Pfizer, the world's biggest drug company, says it paid 4,500 doctors and other medical professionals about $20 million total in professional fees for services like consulting and speaking on behalf of the company, in just the last six months of 2009. During the same period, Pfizer also paid $15.3 million to 250 academic medical centers and other research groups for clinical trials. The payments to medical professionals were required by an agreement the company signed last August to settle a federal investigation into the illegal promotion of drugs for off-label use. Eli Lilly and GlaxoSmithKline made similar disclosures. As part of the new health care reform legislation, starting in 2012, makers of drug and medical devices will have to disclose any payments greater than $10.00 made to doctors, with the first reports becoming available in 2013. The provision is called the Physician Payment Sunshine Act. Eric G. Campbell, lead author of a 2007 study of physician-industry relationships published in the New England Journal of Medicine said, “I think it’s a good thing to do, but I put absolutely no trust in what drug companies voluntarily disclose to the public when those things are unaudited.” Campbell said drug companies were making the disclosures to try and get ahead of a rising tide of public opinion in favor of disclosure.

California officials who oversee the spending of billions of dollars in California's Medicaid prescription drug program failed to disclose free flights, hotel rooms and meals funded by pharmaceutical companies. One of the officials, the chief of the pharmacy division at California's Department of Health Care Services, helps decide which drugs will be among the $8.5 billion worth of medication that California will dispense to low income people. Pharmaceutical companies funneled money for the officials' trips through several non-profit business groups that exist solely for the purpose of funding meetings and conferences. The groups raise money by charging drug company executives who do business with Medicaid programs up to $2,000 in registration fees. The groups have raised about $1.8 million from corporate executives since 2005, and spent the money on travel, lodging and entertainment for California's Medicaid pharmacy directors. Under Medi-Cal policy, state officials are prohibited from accepting gifts worth over $320 from any firm, subsidiary or person that "has financial dealings with the department," and are supposed to report the trips as gifts. After the investigative journism group California Watch revealed the gifts, a Medi-Cal spokesman confirmed that pharmacy officials had taken about a dozen trips since 2006, acknowledged that they should have been reported as gifts and said the omissions would be corrected.

Despite proclaiming a need to cut medical costs, the Senate health care reform bill contains a provision that will benefit large drug companies while hurting manufacturers of generic drugs. As it is now written, the bill will keep less-expensive generic drugs from entering the market for fully 12 years, far longer than the five to seven years President Barack Obama had advocated. The concession to Big Pharma companies, which manufacture expensive brand-name drugs, follows an $80 billion agreement made earlier this year between the White House and large drug makers like Merck and Pfizer, who promised to support President Obama's health reform plan, cut drug prices and pay additional taxes to help expand health insurance coverage over the next 10 years. Kathleen Jaeger, President and CEO of the Generic Pharmaceutical Association, said the health reform bill passed by the Senate " ... unfortunately, amounts to a treasure trove to brand drug companies who stand to make enormous profits from health care reform -- putting brand drug profits over patients ... With generics saving the health care system one billion dollars every three days, Congress should be looking at increasing, not decreasing, access to safe effective and affordable generic and biogeneric medicines."

The pharmaceutical industry-funded front group Center for Medicine in the Public Interest (CMPI) is helping its corporate funders fight health care reform by disseminating misinformation and orchestrating campaigns to generate fear about health care reform. CMPI arose out of the Pacific Research Institute, a corporate front group that worked with Philip Morris in the past to fabricate academic support for the tobacco industry. CMPI has been sponsoring anti-Obama Tea Party protests, producing attack ads against health care reform and creating Web sites that feature "horror stories" about citizens in countries that offer universal health care. CMPI is headed by Peter Pitts, the head of global health care for the international corporate public relations firm Porter Novelli, which specializes in helping drug companies evade FDA marketing restrictions by using stealth marketing techniques, like creating fake, unbranded "public service ads" nominally to raise awareness of diseases, but that really drive people to drug-company funded Web sites that advertise drugs.

Dick Armey, who was the Republican Majority Leader of the U.S. House of Representatives between 1995 to 2002, has been doing well for himself as the Chairman of FreedomWorks, a conservative lobby group. Meredith Simons reports that, according to the group's tax filings for 2008, Armey was paid $550,000. “I don't apologize for my paycheck. I'd like to think I'm worth it," he said. FreedomWorks has been one of the leading groups opposing proposals for healthcare reform. Up until August, Armey had also been a consultant for the Washington D.C. lobbying firm, DLA Piper. He resigned following controversy over his role with Freedomworks as well as with a lobbying firm which represented, among other clients, drug companies supporting health care reform and companies opposing tough action on global warming. Armey told Simons that resigning from the lobbying firm "cost me $750,000 a year for the next 10 years. That's not an easy thing to walk away from.”

After receiving six-figure grants from the pharmaceutical company Merck, three medical associations promoted the company's Gardasil vaccine, "using virtually the same strategy that Merck employed in its marketing campaign." That's according to an analysis published in the Journal of the American Medical Association, which warned that Gardasil's marketing campaign presents "important challenges to physician practice and medical professionalism." Merck gave $199,000 to the American College Health Association (ACHA), $300,000 to the American Society for Colposcopy and Cervical Pathology (ASCCP) and $250,000 to the Society of Gynecologic Oncologists (SGO). ACHA then sponsored "a Webcast viewed by 350 members" about Gardasil and sent "e-mails to college and university students urging them to get vaccinated." ASCCP encouraged doctors to ask "states and federal agencies to pay for the vaccine" and support "mandates for use" of Gardasil. SGO developed "teaching materials [that] omitted cautionary qualifications" about Gardasil. The groups say they disclosed the Merck funding and their activities were not impacted by it.

"Faced with declining sales for Gardasil, the controversial -- and so far only -- vaccine for prevention of human papillomavirus, Merck & Co. is planning to boost the drug's visibility during the key back-to-school shopping period beginning this month," reports Advertising Age. "Merck is participating in vaccination-day events with physicians' offices, clinics and nursing groups by offering supportive resources such as posters, mailers, consumer material and pocket cards that coincide with the time when kids and young adults typically get physicals before school starts in September." U.S. and worldwide sales of Gardasil have declined significantly since last year. On a recent "earnings conference call," Merck's executive vice-president of global human health, Ken Frazier, blamed the decrease on "saturation" of the "prime target of girls ages 13 to 18." So Merck is "firmly committed to achieving greater vaccination rates in the 19-to-26 age group," said Frazier, even though the vaccine must be administered before the onset of sexual activity to provide optimal protection. Merck has also asked the U.S. Food and Drug Administration to approve Gardasil for "use in boys and men ages 9 to 26 to prevent external genital lesions ... and for use in women ages 27 to 45." Merck's heavy lobbying of states to require Gardasil vaccinations -- including through the group Women in Government -- has been widely criticized.

"Newly unveiled court documents show that ghostwriters paid by a pharmaceutical company played a major role in producing 26 scientific papers backing the use of hormone replacement therapy in women," reports Natasha Singer. "The articles, published in medical journals between 1998 and 2005, emphasized the benefits and de-emphasized the risks" of Premarin and Prempro, two homone drugs produced by the Wyeth pharmaceutical company. The articles, which were ghostwritten for Wyeth by the DesignWrite medical communications firm, created an illusion of consensus in favor of hormone replacement therapy until a large federal study discovered that the drugs created "increased risk of invasive breast cancer, heart disease and stroke." Court documents suggest that the practice of ghostwriting articles for medical journals without disclosing their corporate sponsors "went well beyond the case of Wyeth and hormone therapy, involving numerous drugs from other pharmaceutical companies."

The healthcare industry is waging a "record-breaking influence campaign," spending "more than $1.4 million a day on lobbying," reports the Washington Post. "The Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million" spent in just three months. Among the lobbyists are many former Congressional staffers and even former members of Congress, including Dick Armey and Richard Gephardt. The impact is illustrated by a recent meeting in the office of Senate Finance Committee Chair Max Baucus, which "included two former Baucus chiefs of staff: David Castagnetti, whose clients include PhRMA and America's Health Insurance Plans, and Jeffrey A. Forbes, who represents PhRMA, Amgen, Genentech, Merck and others." The Post "identified more than 350 former government aides, each representing an average of four firms or trade groups." PhRMA leads "the pack in spending and employs 49 former government staff members among its 136 lobbyists." Many of the major lobbyists "remain opposed to the public-insurance option" supported by the Obama administration. PhRMA's head, former Congressman Billy Tauzin, finds the Congress-drug industry revolving door "pretty normal." He asked, "Is it a distortion of baseball to hire coaches who have played baseball?"

The global drug firm Roche has decided to withdraw from the Pharmaceutical Research and Manufacturers Association (PhRMA), the peak lobbying group for the U.S. drug industry. Following its purchase of the biotechnology company Genentech, Roche decided that it prefers to belong to the Biotechnology Industry Organization. In The Star-Ledger, Susan Toddalso reported that "without Roche, PhRMA also loses critical revenue for carrying out its lobbying activities." Roche, she wrote, also "plans to pull out of another pharma-related affiliation, its sponsorship of a special pharmaceutical management program at Rutgers Business School." In Britain, Roche UK decided "not to renew its membership of the Association of the British Pharmaceutical Industry, after it was suspended for six months for 'bringing the industry into disrepute'," reported the Financial Times.