by Dr Theodoros Mégaloeconomou, psychiatrist, Athens
Translation : Emmanuel (Manolis) Kosadinos
Greek source: http://www.efsyn.gr/arthro/skandalo-novartis-einai-i-skandalodis-kanonikotita-olis-tis-farmakoviomihanias
Disclaimer: The publication on this blog of some cartoons with provocative or excessive content does not, in any case, support the theses of the websites from which they were reproduced. Any caricature, by definition, forces the line of a situation to stimulate the debate on the subject treated.
This is certainly not an isolated "Greek case"
The alleged long-standing involvement of politicians, former ministers and prime ministers, who are suspected to have received high bribes from Novartis, is a scandal of huge and sprawling dimensions that is causing new quakes in a multiply failed, corrupt, and constantly in crisis political system. But the issues arisen are not just about Novartis' practices, nor about just an isolated "Greek case".
What is being unveiled is only the face of the scandalous "normality", of the way the whole pharmaceutical industry operates worldwide (a sector which is the second most profitable worldwide after the war industry) as a part of a mutually beneficial "Sacred Alliance" with the political system and, of course, a large part of the medical profession, some Universities, but also the media, etc.
An example to mention is the case involving George Bush Jr., who as governor of Texas had supported the implementation of a pilot project, with the participation of a number of pharmaceutical companies, aimed at the administration of antipsychotics and antidepressants to young persons aged less than 18. These drug companies contributed three times as much to Bush's election campaign in 2000 as to Kerry's. Of the $ 1.6 billion in Eli Lilly's campaign contributions - whose anti-psychotic drug Zyprexa (still very expensive at the time) was the first proposed by that project, 82% were attributed to Bush's campaign.
After his election, Bush favored the mandatory implementation of the project at the federal level to diagnose mental disorders "not yet diagnosed" (or even manifested) in the general population and even in preschool children - to achieve, in a second time, the administration of antidepressants and antipsychotics by millions of prescriptions, even in infants under 2 years of age. As it was revealed, senior officials and executives placed in critical positions for the implementation of the drug administration project, received money and gifts from pharmaceutical companies to certify the validity of a project, which was a hard-to-mask effort of pharmaceutical companies to access a broader market for expensive antidepressants and antipsychotics, through a mandatory government plan, which opened the doors to areas of people's lives who until then were beyond their competence.
Clearly, it is no coincidence that the international trend to overdiagnose ADHD (Attention Deficit Hyperactivity Disorder) in children, and even the fact that any "very lively" child (though growing in an education system under collapse and / or a in a family in crisis) tends to be diagnosed as "ADHD" is related to the promotion of prescribing (often unreasonably) the drug Ritalin (methamphetamine, a derivative of amphetamine), produced by Novartis, whose label brand holds a dominant market position compared to similar drugs produced by other companies.
This is a drug that, presented as "the pill of obedience" but qualified by international experts "kiddy coke", was also presented (especially in Greece), by the media, as " the drug that helps the student to prepare for exams "no matter if he can make young people subsequently dependent because it is a highly addictive substance.
The Novartis scandal is not just about bribes
The issue having emerged from the Novartis scandal should not be limited to castigating the bribing of politicians and other officials (though a very serious matter in itself) neither degenerate into some tactical political squabbling, with the political survival of some or others at stake, into an endless cycle of discoursing about corruption, while experience teaches us that sooner or later such speeches fade out into oblivion. The argumentation must deepen and reach the roots of the problem, it must examine the whole field inside which the production and marketing of medicines evolves, and its relationship to the health system. Thus, there is a need to understand why, on such a ground, bribes are the rule, so that arrangements favorable to the interests of the pharma companies are established and validated by the right signatures. A procedure that that is implemented regardless of the health needs to which those medicines are supposed to respond.
Therefore the question concerns not only Novartis, but all the pharmaceutical companies, which in our capitalist society have appropriated the exclusive production of a "social good" par excellence such as medicines, as if it was a commodity like any other, generating benefits and high profits on international stock exchanges when the company "is doing well", making growing profits at present and anticipating such for the future. The production, distribution and marketing of medicines, are essentially related to these capitalist dynamics. There lies the contradiction that determines the production of medicines as a commodity. All scientific knowledge, all therapeutic objectives at the origin of their invention and production must be in adequacy with needs of profitability. In all other cases (with some exceptions), their therapeutic use must be modulated and promoted in a way that not only would reduce profitability but, on the contrary, increase it.
Systematically therefore, pharmaceutical companies
- Conceal test results when they are unfavorable to the use of medicines they produce and publish at a disproportionate scale those who favor them.
- Pay doctors and academics to communicate in scientific conferences and congresses about their products and promote them.
- Deploy their efforts to multiply the indications of their medicines - from a single illness, suddenly to several (this is the rule, especially for psychotropic drugs) because this method is much less expensive for pharma companies than to manufacture a new drug.
Most of the published articles in international literature that praise "the great qualities" of their products are concocted by those same pharmaceutical companies who produce these publications and have them signed by nominees, otherwise known as "ghost writers", personalities some scientific renown, paid to simply affix their signature, as revealed by the British weekly "The Observer" on 12/07/2003.
In 2012, a fine of 3 billion US dollars was imposed on GlaxoSmithKlein (GSK) following a series of offenses related to the "illegal promotion of prescription drugs and omission of safety data. Part of this fine, $ 600 million, was allocated to "protected witnesses", such as the "three FBI witnesses" of the Novartis Greece case who traveled to the United States to testify. Actually in the United States there is a contrasting system, on the one hand a broad immunity for the pharmaceutical industry and on the other hand severe penalties for infringements, judged in function of material interests at stake. The FDA  itself, competent for authorizing the circulation of medicines on the US market, wavers between these two extremes - between imposing high fines and tacit tolerance.
Structural collusion between doctors and pharmaceutical companies
Let us now examine certain aspects of this structural collusion (which certainly does not imply all physicians, but unfortunately a majority), as we experience it in our country (Greece), deserving to be known by all.
- Let's start with the daily and highly invasive, but accepted as standard, siege of all public hospitals, clinics, etc., by the medical visitors. The function of these medical visitors has nothing to do with a supposed "information" of the doctors on drugs (which does not concern new products but, in general and especially, old and well known ones), but aims at the subjection of the practitioner (through various manipulations) to the prescription routine of the promoted drug. These visits are "tune-up" transactions, sometimes relating to the number of doctor's prescriptions with a proportional "reward" offered for these, and so on. Nurses are also approached (especially nursing managers) and, in each hospital, all those in contact with the distribution of medicines. The question is: what is the purpose of these so-called informative visits of medical visitors? Why, for a "scientific problem", have other ways of accessing "scientific knowledge and information" been excluded? Maybe because all that are just marketing procedures.
- Let's then talk about congresses fully paid for all doctors and residents (whose training and its funding relies completely nowadays on the pharmaceutical industry) in five-star hotels, often held in "exotic" places, in which "shines" a "Science" skillfully manipulated by the pharmaceutical industry.
Such congresses that can hardly be distinguished from trade fairs (medico-pharmaceutical ones) where, behind the stands of the presentations, one can find the space where the oral presentation of the products takes place.
More than that, in recent years, it is no longer enough to mention in the program of these congresses, the pharmaceutical companies that sponsor them (two, three, four, five, etc.), but some "round tables" are set up apart , taking place as indicated, with "the noble sponsorship ... of Janssen ... Eli Lilly ..., Ludbeck etc." We are right to wonder, what is precisely sponsored during these "round tables" by the pharmaceutical companies? Is it the bottles of water, the microphone, the speaker's desk, what indeed?
- In May 2017, at the Annual Congress of the Hellenic Psychiatric Association, was announced the creation, in the Department of Psychiatry of a General Hospital, of a dedicated "clozapine clinic", an antipsychotic drug, which serious side effects, which was supposed to be, until now, a means of "last resort".
It is easy to figure out that when creating a clinic dedicated to a single drug, its aim will be to promote its increasing use. This drug is, of course, Leponex, marketed by Novartis.
Our position is that in an integrated network of community-based psychological care services, Leponex use may be much less.
- The setting up of a "special clinic" based on that same concept (of pharmaceutical brand oriented psychiatry) was also announced for the dispensing of long-acting injectable (LAI) antipsychotics, to administer three relatively new and costly (but not more effective than the older ones) medicines that compete today for the market share.
One more recent "innovative practice", this one like many others being imported from the Anglo-Saxon world, are agreements passed between doctors of the public hospitals and the pharma companies, according to which employees of the pharma companies would visit at home patients recommended by the physicians, in order to dispense them long-acting injectable (LAI) antipsychotics and thus ensure that the pharmaceutical products they are promoting do not remain unsold or unused.
In this regard, in England this practice has been established since 2012 as an official project, allegedly to counter the collapse of the NHS.
- That way, close cooperation of general practitioners with pharma companies has been formalized to treat patients (especially cases with uncertain diagnosis or difficult to treat) in particular, they allege, to improve the compliance of patients to treatment. Pharma companies employees are free to select from the patient base of general practitioners those patients more likely to "benefit" from the treatment of company's medicines. Unfortunately, in small Greece we are not very far from these scientifical and ethical "innovations" achieved in the Anglo-Saxon world.
- What comments deserves the policy of the Hellenic Psychiatric Association (ΕΨΕ), which on the World Day of Mental Health (10/10/17), dedicated to the theme "Mental Health and Work", invited as first speaker, the President of the Association of Pharmaceutical Companies of Greece (ΣΦΕΕ / SFEE), the successor of the unjustifiable Mr. Konstantinos Frouzis  ?
- Lastly, let's mention those "trials" of psychotropic drugs already marketed (therefore accredited) in public hospitals, conducted without any preliminary study of the terms and conditions under which those "trials" were practiced, since there were sometimes to the detriment of the care of patients who did not participate to them.
The Greek Ministry of Health keeps far away from all these specific aspects. It deals mainly with the formal management of conflicts of interest (billing, etc.), in application of the clauses of the memoranda, failing to address the root of the problem. A question actually arises, whether the doctors of the various committees of the Ministry maintain relations with pharmaceutical companies, whether for instance they take part to Congress "fully paid" by the pharmaceutical companies. Are there persons among the scientific people of the Ministry's committees who perform trials and studies commissioned by the pharmaceutical companies? Do they promote, by any means, drugs of any specific company - for example, through supposed scientific conferences, etc.? Have any of them, for instance, participated in the promotion of the newest and most expensive long-acting injectable antipsychotics ?
Further on, what is the role of the staff of the University Medical, Pharmaceutical and Biology Departments in researching and eventually promoting specific products?
There will be no satisfactory solution as far as medicines are treated as a commodity
Clearly, there will be no solution to the problem as far as medicines remain in the hands of the pharmaceutical industry. As long as any physician is summoned to act as an "intermediary" between the company and the patient-user, to whom he / she must administer the drug / product for his/her treatment. Because it is through this type of relationship that all the tentacles of collusion and corruption unfold.
The stake is not just to end the diffuse collusion and corruption of the system. It is to change the "way of thinking and practicing" of the medical profession, shaped and manipulated as it actually is by the logic and profitability practices of pharmaceutical companies - always in line with the dominant biopower. That equally applies to knowledge, constituted and proposed as the only "scientific" (concerning therapy, "appropriate medicines", etc.) presented as the only choice available even for those physicians having the best intentions and primarily considering their patients' interest.
Although our bottom line might today sound as a unrealizable project, " a pie in the sky", the nationalization of the pharmaceutical industry, under social and workers' control, is the only full scale response to the ongoing scandals and the one, perpetual, standing before us - the scandal of the very existence of the capitalist pharma industry and the overall dealing with medicines as if being a commodity. There can be no satisfactory intermediate solution does not exist - and this, again, will certainly be demonstrated along the way.
About the author:
Dr. Theodoros Megaloeconomou is a distinguished and pioneering Psychiatrist. He has been a leading figure of the Psychiatric Reform and of the movement for the deinstitutionalization of psychiatric patients in Greece and he has a rich scientific published work. As a psychiatrist of the Greek NHS (Ethniko Systima Ygeias - ESY/ΕΣΥ), he served at the Leros psychiatric asylum where his commitment to patients left a deep mark in Greek psychiatry, leading to the closure of that asylum, a shameful case of massive psychiatric confinement . He also served as Head of the 9th Psychiatric Department of the Psychiatric Hospital of Athens (PHA/ΨΝΑ - Dafni). Because of the pioneering methods he applied in his career, such as the setting up of the only open department of the PHA (ΨΝΑ), his fight against constraint (both mechanical and pharmaceutical), and his overall progressive and humanist commitment, he has several times been targeted by conservative circles, never hesitating to clash with them when necessary.
After the imposition on Greece by its international creditors, in 2010, of neoliberal policies of austerity, Dr. Theodoros Megaloeconomou joined the broad citizen movement against the dismantling of public services and participated in the establishment of self-managed health care structures run by volunteers, known as the Social Solidarity Clinics. He is campaigning all that time for a humanist and democratic psychiatry, for the unconditional reception of refugees and for Health Care accessible to the entire population.
Notes of the translator:
- [1 ] FDA: Food and Drug Administration (the US Supreme Drug Authority)
-  Konstantinos Frouzis, former President of the Association of Pharmaceutical Companies of Greece (ΣΦΕΕ / SFEE), whose heavy responsibility in the scandal Novartis Greece would be quite certain.
-  Novartis: Novartis International AG is a Swiss multinational pharmaceutical company based in Basel, Switzerland. It is one of the largest pharmaceutical companies by both market capitalization and sales (from Wikipedia) https://en.m.wikipedia.org/wiki/Novartis
- The "Novartis Greece case": A Scandal or just institutionalized corruption? (by Professor Alexis Benos in Mediapart blog) https://blogs.mediapart.fr/emmanuel-kosadinos/blog/270818/novartis-greece-case-scandal-or-just-institutionalized-corruption
- Greece: The Novartis scandal is only the tip of the iceberg (by Antonis Karavas, Greek health unionist, in Mediapart blog) https://blogs.mediapart.fr/emmanuel-kosadinos/blog/240818/greece-novartis-scandal-just-tip-iceberg
- Qu'en est-il aujourd'hui de la protection sociale et de la santé en Grèce? (by Emmanuel Kosadinos in Mediapart blog) https://blogs.mediapart.fr/emmanuel-kosadinos/blog/141217/quen-est-il-aujourdhui-de-la-protection-sociale-et-de-la-sante-en-grece-0
- Novartis bribery claims: Greek MPs vote to investigate top politicians (The Guardian, 02/22/2018) https://www.theguardian.com/world/2018/feb/22/greece-to-investigate-top-politicians-over-novartis-bribery-claims
- Greece rocked by claims drug giant bribed former leaders (The Guardian, 02/12/2018) https://www.theguardian.com/world/2018/feb/12/greek-pm-calls-for-inquiry-into-bribery-claims-against-two-predecessors
- Revealed: how drug firms 'hoodwink' medical journals (in The Guardian, reproducing an article of Antony Barnett - email@example.com - web publication of the 12/07/2003) https://www.theguardian.com/society/2003/dec/07/health.businessofresearch