美國一藥企高價收買問題醫生推銷止痛藥

Dr. Judson Somerville, a pain specialist in Laredo, Tex., received $67,000 in speaking fees, travel and meals in 2013 to promote a powerful and addictive painkiller called Subsys, according to a new federal database of payments that drug companies make to physicians.

得克薩斯州拉雷多市的痛症專科醫師賈德森•薩默維爾(Judson Somerville)博士，因推銷效力強大但卻會讓人上癮的止痛藥Subsys，而在2013年收到了6.7萬美元的演講費和餐旅費。這一數據來自一個新成立的聯邦數據庫，它專門蒐集製藥公司付給醫生的款項的數據。

But while Insys Therapeutics, the Arizona company that makes the product, was paying Dr. Somerville to promote it, he was under investigation by the Texas Medical Board. Last December, the board ordered him to stop prescribing painkillers after it found that he had authorized employees to hand out pre-signed prescriptions to patients and after it learned that three of his patients had died in 2012 of drug overdoses, most likely from drugs that he had prescribed.

Subsys是由亞利桑那州的Insys Therapeutics公司生產的。該公司付款給薩默維爾，請他推銷這種產品的時候，他正在接受得克薩斯醫學委員會(Texas Medical Board)的調查。該委員會發現他曾授權員工把他預先簽過名的處方分發給病人，還了解到他的三位病人因用藥過量而在2012年死亡——最有可能的致死原因就是他開的藥——於是在2013年12月勒令他停止給病人開止痛藥。

Dr. Somerville, who received more money from Insys than any other doctor between August and December 2013, is just one of the company’s highly paid doctors who have recently faced legal or disciplinary trouble.

近期以來，在從該公司獲得高額報酬的醫生當中，遇到法律問題或者行業紀律問題的不是隻有薩默維爾，雖然他在2013年8月至12月之間收到的錢比其他人都多。

Dr. Gavin Awerbuch, a Michigan neurologist who received $56,000 from Insys, was arrested this spring after federal prosecutors said he defrauded Medicare of $7 million and improperly prescribed Subsys to patients who did not need it. Another top Insys speaker, Dr. Jerrold Rosenberg of Rhode Island, was reprimanded in September for inappropriately prescribing painkillers, including Subsys.

從Insys公司收取了5.6萬美元的密歇根州神經科醫師加文·奧爾巴克(Gavin Awerbuch)博士於今年春天被捕，聯邦檢察官稱，他騙取了700萬美元的醫保(Medicare)基金，還曾把Subsys不恰當地開給並不需要服用這種藥的病人。9月，Insys公司的另一位得力代言人、羅德島州的傑羅德·羅森伯格(Jerrold Rosenberg)博士，因爲濫開包括Subsys在內的止痛藥而受到申斥。

An analysis of the new federal Open Payments database shows that five of the 20 physicians who received the most money from Insys recently faced legal or disciplinary action, including three who were said to have inappropriately prescribed painkillers.

來自新建的聯邦數據庫“款項公開”(Open Payments)的一份分析報告顯示，近期從Insys公司拿錢最多的前20名醫生當中，有5名面臨着法律或者行業紀律的制裁，其中包括前述所說曾濫開止疼藥的3個人。

Many of the 20 highly paid doctors — most of them pain specialists — were also top prescribers of Subsys, according to prescribing information from Tricare, the health insurance program for military families, and internal Insys documents.

來自服務於軍人家庭的醫保計劃Tricare的信息以及Insys公司的內部文件顯示，拿錢最多的這20名醫生——多爲痛症專科醫師——同時也是最常給患者開Subsys的人。

The data, which covered only that five-month period in 2013, provides unusual insight into the lengths that some drug companies go to cultivate relationships with doctors, and shows that Insys enlisted doctors with troubled track records to market its product to other physicians.

這些數據只反映了2013年5個月的情況。它們給我們提供了不同尋常的新視角，讓我們得以瞭解某些製藥公司爲了跟醫生搞好關係而付出的代價；同時還顯示出，Insys公司網羅了一些有不良記錄的醫生，讓他們把Subsys推銷給其他醫師。

The aggressive marketing of Subsys, the company’s only brand-name product, is especially remarkable, given that its use is highly restricted; it is approved only for cancer patients who are already taking opioid painkillers around the clock. Previous analyses have shown that only 1 percent of prescriptions for the product are written by cancer specialists.

Subsys是Insys公司的唯一一款知名產品，鑑於這種藥的使用是受到嚴格限制的，該公司激進的市場推廣手法顯得尤爲引人注目；按照規定，只有已經在全天服用阿片類止痛藥的癌症病人才可以服用Subsys。此前的一些分析報告已經顯示，這種藥的處方只有1%是來自癌症專科醫師。

Several former sales representatives said in interviews that they were encouraged by the company to call on pain doctors who treated patients with a wide range of ailments, and to reward high-prescribing physicians with perks like paid speaking engagements. And in at least two cases, the company hired the adult children of top doctors to serve as their parents’ sales representatives.

幾個前銷售代表接受採訪時表示，該公司曾鼓勵他們去拜訪爲患者診治各種小病痛的痛症醫生，並給予開藥多的醫生付費演講之類的好處。此外，起碼有兩個例子顯示，該公司曾僱傭開藥最多的那些醫生的成年子女擔任其父母所在地的銷售代表。

In a statement, Insys said that it had appropriately marketed Subsys and that the drug had been successful because it works better than its competitors. “We believe that existing data strongly supports that prescribing decisions have been driven primarily by the clinical attributes of Subsys,” the company said.

Insys公司在一份聲明中表示，自己一直在以恰當的方式推銷Subsys，而且這種藥取得了非常好的成績，因爲它比同類產品更有效。該公司稱，“我們認爲，已有的數據有力地表明，Subsys的臨牀屬性是醫生決定開具處方的主要推動力。”

Insys paid doctors $2.8 million in the final five months of 2013, a marketing budget that put it in the company of major drug makers like Boehringer Ingelheim and Novo Nordisk, which market several products that are used to treat common medical conditions like diabetes and heart disease. During a five-month period at the end of 2013, Insys paid 20 doctors more than $30,000 each in speaking and consulting fees as well as perks like travel and meals.

2013年8月至12月，Insys公司總共向醫生們支付了280萬美元。如此龐大的市場推廣預算足以比肩一些大型製藥公司，如勃林格殷格翰(Boehringer Ingelheim)和諾和諾德(Novo Nordisk)，後兩者所銷售的是一些用於治療糖尿病、心臟病等常見病的藥物。在2013年的後5個月，Insys公司以演講費、諮詢費、餐旅費等形式向每一名開藥量排在前20名的醫生都支付了3萬美元以上的款項。

Several of the highest-paid doctors said they spoke on behalf of Subsys because they believed in the product.

拿錢最多的幾個醫生表示，他們之所以推介Subsys，是因爲相信這個產品。

“I’m not a big ‘talk for companies’ kind of guy,” said Dr. Somerville, who noted that he was a former president of the Texas Pain Society. “They liked my personality and how I approached things, and I liked their product.”

“我不是那種大力‘爲公司說話’的人，”薩默維爾說。“他們喜歡我的個性和我處理事情的方式，而我喜歡他們的產品。”薩默維爾表示，他曾擔任過德克薩斯疼痛協會(Texas Pain Society)的主席。

Dr. Somerville, who was a top prescriber of Subsys, said Insys representatives never questioned him about the Texas Medical Board’s ruling, and he continued speaking about Subsys for a few months after the board’s decision. Insys officials said they removed him as a speaker after learning of the disciplinary action.

薩默維爾是開出最多Subsys的醫生之一，他表示Insys的代表從未問過他有關德克薩斯醫學委員會的裁定的問題，他在該委員做出裁定後的幾個月的時間裏，仍在演講推銷Subsys。Insys高管表示，在得知相關紀律制裁後，他們取消了薩默維爾的演講者資格。

Dr. Somerville took issue with the medical board’s claims, saying the board did not have evidence that he contributed to the patients’ deaths and that the action was the result of a vendetta against doctors who frequently prescribe opioids. “I’m very aggressive in trying to help my patients,” he said. “I’m a very caring doctor. I like money, but that’s not my god, O.K.?”

薩默維爾反對醫學委員會的說法，稱該委員會沒有證據證明他的行爲與病人死亡有關，並稱該委員出於對經常開阿片類藥物的醫生的怨恨，做出了懲罰決定。“我非常積極地幫助我的病人，”他說。“我是一個關懷病人的醫生。我喜歡錢，但錢不是上帝，對嗎？”

Other top speakers for Insys have also faced regulatory or legal trouble. Dr. Paul Madison, a pain specialist in Chicago, was indicted in 2012 on federal fraud charges after the authorities claimed that the surgical center he owned billed insurers for procedures that were never performed. Insys paid Dr. Madison nearly $33,000 in 2013. Another top Insys speaker, Dr. Steven Y. Chun of Sarasota, Fla., paid $750,000 in February to settle federal charges that he had billed for procedures he did not perform. Dr. Chun received $45,000 from Insys in 2013, according to the database.

Insys公司的其他主要代言人也面臨監管或法律問題。2012年，芝加哥的疼痛專家保羅·麥迪遜(Paul Madison)遭到聯邦的欺詐指控，相關機構稱他擁有的手術中心提交給保險公司的賬單中包含一些從未涉及的程序的費用。2013年，Insys給了麥迪遜將近3.3萬美元。Insys的另一名主要演講人——佛羅里達州薩拉索塔的史蒂文·Y·陳(Steven Y. Chun)在2月份支付了75萬美元，就聯邦訴訟達成和解，他被控在報銷賬單中加入了從未涉及的程序的費用。數據庫顯示，Insys在2013年給了史蒂文4.5萬美元。

Dr. Chun said that he admitted no wrongdoing in the federal settlement and that he provided excellent care to his patients. Dr. Madison said he had done nothing improper; both doctors declined to comment further.

史蒂文表示，他在和解的過程中沒有承認自己存在不法行爲，並稱自己非常關心病人。麥迪遜也稱自己沒有不當行爲；這兩名醫生都拒絕進一步置評。

Insys officials said Dr. Chun and Dr. Madison were not accused of improper medical care. Dr. Awerbuch, the Michigan neurologist who was arrested on Medicare fraud charges, declined to comment through his lawyer. Insys said it ended its arrangement with him after his arrest.

Insys高管稱，史蒂文和麥迪遜都沒有受到存在不當醫療護理行爲的指控。因醫保欺詐被逮捕的密歇根州神經科醫師奧爾巴克拒絕通過律師發表評論。Insys稱，公司在奧爾巴克被捕後終結了與他的協議。

In addition to paying high-prescribing doctors to speak on behalf of Subsys, Insys also hired the doctors’ family members. In 2013, Dr. Rosenberg’s son, Abraham, was a top sales representative for the company. Another highly paid doctor, Thomas L. Whitten, has a daughter who worked this year for six months as a sales representative.

除了爲大量開藥的醫生支付款項，讓他們推銷Subsys外，Insys還聘用了這些醫生的家人。2013年，羅森伯格的兒子亞伯拉罕(Abraham)成爲了該公司的金牌銷售代表。另一名拿到高額費用的醫生托馬斯·L·惠滕(Thomas L. Whitten)的女兒今年在該公司工作了六個月，擔任銷售代表。

Dr. Whitten, who received $43,000 in payments from Insys at the end of 2013, said his daughter, Alexandria, began working for the company about this year after the previous representative in his region quit. He said the company asked him for a few recommendations to replace the previous representative, but when his suggestions fell through, his daughter’s name came up. “It was kind of mutual — it was simultaneous,” he said. Ms. Whitten is a recent college graduate and had never worked in pharmaceutical sales previously, he said, adding that she quit a few weeks ago.

到2013年底，惠滕從該公司獲取了4.3萬美元。惠滕稱自己的女兒亞歷山德里婭(Alexandria)在他所在地區的銷售代表離職後，於今年開始爲Insys公司工作。他表示，該公司讓他推薦幾個代替前代表的人選，但他的建議沒有被採納，然後他女兒的名字被提了出來。他說，“算是共同的看法，雙方同時想到了這一點。”他表示，亞歷山德里婭最近剛從大學畢業，之前沒有醫藥銷售經驗，並稱她在幾周前離職了。

Dr. Whitten said he did not write any new prescriptions for patients while his daughter was his sales representative. “She didn’t get any extra bonuses for anything she did,” he said.

惠滕表示，他在女兒擔任自己的銷售代表期間，沒有爲病人開新處方。他說，“她沒有獲得額外的獎金。”

In a statement, Insys officials said Dr. Whitten was already prescribing Subsys before his daughter was hired as a sales representative, and he continues to prescribe it even though she has quit.

Insys在一份聲明中表示，惠滕在女兒擔任銷售代表前就爲病人開Subsys，而且儘管女兒已經離職，他仍舊在開這種藥。

Abraham Rosenberg did appear to benefit from his father’s prescribing practices. As of last June, Mr. Rosenberg was the second-highest performer in his region and the seventh-best sales representative nationwide, according to a company report that was provided by a former sales representative for Insys. At the time, Mr. Rosenberg’s top-prescribing doctor was his own father, who wrote prescriptions for 6,404 units of the drug in the second quarter of 2013, more than the combined total of drug units written by all the other doctors in his son’s territory.

亞伯拉罕·羅森伯格(Abraham Rosenberg)貌似因爲父親的處方而獲益。前Insys銷售代表提供的公司報告顯示，截至去年6月，亞伯拉罕的銷售業績在他所在的地區排名第二，在全國排名第七。當時，在亞伯拉罕負責的地區，開藥量最大的醫生正是他的父親。其父在2013年第二季度開出了6404盒Subsys，超過了兒子負責的地區其他醫生開出的藥量總和。

Dr. Rosenberg, who did not return calls for comment, was also among the company’s highest-paid doctors at the end of 2013, according to the federal database, earning close to $36,000 from Insys.

羅森伯格沒有回覆電話置評。聯邦數據庫顯示，到2013年年底，羅森伯格是該公司付錢最多的醫生之一，他從該公司獲得了大約3.6萬美元。

In September, Dr. Rosenberg was reprimanded by the Rhode Island Board of Medical Licensure and Discipline for prescribing Subsys to patients without cancer pain and failing to properly document the reasons.

9月，羅德島醫療許可與紀律委員會(Rhode Island Board of Medical Licensure and Discipline)譴責稱，羅森伯格爲沒有受癌痛困擾的病人開Subsys，而且沒有正確地記錄原因。

In a brief interview, Abraham Rosenberg confirmed that he had worked for Insys for “about a year,” but said he had quit around a year ago and declined to comment further.

亞伯拉罕·羅森伯格在接受簡短採訪時承認，他爲Insys工作了“大約一年”，但他稱自己在大概一年前離職，並拒絕進一步置評。