry investment organs have described Michigan insurers' profits as "eye-popping" or "the second-highest of a generation".  As the Auto Insurance Report described the situation:  "Everyone, and we mean everyone, made money..."  For the decade ending in 2002, [this would be measuring performance prior to the full impact of "reform"], AIR estimated that Michigan auto insurers earned a profit on net-worth that was approximately 25 percent higher than auto insurers nationwide.  These profits will rise in 2007 and in the future as Michigan apparently has the lowest loss-to-premium ratio in the industry and that ratio is declining on an annual basis as "reforms" reduce the number of viable claims. 

            AAA, the best indicator of Michigan's auto insurance performance, had a loss ratio (earned premiums to defense costs) of eight percent:  "lower than virtually all insurers doing business on a national level".  In fact, in Michigan these premium dollars are so lucrative that the only area of increased expense is marketing.  Michigan insurers are willing to spend one-third of their premium dollar on agents' commissions and underwriting expenses in order to compete to attract these low-payout premiums.

          AAA, which writes 80+ percent of its business in Michigan, doubled its annual profits in the past five years (from 50.9 million in 2002 to 104.2 million in 2006) and increased its surplus from 915 million dollars to $1.534 billion by the end of 2006.  Allstate and State Farm, which conduct substantial business in other states, reported similar profits and surpluses. 

          These record profits originate substantially from automobile liability coverage.   Auto insurance accounts for about forty percent of all property and casualty insurance. While liability coverage constitutes only between 15 and 16 percent of the total cost of Michigan No Fault coverage, it is highly lucrative.  About fifty percent of the cost of coverage is for physical damage to property.  The remaining one-third of the Michigan auto premium dollar goes to no fault coverage (which primarily covers medical expense). 

          Analysis of the claims incurred or paid, when compared with premiums collected, shows that premiums collected for liability coverage are "excessive" and are a primary source of the documented profits.  Premiums collected for this coverage exceed the dollars paid out and disproportionately support profits and other coverages.  While it is clear that Michigan insurers make a significant profit on liability coverage and property coverage, it is impossible to evaluate the propriety of the final component of no fault premiums--no fault medical profits, because all Michigan insurers must contribute to the catastrophic claims fund which is operated by a board of insurance representatives:  this board has refused to release its actuarial or reserve calculations to the public and denies that it is subject to the Freedom of Information Act.  The catastrophic claims fund that sets and collects these premiums is the same entity that was embarrassed into returning excessive premiums ($180 per car) to Michigan rate-payers in 1998.

          Since liability coverage constitutes only fifteen percent of total Michigan auto premiums, if half of all existing liability claims were eliminated it would reduce the cost of auto insurance by only about seven percent.  Nevertheless, when insurers talk about the cost of coverage and "reform", liability and trial lawyers are the only topics they discuss:  where "liability" was once associated with "safety" and "accountability", it has now been purposely equated in the public's mind with frivolous greed.

         Investigation of these profit figures and claims information make clear that Michigan citizens have been duped into giving away their rights when victimized, not to save on insurance premiums, but rather to enhance the profit potential of large insurance corporations.  If insurance or tort "reforms" and profits were monitored by the State and actually translated into a reduced cost of using the roads, we could say that a legitimate public policy choice ( cheap transportation over reparations for injury) had been made.  As matters stand, however, we merely have one more example of ordinary people being taxed through auto insurance to support big business profits.

Traveling employees

          For the past forty years or so, an employee in Michigan has been entitled to workers compensation if he was injured while traveling on behalf of his employer.  That ended definitively this year when the insurance-oriented majority of the Mighigan Supreme Court decided Bowman v. R.L. Coolsaet. 

          Mr. Bowman was working out of town and driving back to his hotel room when he was paralyzed in a motor vehicle accident.  The lower courts held that since he was traveling for his employer and was not off on a personal lark when the wreck occurred, he should be entitled to workers compensation.  The conservative majority rejected this analysis--which had been the law of our state for several decades--and held that Mr. Bowman was not entitled to workers compensation.  This group of judges would pay him comp only if he was injured while directly engaged in the employer's business task, regardless of the fact that he was visiting another city solely for the employer's purposes.

The Supreme Court and "independent medical examinations"

    This week the conservative four-member majority of Michigan's Supreme Court issued a new ruling on independent medical examinations (IME's).  It was presented with a controversy regarding an examination scheduled by State Farm.  State Farm had set the examination with a doctor whom it consulted regularly, and who had previously violated the attorney-client privilege during examinations by inquiring into the insured's conversations with her attorney.

          The IME came up in the context of litigation over personal injury protection (PIP) benefits sought by the insured after a motor vehicle collision.  State Farm had denied payment and the insured had initiated suit.  After suit was started State Farm compelled the insured to attend the IME at its' doctor's office.  Faced with the history of inappropriate questioning by this doctor, the trial judge relied upon the Court Rule governing IMEs in personal injury litigation to impose certain conditions upon the examination.  State Farm did not claim that the conditions were unreasonable:  it claimed and "unconditional right" to an examination...without regard to "good cause".  It maintained that the Court Rule regarding IMEs in litigation should not apply to a no fault insurance claimant and that the only requirements should be those contained in the parties' insurance contract.  The trial judge and the Court of Appeals rejected this claim and ruled that all IMEs are subject to the court rule.

          The four members of the Supreme Court who have been regularly criticized for pandering to the insurance industry overturned the lower courts' rulings and held that State Farm was not required to meet the conditions imposed by the trial court.  The four members suggested that the rights of the no fault insured were limited to the insurance policy and two limited provisions in the no fault act.  It held that no fault insureds don't enjoy the normal court rule protections incorporated into personal injury actions.

          The insurance-oriented majority held that "physicians are presumed to be bound by the methodologies of ther profession and by principles of professional integrity" and that until an insured submits to the court demonstrable evidence to rebut this presumption, a court may not impose conditions on the conduct of a no fault IME.

          As a result of the Court's decision, fewer insureds will have the protections which were assumed to apply to IMEs and insurance-retained physicians will be entitled to stretch the envelope in their dealings with injured victims.  We believe, along with the majority of judges who considered this issue (3 in the Supreme Court, two in the Court of Appeals and one in the trial court) that there was no rational or statutory basis to deny the carefully considered court rule protection framework to all injury claimants.  The protections in the Court Rule impose basic obligations such as requiring the IME insurer to provide a copy of the resulting report to the victim.

The Drunk Driver's Relief Act

       The No Fault act makes an at-fault driver responsible for any "serious" injuries he causes.  For many years, the meaning of this threshold requirement was simple:  jurors had to consider the facts of the injury and damages and decide whether it was "serious" in normal parlance.  As most people now know, in the Kreiner case the conservative majority of the Supreme Court re-intrepreted "serious" to require that the injured person's injuries have a "life-altering" impact.  They also stated that the life-altering impact cannot be based on pain and can only be based upon physician limitations and restrictions.

           There have been many notorious and senseless pro-insurance and anti-victim decisions since Kreiner.  A teen-aged girl's closed head injury that necessitated  missing a full year of school was deemed "not serious".  A neck injury that caused a herniated disc, dangerous surgery, several months of missed work and nagging permanent pain "was not a serious impairment".  Several victims with  serious limb or facial fractures, torn knee ligaments, ruptured discs, and other colloquially "serious" injuries have been denied compensation, despite permanent restrictions on work activities and hours (even to the extent of being limited to working 24 hours per week), total loss of recreational activities, and doctor-confirmed lifetime pain problems.

        The latest of these extreme decisions releasing a careless driver's insurance from paying compensation , involved a man who suffered a torn rotator cuff and other injuries in a high-speed collision when the at-fault blew a red light at an intersection.  The victim, Herbert Jurnikian, made a fairly prompt recovery form injuries to his knees, hands, and neck, but his torn rotator cuff turned out to be intractable. 

          His family doctor wouldn't approve the recommended surgical repair because of his age and pre-existing emphysema, so Mr. Jurnikian was forced to live with chronic, severe pain in the shoulder.  He had attended literally dozens of physical therapy sessions over more than a year.  The therapists recorded that he could not do any pushing, pulling, lifting, carrying or heavy work involving his shoulder.   He could not even shoot pool without experiencing pain, and often required help with dressing and bathing.

          Despite the fact that he endured severe pain with virtually all activities that was so severe his doctors would have liked to operate to give him some relief, two judges of the Court of Appeals ruled that "reasonable minds could not conclude" that he had suffered "a serious impairment of bodily function."  These two judges thought the issue was so clear that they did not even allow Mr. Jernukian's attorneys to participate in Oral Argument on appeal.  One would think that with the threshold for liability claims raised this high, all Michigan residents should have seen a significant reduction in our no fault insurance premiums:  has your insurance gone down in the past few years?

Money and our Supreme Court

          In June of  2007, the Northern Express included an article by Rich Robinson of the Michgian Campaign Finance Network, a non-partisan watchdog group, that tracked financial contributions to the conservative majority of the Michigan Supreme Court.  Their findings help to explain why the Court, nearly always on a 4 to 3 vote, has "reformed" so many existing rulings for the benefit of the insurance industry and the Chamber of Commerce.  Leading a national trend, Robinson claims that these conservative interests have created the appearance of purchasing a court composed to their satisfaction.

           According to Robinson, 16 million dollars was spent on three Michigan Supreme Court seats during the 2000 election.  Less than half of that total was subject to disclosure under Michigan's loosely regulating campaign finance laws.  For example, tracing expenditures through the files of Michigan broadcasters and other public records, Robinson noted that in the year 2000, several corporations, including WalMart, Home Depot and Daimler-Chrysler each contributed 1 million dollars to the U. S. Chamber of Commerce, which then spent 10 million dollars on state Supreme Court races in Michigan and four other states. 

            The U.S. Chamber gave 3 million dollars to the Michigan Chamber to directly subsidize Michigan television advertising critical of consumer-oriented Supreme Court judicial candidates.  Not surprisingly, soon after the Chamber-supported candidates won, they overturned two Daimler-Chrysler verdicts that saved the corporation more than 50 million dollars in damages.  As Robinson notes, without examining the merits of either of these cases, if one is inclined to see the world in this light, it appears that Daimler-Chrysler obtained an excellent return on its million-dollar investment.  There is at least an appearance of impropriety, the stain of which should be removed from our judicial elections.

         Nor is this problem an isolated situation.  The same thing continues to happen on a consistent basis in Michigan and many other states.  Since 2000, Robinson notes that the Michigan Chamber has spent an additional 6 million dollars on advertising complimenting the performance of its pet "reformers".    According to Robinson, a review of broadcasters' public records shows that the Chamber has spent more on each of these judicial elections than the candidates, themselves, have spent.

          Robinson and Northern Express make a persuasive argument for public-financing of Michigan judicial races and for full disclosure of all expenditures to influence judicial voting.  Our courts should not be on the market for purchase by the highest, secret bidder; and there should not be even the appearance that they are.  When one combines this kind of one-sided expenditure [and this doesn't tally the contributions made by insurers to the same candidates] with equally one-sided anti-consumer rulings, you have a recipe for the loss of public trust in the judiciary.  In the long run, that doesn't serve the interests of anyone in our society.

         

More information on drug research and approval

          Minnesota disciplines a lower percentage of doctors than most states, however, it is also the only state that allows public access to its records.  Periodically and frequently this data base allows for the collection of some enlightening information.  This week, analysis of Minnesota's public records showed that many of the doctors who are recruited by drug companies to test or market their pharmaceuticals have documented convictions for fraud, reckless conduct, suspended licenses and other problems that would seem to make them ineligible to supervise drug studies.

          In this recent study, at least 103 doctors who had been disciplined or sanctioned by the state medical board had received a total of $1.7 million dollars in compensation from drug makers.  The smallest payment was $1250.00; the largest was $479,000.00.  Of the 103, the New York Times reported that 39 were sanctioned for inappropriate prescribing practices, 21 for substance abuse, 12 for sub-standard care and 3 for mismanaging drug studies.  The FDA inspects fewer than one percent of drug trials, but when it approves a drug--usually through a committee dominated by drug manufacturer's representatives--the company becomes immune to suit in Michigan, even where there has been fraud or reckless non-disclosure.         

            A prime example of the disciplined doctors was a psychiatrist who was convicted of "reckless, if not willful, desregard for the welfare of 46 patients," five of whom died under his care or immediately after release. His license was suspended and then restricted  for two years.  When he came back to practice, he resumed overseeing drug testing on his patients and was handsomely paid by pharmaceutical companies for doing so.  He claimed to have assisted in the study and approval of Paxil, Prozac, Risperdil, Seroquel, Aoloft and Zyprexa. 

          A child psychiatrist who was convicted of fraud involving a Ciba-Geigy study continued to be hired by Eli Lilly for drug marketing until he decided, on his own, that given his reputation, he lacked credibility and was being hired only "to influence his own prescribing habits".  A former drug marketer told the authors of the investigation that manufacturers select phyisicians for marketing and speaking fees solely on the basis of the volume of prescriptions they are able to write.

         Another Minneapolis psychiatrist who was criticized and forced to clinical re-training in 1994 told the authors that he was paid more than $350,000.00 over a seven year period (including $314,000 by Eli LIlley) because he is "respected by his peers".  Another, who pleaded guilty in 2003 to Medicaid fraud, collected $63,000.00 in 2004 and 2005.  He described the author's questioning as "ridiculous" and "insulting" and managed to justify prescribing Resperdil in the same way he justified buying his new Mercedes. (The maker of Resperdil paid him $30,000.00 over a two year period.) He concluded by telling the authors "I will pray for you daily."   I guess we should be praying for him, too.