We’ve often written about the conflicts of interest that can compromise patient safety when doctors and other medical providers are paid for promoting drugs, devices or services. In another case of cross-my-palmism, the Texas Department of State Health Services (DSHS) has outed two doctors whose priorities appeared to have drifted away from patient safety.
As reported earlier this month by the Texas Tribune, when two psychiatrists at Terrell State Hospital were told they would be disciplined for accepting hundreds of thousands of dollars to promote the drugs Seroquel and Seroquel XR, they resigned.
Terrell State Hospital is one of 10 psychiatric hospitals operated by DSHS. Seroquel, made by AstraZeneca, is an antipsychotic often prescribed to treat schizophrenia, major depressive disorder and bipolar disorder. Several years ago, the drug earned an FDA “black box” warning, a mandatory alert on the label signifying an extreme risk; in this case, it was issued because the FDA determined that patients with dementia had an elevated risk of death by taking this drug.
Documents from the Texas agency showed that Dr. Anthony Claxton, Terrell’s clinical director, and Dr. Lisa Perdue, a psychiatrist, received massive amounts of money from AstraZeneca to promote the company’s drugs to other doctors and state regulators. When informed that they had violated department rules, both doctors resigned.
Claxton is accused of taking $231,000 from AstraZeneca for “promotional speaking and consulting services” at least 166 times since 2005. Perdue allegedly received $615,525 for 460 occasions since 2005. Texas state law forbids employees from accepting outside compensation that could affect their official duties.
Given the amounts involved here, and the time it takes to earn it, you have to wonder when these people had time to practice medicine … you know, their “official duties”?
The state claims that both doctors contacted members of the Executive Formulary Committee, the body that oversees drug standards in Texas, to advocate for adding AstraZeneca’s products to the state’s list of approved drugs. Perdue supposedly used a pitch in that effort that was written by an AstraZeneca employee.
If your loved one was a patient at Terrell, how good would you feel knowing that his or her drug regimen might have been determined not by best medical practice, but by best promotion speech?
Remarkably, Claxton was surprised by the recent events. In a letter to the DSHS reviewed by The Tribune, he wrote, “I do not deny that I presented these programs,” adding that he thought he had received permission to do so. He also objected to “the timing of this action” because he was scheduled to retire in 76 days.
Perdue’s lawyer suggested that the state had violated her legal rights by demanding an immediate response to the allegations, and questioned the amount of money DSHS says she received. He didn’t deny she received payment, just how much. The lawyer defended her by saying she had promoted the drugs “on her own personal time” because she thought they “offered less toxic side effects for some patients.”
Then why didn’t she do it for free?
A spokeswoman for the Texas agency told The Tribune that the violations were discovered during an investigation into AstraZeneca by the Texas Attorney General, and that there was no evidence that the psychiatrists had compromised their patients’ health by overprescribing the drug.
Who knows if anyone looked for such evidence, and because the doctors resigned, we’ll never know because the state isn’t pursuing the case further.
Find out more about who takes money from drug companies, how much and for what at ProPublica.org’s, data base, Dollars for Docs.