The Pharma Giles blog is best known for its satirical take on the pharmaceutical industry. So when its anonymous blogger chooses to drop the tongue in cheek approach and get serious, you know something is up.

This week, the subject was whether the punishment of those responsible for the deceptive marketing of OxyContin fit the crime. We noted here that this case was unusual in that some of the corporate leaders involved actually had to face some negative consequences, in addition to the usual fines levied against the company. However, there is an argument that even paying millions of dollars in fines is not that much punishment for extremely well-paid health care corporate executives.

ED Silverman, on PharmaLot, has chronicled the campaign by , an intrepid lady whose daughter died after taking OxyContin, to have "Howard Udell, Purdue's top lawyer, disbarred, and Paul Goldenheim, formerly Purdue's medical director, to have his medical license revoked." (See our post here.)

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On the Health Beat Blog, Niko Karvounis called attention to a report that suggested the benefits of drug treatment of attention deficit hyperactivity disorder (ADHD) may have been overstated, and dubbed the American approach to drug treatment of ADHD a "feeding frenzy." Karvounis pointed out the role of marketing in this situation, and noted that the major US not-for-profit disease advocacy organization for ADHD gets more than a quarter of its money from the pharmaceutical industry.

On the Health Beat Blog, Maggie Mahar discussed the November 2007 Consumers International (CI ) study, "Drugs, Doctors and Dinners: How Drug Companies Influence Health in the Developing World," in detail. We had mentioned the report briefly, and Howard Brody's thoughts on it, here. Mahar fleshed out the arguments more, and reminds me that I really need to read the whole 39 page document.

We have previously posted ( here, here, and here) about the payments, often huge, that five manufacturers of prosthetic joints ((Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Stryker Orthopedics,a unit of Stryker Inc, Zimmer Holdings, and Smith & Nephew) just revealed they made to orthopedic surgeons and various academic and other organizations. The lists are here: Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer.

We analyzed a letter by President James H. Beaty MD of the American Academy of Orthopedic Surgeons and the American Association of Orthopedic Surgeons (AAOS), and suggested that it was more remarkable for what it did not say than what it did say. We noted that the presence among the leadership of AAOS of many individuals who had received payments, some large, from artificial joint manufacturers may have lead to its lack of clarity.

The AAOS also produced a "Patient Discussion Guide" which was "intended to provide you [orthopedic surgeons] with important facts and information to facilitate discussions with your patients, and to help you answer any questions that you may receive from your patients concerning a settlement announced by the Department of Justice with five medical device manufacturers of artificial hips and knees."

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We have previously posted about "astroturf movements," defined as artificial grass-roots movements bankrolled by corporations, and their applications in health care. It seems to be the season to cultivate astroturf (it is the US football season).

The Wall Street Journal reported how Amgen "is pouring millions of dollars into a lobbying campaign to get Congress to change a Medicare rule that dealt a big blow to the company's lucrative anemia drugs." Part of this effort appeared to be an astroturf campaign,

Since the summer, the company has run an Internet-centered campaign, Protect Cancer Patients, that tries to capture the feel of a grass-roots effort by encouraging cancer patients, survivors and family members to send in their stories and to upload video and audio testimonials. The Web site also encourages individuals to phone members of Congress.

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A conversation yesterday with one of my colleagues reminded me of this issue. So forgive me if I reference some articles that are a few weeks old.

The relevant news article by Lisa Girion was in the Los Angeles Times the beginning of November. The issue was that a major California insurer, Blue Cross of California, a subsidiary of Wellpoint Inc, was accused of putting a confidentiality provision into its contracts with physicians and hospitals that prevented them from consulting lawyers for their help in contract negotiation:

The state stepped into a bitter battle Thursday between Blue Cross of California and the doctors, hospitals and medical labs that serve about 700,000 people covered by the state's largest health plan.

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We previously posted about how one well-reputed US state-supported academic medical center allegedly maintained an "A-list" of donors and other VIPs who received additional amenities, and easier access to health care. One of our readers responded to it thus:

The 'A list' idea is a very common practice. I've always found it

offensive, intrusive and detrimental to patient care. Of course it suggests

that the UIP's (unimportant persons) get lower quality treatment.

Our hospital has a program that is almost like calling a 'code.' When a

patient on the list is admitted, the administrator on call is paged and the

administration people then proceed to make a nuisance of themselves. I have

actually had the chief of staff of the hospital poking around in the

patient's chart and giving the patient's family his card so that they were

calling the administration about routine issues that should have come to me.

In one case, the VP of nursing was pacing the floor outside the patient's

room watching everything that was going on.

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On the Hooked: Ethics, Medicine, and Pharma blog, Howard Brody posted about his foray into the world of the CafePharma bulletin board, and focused on a debate - that is a polite term for it - which started when an anonymous person asked "do you ever mess with the food [provided free to a medical office] before lunch?" This produced a lively and scatalogical exchange, made livelier, if that is the word, by the participation of PandaBearMD (who blogs here). Since nearly everything on this bulletin board is anonymous, it is a bit hard to determine which stories are true, and which rants are authentic. But Brody summarized his thoughts thus:

I have tried hard in my own work never to villainize reps. As I see it, reps have an impossible job. From the company's point of view, they have one function only, to move product. I ask at every opportunity for someone to tell me about a single rep who was ever paid a single bonus for anything other than quantity of drug sales--and no one has ever given me an example.

The other part of their job is to lie about this. They have to lie to two people. First they have to lie to us, because we demand it. We will not easily and comfortably take all the goodies they shove our way, unless they keep repeating over to us the soothing rationalization, "It's education, not marketing." Second they often have to lie to themselves because they can live with themselves much easier if they can see themselves as educators and not as mere salespeople. Or at least they can lie to us more glibly if they lie to themselves first.

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The Los Angeles Times just published a story about one health insurance company's attempts to cancel individual health care insurance policies after their holders became sick. Internal company documents became available in the course of a law-suit, and provided some important revelations.

Health Net's disclosures Thursday provided an unprecedented peek at a company's internal operations and marked the first time an insurer had revealed how it linked cancellations to employee performance goals and to its bottom line.

The bonuses were disclosed at an arbitration hearing in a lawsuit brought by Patsy Bates, a Gardena hairdresser whose coverage was rescinded by Health Net in the middle of chemotherapy treatments for breast cancer. She is seeking $6 million in compensation, plus damages.

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The Dallas Morning News just printed a story about one hospital's alleged "A-list."

UT Southwestern Medical Center at Dallas keeps a detailed list of wealthy, high-profile and influential people and their family members to ensure that they get favored treatment if they become patients.

Here is what is known about the people on the list.

The News reviewed a list dating from 2003 and found a virtual "Who's Who" of Dallas and the region. The list is maintained by UT Southwestern's Special Assistance Office and appears to identify wealthy and influential people who either are or might become major donors to the university. The list also includes family members, employees, friends and even one prominent person's maid.

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