美国一药企高价收买问题医生推销止痛药

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.

得克萨斯州拉雷多市的痛症专科医师贾德森•萨默维尔(Judson Somerville)博士，因推销效力强大但却会让人上瘾的止痛药Subsys，而在2013年收到了6.7万美元的演讲费和餐旅费。这一数据来自一个新成立的联邦数据库，它专门搜集制药公司付给医生的款项的数据。

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是由亚利桑那州的Insys Therapeutics公司生产的。该公司付款給萨默维尔，请他推销这种产品的时候，他正在接受得克萨斯医学委员会(Texas Medical Board)的调查。该委员会发现他曾授权员工把他预先签过名的处方分发给病人，还了解到他的三位病人因用药过量而在2012年死亡——最有可能的致死原因就是他开的药——于是在2013年12月勒令他停止给病人开止痛药。

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.

近期以来，在从该公司获得高额报酬的医生当中，遇到法律问题或者行业纪律问题的不是只有萨默维尔，虽然他在2013年8月至12月之间收到的钱比其他人都多。

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.

从Insys公司收取了5.6万美元的密歇根州神经科医师加文·奥尔巴克(Gavin Awerbuch)博士于今年春天被捕，联邦检察官称，他骗取了700万美元的医保(Medicare)基金，还曾把Subsys不恰当地开给并不需要服用这种药的病人。9月，Insys公司的另一位得力代言人、罗德岛州的杰罗德·罗森伯格(Jerrold Rosenberg)博士，因为滥开包括Subsys在内的止痛药而受到申斥。

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.

来自新建的联邦数据库“款项公开”(Open Payments)的一份分析报告显示，近期从Insys公司拿钱最多的前20名医生当中，有5名面临着法律或者行业纪律的制裁，其中包括前述所说曾滥开止疼药的3个人。

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.

来自服务于军人家庭的医保计划Tricare的信息以及Insys公司的内部文件显示，拿钱最多的这20名医生——多为痛症专科医师——同时也是最常给患者开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.

这些数据只反映了2013年5个月的情况。它们给我们提供了不同寻常的新视角，让我们得以了解某些制药公司为了跟医生搞好关系而付出的代价；同时还显示出，Insys公司网罗了一些有不良记录的医生，让他们把Subsys推销给其他医师。

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产品，鉴于这种药的使用是受到严格限制的，该公司激进的市场推广手法显得尤为引人注目；按照规定，只有已经在全天服用阿片类止痛药的癌症病人才可以服用Subsys。此前的一些分析报告已经显示，这种药的处方只有1%是来自癌症专科医师。

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.

几个前销售代表接受采访时表示，该公司曾鼓励他们去拜访为患者诊治各种小病痛的痛症医生，并给予开药多的医生付费演讲之类的好处。此外，起码有两个例子显示，该公司曾雇佣开药最多的那些医生的成年子女担任其父母所在地的销售代表。

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公司在一份声明中表示，自己一直在以恰当的方式推销Subsys，而且这种药取得了非常好的成绩，因为它比同类产品更有效。该公司称，“我们认为，已有的数据有力地表明，Subsys的临床属性是医生决定开具处方的主要推动力。”

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公司总共向医生们支付了280万美元。如此庞大的市场推广预算足以比肩一些大型制药公司，如勃林格殷格翰(Boehringer Ingelheim)和诺和诺德(Novo Nordisk)，后两者所销售的是一些用于治疗糖尿病、心脏病等常见病的药物。在2013年的后5个月，Insys公司以演讲费、咨询费、餐旅费等形式向每一名开药量排在前20名的医生都支付了3万美元以上的款项。

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

拿钱最多的几个医生表示，他们之所以推介Subsys，是因为相信这个产品。

“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.”

“我不是那种大力‘为公司说话’的人，”萨默维尔说。“他们喜欢我的个性和我处理事情的方式，而我喜欢他们的产品。”萨默维尔表示，他曾担任过德克萨斯疼痛协会(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.

萨默维尔是开出最多Subsys的医生之一，他表示Insys的代表从未问过他有关德克萨斯医学委员会的裁定的问题，他在该委员做出裁定后的几个月的时间里，仍在演讲推销Subsys。Insys高管表示，在得知相关纪律制裁后，他们取消了萨默维尔的演讲者资格。

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.?”

萨默维尔反对医学委员会的说法，称该委员会没有证据证明他的行为与病人死亡有关，并称该委员出于对经常开阿片类药物的医生的怨恨，做出了惩罚决定。“我非常积极地帮助我的病人，”他说。“我是一个关怀病人的医生。我喜欢钱，但钱不是上帝，对吗？”

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临监管或法律问题。2012年，芝加哥的疼痛专家保罗·麦迪逊(Paul Madison)遭到联邦的欺诈指控，相关机构称他拥有的手术中心提交给保险公司的账单中包含一些从未涉及的程序的费用。2013年，Insys给了麦迪逊将近3.3万美元。Insys的另一名主要演讲人——佛罗里达州萨拉索塔的史蒂文·Y·陈(Steven Y. Chun)在2月份支付了75万美元，就联邦诉讼达成和解，他被控在报销账单中加入了从未涉及的程序的费用。数据库显示，Insys在2013年给了史蒂文4.5万美元。

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，他在和解的过程中没有承认自己存在不法行为，并称自己非常关心病人。麦迪逊也称自己没有不当行为；这两名医生都拒绝进一步置评。

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高管称，史蒂文和麦迪逊都没有受到存在不当医疗护理行为的指控。因医保欺诈被逮捕的密歇根州神经科医师奥尔巴克拒绝通过律师发表评论。Insys称，公司在奥尔巴克被捕后终结了与他的协议。

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.

除了为大量开药的医生支付款项，让他们推销Subsys外，Insys还聘用了这些医生的家人。2013年，罗森伯格的儿子亚伯拉罕(Abraham)成为了该公司的金牌销售代表。另一名拿到高额费用的医生托马斯·L·惠滕(Thomas L. Whitten)的女儿今年在该公司工作了六个月，担任销售代表。

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，惠滕从该公司获取了4.3万美元。惠滕称自己的女儿亚历山德里娅(Alexandria)在他所在地区的销售代表离职后，于今年开始为Insys公司工作。他表示，该公司让他推荐几个代替前代表的人选，但他的建议没有被采纳，然后他女儿的名字被提了出来。他说，“算是共同的看法，双方同时想到了这一点。”他表示，亚历山德里娅最近刚从大学毕业，之前没有医药销售经验，并称她在几周前离职了。

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，他在女儿担任自己的销售代表期间，没有为病人开新处方。他说，“她没有获得额外的奖金。”

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在一份声明中表示，惠滕在女儿担任销售代表前就为病人开Subsys，而且尽管女儿已经离职，他仍旧在开这种药。

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.

亚伯拉罕·罗森伯格(Abraham Rosenberg)貌似因为父亲的处方而获益。前Insys销售代表提供的公司报告显示，截至去年6月，亚伯拉罕的销售业绩在他所在的地区排名第二，在全国排名第七。当时，在亚伯拉罕负责的地区，开药量最大的医生正是他的父亲。其父在2013年第二季度开出了6404盒Subsys，超过了儿子负责的地区其他医生开出的药量总和。

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.

罗森伯格没有回复电话置评。联邦数据库显示，到2013年年底，罗森伯格是该公司付钱最多的医生之一，他从该公司获得了大约3.6万美元。

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，罗德岛医疗许可与纪律委员会(Rhode Island Board of Medical Licensure and Discipline)谴责称，罗森伯格为没有受癌痛困扰的病人开Subsys，而且没有正确地记录原因。

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.

亚伯拉罕·罗森伯格在接受简短采访时承认，他为Insys工作了“大约一年”，但他称自己在大概一年前离职，并拒绝进一步置评。