Pharmaceutical companies no longer court doctors with tickets to sporting events and lavish trips, but one of the nation's largest drug manufacturers deployed a squad of sports figures to get physicians to play ball.
Novartis Pharmaceuticals Corp, a part of Swiss-based Novartis AG with $44.3 billion in revenue in 2009, relied on a lineup of baseball Hall of Fame members, including Bob Gibson and Johnny Bench, professional football players such as New York Giants quarterback Eli Manning, coaches and other top athletes as lures to get doctors to attend dinners where the company would pitch its products.
The athletes were expected to give short speeches at the dinners, answer questions about their careers and then pose for individual photos with the 50 to 100 doctors in attendance. Novartis marketing representatives later would bring the photos when they went to call on the doctors to sell their products.
"I hope someone at the company got a fat bonus, because this is one of the most clever schemes I've seen to provide gifts to doctors," said Paul Thacker, an investigator for the nonpartisan watchdog group Project on Government Oversight, who probed the financial relationships between doctors and drug companies while working for the Senate Finance Committee.
"If you shove a bag of cash in a doctor's pocket, he might feel like a common streetwalker, but if you give him a picture of his childhood idol, then he might feel like everyone is just being pals," said Mr. Thacker. "Of course, the company wasn't doing this to be friendly. They were doing it to push for more prescriptions. And you don't need an advanced degree from a medical school to figure that out."
Novartis paid $3.6 million in fees to 150 top former and current sports figures — from $8,000 to $35,000 an appearance, according to documents obtained by The Washington Times. In some instances, the athletes and coaches signed memorabilia the doctors brought with them. The program ran from 2006 through 2009.
Dr. Jerome Kassirer, a professor at Tufts Medical School and an expert on the conflicts between physicians and the drug industry, described Novartis' use of the athletes as "a new one to me." He called the practice a "kickback."
"They [the drug companies] will do anything to attract doctors to meetings to promote their drugs," said Dr. Kassirer, former editor of the New England Journal of Medicine. "They [the doctors] are clearly taking some kind of gift, the dinner or the photo or the prestige of meeting with the athlete in exchange for sitting through and listening to a pitch.
Novartis declined to comment on specifics of the athlete-speaker program, citing pending litigation with the Nelson Group, the marketing firm it hired to put on the events.
"Novartis is committed to promoting its products in an ethical and compliant manner and has developed corporate guidelines and procedures to help ensure that all promotional activities and programs meet the applicable requirements by the FDA and other regulatory agencies," said a Novartis spokesman.
On Sept. 30, Novartis agreed to pay $36.5 million to settle Justice Department civil claims that it paid illegal kickbacks to doctors to induce them to prescribe five of their drugs, resulting in false claims being submitted to Medicare, Medicaid and the other federal health care programs.
The Justice Department said that from Jan. 1, 2002, to Dec. 31, 2009, Novartis paid the kickbacks "through mechanisms such as speaker programs, advisory boards and gifts, (including entertainment, travel and meals), to health care professionals to induce them to promote and prescribe the drugs," according to the settlement.
While the settlement does not single out the dinners with athletes, those events were used to help promote three of the drugs that are part of the Justice Department kickback claim. Novartis disputed the civil claims, but agreed to the settlement without making any admissions.
'Harder and harder'
Novartis turned to athletes to help its sales in 2006 after the company and others were having trouble attracting doctors to their marketing events.
"Over the years, it got harder and harder to get physicians to come to the informational dinners," said Rooney Nelson, whose company, the Nelson Group, was hired by Novartis in 2006 to put together the dinners with athletes. In a three-year period, the company put on more than 250 events, ending in 2009.
He said his firm provided the athletes and physician speakers and arranged for the restaurants, some of which were high-end. He said his firm would pay the expenses and then be reimbursed by Novartis.
Mr. Nelson, who is suing Novartis over $538,000 in bills he said were unpaid, recalled that the number of doctors attending the events went from a handful to more than 70 once the athletes were involved.
The 150 athletes paid by Novartis included baseball Hall of Fame pitchers Bob Gibson, Jim Palmer, Bruce Sutter and Goose Gossage, outfielder Lou Brock, third baseman Brooks Robinson, shortstop Ozzie Smith, catcher Johnny Bench and manager Tommy Lasorda, along with former stars Steve Garvey, Fred Lynn, Dale Murphy and Bucky Dent, and former American and National League Manager of the Year Tony LaRussa.
Retired and active National Football League and National Basketball Association players also were well represented, including former Washington Redskins Sam Huff, Doug Williams, Brian Mitchell, Darrell Green, Mark Rypien and Mark Moseley, along with Mr. Manning, Tony Dorsett, Doug Flutie, Jim Plunkett, Randy White, Warren Moon, Paul Warfield, Ed "Too Tall" Jones, Danny White, Ty Detmer, Michael Strahan, Oscar Robertson, Luke Walton, Chauncey Billups, Bill Laimbeer and Walt Frazier.
Some made one appearance, others made several, including Mr. White, the Hall of Fame lineman for the Dallas Cowboys, who made nine paid appearances — the most of any athlete. He was paid a total of $135,000 for events in Texas and Oklahoma, the records show.
The sports figures would often speak at events near where they had their best years as players.
Novartis also used coaches to attract doctors to their meetings, such as Phillip Fulmer, the then-football coach at the University of Tennessee, who made four $17,500 appearances for Novartis in Tennessee in 2008, including three in an eight-day stretch. Mr. Fulmer, now a college football analyst, coached Tennessee to the national championship in 1998.
Mr. Nelson said Novartis never told him it was under investigation over its marketing practices when he was hired.
"Novartis has already paid a substantial fine to begin to resolve those investigations, but they have left my firm and the athletes and the doctors with these long-term Justice Department and legislative concerns that they knowingly exposed us to," he said.
In its response to the lawsuit, Novartis denies owing the Nelson Group any money and claimed instead that discovery will show it is "entitled to a refund of thousands if not millions of dollars" for unsubstantiated expenses. Novartis claims it reimbursed the Nelson Group for honoraria to several doctors and sports figures that were never paid, allegations Mr. Nelson denied.
The new health care reform bill includes a section that requires the manufacturers of pharmaceuticals and medical devices to publicly disclose payments they make to physicians beginning in 2013 for the year 2012.
The requirement was introduced by Sen. Charles E. Grassley, Iowa Republican, and Sen. Herb Kohl, Wisconsin Democrat, who estimated that the drug industry spends $19 billion annually on marketing to physicians in the form of gifts, lunches, drug samples and sponsorship of education programs.
"Rising drug prices hurt us all by undermining our private and public health systems, including Medicare and Medicaid," said Mr. Kohl. "Even more alarming is the notion that these gifts and payments can compromise physicians' medical judgment by putting their financial interest ahead of the welfare of their patients."
Mr. Kohl said the more doctors interact with drug marketers, "the more likely doctors are to prescribe the expensive new drug that is being marketed to them."
In 2002, the drug industry through its trade group, the Pharmaceutical Research and Manufacturers of America (PhRMA), adopted a voluntary code barring companies from providing entertainment to doctors, including tickets to concerts and athletic events. The code also prohibited the companies from allowing the physicians to bring their spouses or staff to marketing events or from giving non-medical related gifts.
Not the villains
Both Dr. Kassirer and Mr. Thacker said the sports figures were not the villains in this scenario.
"Whether it's sneakers, beer or pharmaceuticals, there's nothing wrong with athletes trying to make a buck off their fame," said Mr. Thacker.
Steve Spurrier, head football coach at the University of South Carolina, was paid $35,000 for a 2007 appearance in Columbia, S.C., hometown of the university. Mr. Spurrier, a former Heisman Trophy winner and 10-year NFL veteran, coached the University of Florida to a national championship in 1996. He also was the head coach for the Washington Redskins in 2002 and 2003.
He and Mr. Manning were among only two speakers to be paid $35,000.
According to an official who helped arrange the meetings, the athletes would speak after a physician gave a talk about the Novartis drugs. The physician speakers would be paid $2,000 to $2,500 per event.
Most of the sports figures did not respond to requests for a comment.
"You talk about your life and sports," said Mr. Huff of his speech for Novartis at the Greenbrier Resort in his native West Virginia in December 2008 for $16,500. "It beats working for the mines, like all my relatives did."
Mr. Huff, an All-American college player and NFL Hall of Fame linebacker, is the color commentator for the Washington Redskins radio network. In an interview, he said he would have posed for photos at the event since as a former athlete "I know to start to smile as soon as I see a camera."
A spokesman for Mr. Spurrier said he was asked by Novartis to speak about football and coaching, and he wasn't sure but thought he was paid around $20,000.
The $36.5 million settlement with the Justice Department was part of a larger agreement between Novartis and Justice, in which the company agreed to pay $422 million to settle criminal charges and civil claims that it illegally marketed one of its top-selling drugs for unapproved uses along with kickback claims.
Novartis pleaded guilty to a misdemeanor charge of illegally marketing its anti-epilepsy drug, Trileptal, from 2000 to 2004 to psychiatrists and pain specialists for the treatment of bipolar disease and neuropathic pain, even though the FDA had not approved it for those uses. The company paid a combined criminal fine and forfeiture of $185 million.
It also agreed to pay $237.5 million to settle civil claims from its off-label marketing of Trileptal and paying kickbacks to promote it and the other five drugs.
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