The Industry Veteran some time ago decided that the only decent career path left in pharma was that of whistleblower. He has more evidence to back his case. Here’s the Veteran’s restrained take on the matter.
Here’s another piece of evidence to support my argument that whistleblowing represents the most promising career path for a young person starting out in the biomedical industry. Biotechs such as Genentech, Amgen and the other large ones are an especially fertile venue. The avaricious ambitions of senior executives and their accompanying desire to mimic the Big Pharma operations tend to alienate both the scientists and the commercial people who were originally attracted to the biotech side of the drug discovery business. These increasingly disgruntled coworkers can provide excellent leads into illegal practices that the enterprising whistleblower can use to his/her advantage.
The current Genentech whistleblower held the job of medical science liaison or MSL. The medical science liaison position (also called health science associate, clinical liaison and other terms by various companies) remains especially advantageous for launching a whistleblowing career. The MSLs and their otherwise designated counterparts are hybrids who combine a sales function with that of clinical trials missionaries. Their putative function consists of discussing clinical trials with curious and knowledgeable practitioners. This gives them considerably more leeway in their interaction with physicians than that given to sales reps who are restricted to discussing information appearing on the current labels of existing products. In an effort to foster the appearance that MSLs serve a scientific and educational function, their departments report up to the medical affairs operations of the respective companies, rather than to sales. As part of the same illusory effort MSLs are relieved of responsibilities for delivering samples. Nor are they evaluated by measurements used to calculate bonuses for sales reps, such as market shares or sales volumes within their assigned territories. As a result the MSL people are held in high contempt by the great majority of their sales rep colleagues.
An acquaintance at Abbott Laboratories recently told me about some of his work as an MSL. He plies his trade on behalf of the company’s rheumatoid arthritis product, Humira. In this capacity he recruits influential and high prescribing rheumatologists to conduct redundant clinical trials (see the article from 2 January Washington Post on “superfluous medical studies”). His effort serves several purposes. In the first place, the trials provide an acceptable cover for paying high volume prescribers to use the Abbott product. Marketers call this practice “buying market share,” the rest of us term it bribery. Secondly, by using influential and high prescribing practitioners to run these humdrum trials, the payoffs also exert a trickle down effect. Smaller fry, garden variety physicians develop their product preferences partly by following the usage patterns of acclaimed authorities in their geographic areas. Information about influential colleagues in the neighborhood who are conducting trials for a particular product, typically spread by the sponsor’s sales reps, sends a clear message to the vast number of follower physicians. Both the payoff and the trickle down functions are then enhanced when the sponsoring company hires the investigator-physician to speak to the small fry at dinner meetings and symposia.
Approximately a year and a half ago, my acquaintance was attending a rah-rah session at Abbott headquarters with his associates. The director of MSLs started out by voicing an obstreperous defense of the operation under his leadership and its contribution to Humira sales. “Don’t let anyone tell you,” the director exhorted his underlings, “that we don’t contribute to the top line.” As he advanced to the next PowerPoint slide, he emphasized the fact that MSLs had accounted for $78 million of added Humira sales during the recently ended quarter. Before anyone in the audience could inquire about the particular ass from which the director pulled that number, the company’s CEO, Miles White, jumped to the center of the presentation dais and used his body to block out the slide. In an enraged tone White pointed his finger at the startled MSLs and told them to forget they had ever seen such a slide or heard their director’s last comment. It seems White was immediately aware that his director’s effort to justify the continuing existence of an MSL department tore down the fictive Chinese wall by which the Pharma companies seek to separate their educational and scientific communications from crass selling.
In such an environment, I plaintively ask, is not whistleblowing the most noble calling?
ABC News reporter Joy Victory found a really juicy angle on the problems of being uninsured. Her article is called Need an Organ? It Helps to Be Rich. As you might suspect getting on the waiting list for an organ if you’re uninsured is pretty tricky. Entry to the list is controlled by the big medical centers that do transplants. Although everyone is supposed to be viewed independently of means, its totally obvious that if the patient is uninsured the hospital concerned will lose a packet on the procedure. So like every other aspect of care access for the uninsured, their chances of getting access to that list are much lower than those with insurance. And of course it goes without saying that unless they are lucky enough to be in a job offering great insurance — a number which is getting lower every day — they are not going to be able to buy insurance at any affordable price.
Jonathan Cohn takes a good look at the Medicare implementation now and then, in 
