Medical conflicts of interest

[Guest guest]

Hi Everyone,

In the continuing saga, here is another example of the conflicts of

interest in the medical profession. Today's Wall Street Journal

reported that 6 regional sales directors of a biotechnology firm

pleaded guilty to violating antikickback laws. Senior employees

targeted top-prescribing doctors to induce them to write more

prescriptions. For writing the prescriptions doctors would receive

a free trip to an AIDS conference in Cannes, France, a trip valued

at $5,000 to $10,000.

Jean

[Guest guest]

Hi Everyone,

More disturbing news, this time government scientists in the NIH are

now highly paid consultants for the drug companies. They are

intentionally misleading prescribing doctors and the public into

believing that the NIH has sanction various claims by drug

companies. Who can we rely on for an independent analysis of drugs

our children take?

The following article was in today's LA Times.

Jean

The National Institutes of Health: Public Servant or Private

Marketer?

By Willman, Times Staff Writer

For 15 million Americans, it is a daily ritual: gulping down a pill

to reduce cholesterol.

They do it because their doctors tell them to. Their doctors, in

turn, rely on recommendations from the National Institutes of Health

and its scientists, such as Dr. H. Brewer Jr.

Brewer, as a leader at the NIH, was part of a team that gave the

nation new cholesterol guidelines that were expected to prompt

millions more people to take the daily pill. He also has written

favorably of a specific brand of cholesterol medication, Crestor,

which recently proved controversial.

What doctors were not told for years is this: While making

recommendations in the name of the NIH, Brewer was working for the

companies that sell the drugs. Government and company records show

that from 2001 to 2003, he accepted about $114,000 in consulting

fees from four companies making or developing cholesterol

medications, including $31,000 from the maker of Crestor.

Brewer was far from alone in taking industry's money: At least 530

government scientists at the NIH, the nation's preeminent agency for

medical research, have taken fees, stock or stock options from

biomedical companies in the last five years, records show.

NIH Director Dr. Elias A. Zerhouni has told Congress that outside

work should be allowed if " the scientist is giving advice in an area

… that is not part of his official duties. "

Information gathered by a congressional committee, in addition to

company records and 15,000 pages of government documents obtained by

the Los Angeles Times under the Freedom of Information Act, shows

that NIH researchers have repeatedly crossed Zerhouni's line.

For example:

• Dr. P. Trey Sunderland III, a senior psychiatric researcher,

took

$508,050 in fees and related income from Pfizer Inc. at the same

time that he collaborated with Pfizer — in his government

capacity —

in studying patients with Alzheimer's disease. Without declaring his

affiliation with the company, Sunderland endorsed the use of an

Alzheimer's drug marketed by Pfizer during a nationally televised

presentation at the NIH in 2003.

• Dr. Lance A. Liotta, a laboratory director at the National

Cancer

Institute, was working in his official capacity with a company

trying to develop an ovarian cancer test. He then took $70,000 as a

consultant to the company's rival. Development of the cancer test

stalled, prompting a complaint from the company. The NIH backed

Liotta.

• Dr. Harvey G. Klein, the NIH's top blood transfusion expert,

accepted $240,200 in fees and 76,000 stock options over the last

five years from companies developing blood-related products. During

the same period, he wrote or spoke out about the usefulness of such

products without publicly declaring his company ties.

Announcing such ties is not required by the NIH. The agency has

encouraged outside consulting, and has allowed most of its

scientists to file confidential income disclosure forms.

Supported by the taxpayers at a cost this year of $28 billion, the

NIH oversees research with a mission to extend healthy life and to

reduce " the burdens of illness and disability. " The laboratories and

offices of most NIH scientists are at the agency's woodsy, 300-acre

headquarters in Bethesda, Md., nine miles north of the White House.

The scientists at the NIH — seen by many outsiders as neutral

government experts — advise federal regulators and write hundreds

of

articles for influential medical journals. Some travel the world

encouraging doctors to prescribe a particular medication.

The flow of drug industry fees and stock options to NIH scientists

was disclosed in December 2003 in an article in The Times. The

article also explained the bureaucratic means by which most of the

payments had been kept secret from Congress, the public and the

nation's doctors.

Subsequent inquiries this year by Congress have shown that even

Zerhouni, the NIH's director, did not know the extent to which

agency scientists were being paid by industry.

When leaders of the House Energy and Commerce Committee felt the NIH

was not complying with a request to identify every drug industry

payment, the panel went directly to 20 companies. Those responses

revealed more than 130 consulting deals with industry that did not

appear to have the required NIH approval. One of them was the

$508,050 relationship between Sunderland, the Alzheimer's

researcher, and Pfizer.

Other documents obtained this year by The Times, including programs

of industry meetings for physicians that featured NIH scientists as

speakers, reveal dozens more relationships not reported as approved

by the agency.

The companies, in marketing their products, have frequently cited

the NIH's reputation for high scientific standards. The cholesterol

guidelines, for example, have been widely circulated by makers of

anticholesterol drugs.

Dr. Curt D. Furberg, a former head of clinical trials at the

National Heart, Lung, and Blood Institute and now a professor at

Wake Forest University in North Carolina, explained how such

information reached physicians: " The [company] reps tell the

doctors, 'You should follow these guidelines,' implying that you're

not a good doctor if you don't follow these guidelines. "

Often NIH involvement is featured, while the government researchers'

links to the companies go unmentioned.

When Brewer, the cholesterol researcher, praised Crestor in a

medical journal in 2003, the article identified him as an NIH

scientist, not as a paid consultant to the manufacturer. In

marketing Crestor to doctors, the company cited Brewer's findings

without mentioning that he was on its payroll.

As leader of the NIH, Zerhouni has acknowledged that some past deals

have been improper. But he has also argued for allowing most agency

scientists to consult privately for industry. Close government-

industry cooperation, he says, can help bring important products to

market. He has also said that the supplemental income from industry

fees can help the NIH retain talented scientists.

Others disagree. Dr. Marcia Angell, the former editor of the New

England Journal of Medicine, said in an interview that doctors and

patients counted on NIH scientists for " their critical, scientific,

dispassionate judgment. "

" When they have financial ties to the companies that make the

products that they're supposed to be impartial about, we can't

assume that, " Angell said.

Dr. Philip R. Lee, who served Presidents Lyndon B. and Bill

Clinton as an assistant secretary of Health, said that every NIH

scientist should be prohibited from taking industry money.

" Damn it, if you work for NIH, you're not working for a drug

company, you're working for the public, " Lee said. " When you have

people who have a split allegiance, undisclosed to the public, to me

it is just unthinkable. "

'Should Have Mentioned It'

As chief of the National Heart, Lung, and Blood Institute's

molecular disease branch since 1976, Brewer is one of the nation's

leading experts on cholesterol.

With his rimmed glasses and shock of sandy hair, he has the bearing

of an accomplished scientist and the credentials to match. Born in

Casper, Wyo., he gained his medical degree from Stanford University

and received further training at Massachusetts General Hospital. Now

66, Brewer has a manner that is both authoritative and plain-spoken.

But when Brewer wrote a medical journal article in 2003 helping to

introduce Crestor, he did not inform doctors about a potentially

lethal safety risk.

The product was about to be launched in the United States by

AstraZeneca, a British company that had put Brewer on a scientific

advisory board and paid him $31,000 from 2001 through 2003,

according to NIH records.

In the Aug. 21, 2003, American Journal of Cardiology, Brewer wrote

that Crestor " produced markedly greater reductions " in cholesterol

levels than three established competitor drugs tested in clinical

trials. That was true. But Brewer also concluded that

Crestor's " benefit-risk profile … appears to be very favorable, "

and

that proved to be questionable.

Brewer assured doctors there was no basis for worry about a muscle-

wasting side effect called rhabdomyolysis, which can cause kidney

failure and death. (Another anticholesterol drug, Baycol, was

removed from the market in 2001 after at least 31 deaths related to

rhabdomyolysis were reported.)

Brewer wrote: " No cases of rhabdomyolysis occurred in patients

receiving [Crestor] at 10 to 40 " milligrams.

But eight cases of rhabdomyolysis were reported during clinical

trials of Crestor. One of the case reports cited a patient who took

the drug in 10-milligram doses, according to records filed with the

Food and Drug Administration and reviewed by The Times under the

Freedom of Information Act. Sales representatives for AstraZeneca

have routinely provided copies of Brewer's journal article about

Crestor to doctors nationwide, a company spokeswoman confirmed last

week.

The FDA received 78 reports of rhabdomyolysis among patients taking

Crestor during its first year on the market, FDA records show. Two

of those patients died.

In contrast to Brewer's opinion in August 2003, an editorial two

months later in the Lancet, the prominent British medical journal,

said: " Physicians must tell their patients the truth about

[Crestor] — that, compared with its competitors, [Crestor] has an

inferior evidence base supporting its safe use. "

In March of this year, a U.S. consumer group, Public Citizen, called

for banning Crestor based upon several cases of kidney failure or

muscle damage. AstraZeneca defended its drug as safe and effective

in print and television ads this fall, adding that FDA management

agreed. But on Nov. 18, senior FDA epidemiologist Dr. J.

Graham told a Senate committee that the safety of Crestor needed

reassessment.

After Dr. Sidney Wolfe of Public Citizen questioned Brewer's ties to

AstraZeneca and his depiction of Crestor's safety, Brewer sought to

explain himself in a July 9 memo to NIH Director Zerhouni.

Brewer told Zerhouni that he had not mentioned seven of the

rhabdomyolysis cases because those patients had received doses of

Crestor higher than the approved level. As for the patient who took

the drug at 10 milligrams, " it was not possible to definitively

conclude " that Crestor had caused her rhabdomyolysis, Brewer wrote.

Other medical experts said reviewers should report such a serious

event regardless of possible cause.

" Baycol had already been pulled for exactly that same side effect

and it was a matter of great concern, " said Angell, the former

editor of the New England Journal of Medicine. " If he knew about it,

he should have mentioned it. "

Zerhouni sought to distance his agency from the controversy in a

written response to Wolfe, suggesting that the NIH had no

responsibility for omissions in Brewer's article about Crestor.

Brewer had produced it in his " private capacity " as a consultant to

AstraZeneca, Zerhouni wrote. That the article identified Brewer as

an NIH employee and directed reprint requests to the NIH was " most

unfortunate, " Zerhouni added, acknowledging that it " gives the

reader the impression that it was done in his Government capacity. "

Zerhouni's letter added: " Dr. Brewer has been counseled about these

requirements. " A spokeswoman for AstraZeneca, Denney, said

that Brewer had remained a consultant to the company until April of

this year.

AstraZeneca was not the only client of Brewer's who made use of his

NIH title. Agency rules have long instructed employees not to use

their NIH affiliations for outside consulting work. Nonetheless,

Lipid Sciences Inc. of Pleasanton, Calif., listed Brewer by his

title on the company website — and displayed video clips of

Brewer

that showed the entrance to his federal workplace, the NIH Clinical

Center.

In the clips, Brewer appeared in his white lab coat, telling

viewers, " Currently, there are a number of excellent new drugs that

have come out. " In late November, after The Times submitted

questions to Brewer about his role with the company, Lipid Sciences

removed the video clips and all references to Brewer from the

website.

The company, which is developing a product that would remove

cholesterol from human cells, paid Brewer $83,000 from 2002 through

2003. As of September 2003, his consulting contract with Lipid

Sciences was to pay him $125,000 annually plus stock options,

according to a filing with the Securities and Exchange Commission.

The company reported in March that Brewer, who until recently served

on its board of directors and scientific advisory board, held

411,927 stock options.

Brewer also has taken consulting fees from Pfizer, the maker of

Lipitor, the nation's biggest-selling cholesterol pill. From 2001 to

2003, Pfizer paid Brewer fees totaling $55,500, according to NIH

records. Brewer has been among the many agency employees whose

annual financial reports were kept confidential by the NIH.

Brewer's other duties have included serving with the agency-

sponsored National Cholesterol Education Program, which issued

aggressive guidelines for reducing cholesterol in 2001, and revised

them in July of this year to call for even wider use of cholesterol

drugs.

Eight of the nine authors of the guidelines, including Brewer, had

financial ties with companies that marketed cholesterol drugs —

but

their connections were not mentioned in their report, published in

July by the medical journal Circulation. Following criticism from

consumer advocates, the NIH posted on its website a listing of the

authors' financial ties.

Dr. L. Brown, chief of cardiology at the State University of

New York at Stony Brook, said the interpretations of data in the

cholesterol recommendations should not be trusted because the NIH

panel was " in the pocket of the drug companies. "

Brown was among 22 physicians who wrote to Zerhouni in September,

questioning the 2001 guidelines and the revisions this year. NIH

officials said they stood behind the recommendations.

Brewer, whose annual government salary is $187,305, referred

questions submitted by The Times to an NIH spokeswoman, Diane

Striar, who said Brewer's paid consulting arrangements for four drug

companies had been approved in advance.

As of this month, Brewer " no longer serves on any advisory boards of

pharmaceutical companies, " Striar said, adding that the agency would

not comment further. Brewer, after accepting consulting payments

from companies for several months this year, had stopped doing so by

this fall, records show.

Meanwhile, anticholesterol pills are the biggest-selling category of

prescription drugs in America, with sales last year of $14.7

billion. Under the current guidelines, the number of Americans

taking the medications may more than double, to 35 million,

according to NIH estimates.

Winning Over Its Critics

The pharmaceutical bonanza that has swept the country in the last

decade has created one of the most influential lobbies in

Washington. A total of 3.5 billion prescriptions — medicating

about

129 million Americans — were filled last year. Drug industry

revenue

in the U.S. tops $231 billion annually. The drug companies donated

$41 million to candidates for federal offices in the last four

years, according to the Center for Responsive Politics.

" The pharmaceutical industry has never been more powerful than now, "

said Rep. Henry A. Waxman (D-Los Angeles). " The companies have made

investments in the people who have power in Washington. And they've

gotten a very good return on those investments. "

In the last 12 years, the companies have secured passage of

legislation that fast-tracked FDA approvals of new drugs and

transformed the agency into a more compliant partner of industry.

And when congressional critics surface, the industry has a way of

winning them over: This year's top two recruits had recently

launched a congressional investigation of conflicts of interest at

the NIH.

Rep. W.J. " Billy " Tauzin (R-La.), as chairman of the House Energy

and Commerce Committee, had cited " secret consulting fees and stock

options from drug companies " to NIH scientists as a reason for

requesting that the agency produce documentation of all the

payments. Tauzin, who did not seek reelection, was hired this month

to be the president of the Pharmaceutical Research and Manufacturers

of America, the group that represents the nation's largest drug

companies.

Rep. C. Greenwood (R-Pa.), who led three hearings this year on

NIH conflicts of interest, had criticized the agency for allowing

its scientists to use " a swivel chair " to make government decisions

while taking drug company fees. In July, Greenwood announced that he

would give up his position as chairman of the Energy and Commerce

subcommittee on oversight and investigations and retire from

Congress to become president of the Biotechnology Industry

Organization — a group that urged policymakers this year not to

prohibit NIH scientists from paid consulting deals.

In the face of such industry influence, leading the NIH has become

more complicated. Zerhouni, the agency's director, is an expert in

magnetic resonance imaging. He also knows the value of moonlighting:

While serving as executive vice dean of the Medical School at s

Hopkins University, he cofounded a land company that developed

and marketed devices to enhance the usefulness of MRI scans.

He was trained as a physician in his native Algeria. With a gently

accented English and a propensity to say that he agrees with members

of Congress even when they pose pointed questions, Zerhouni, 53, has

projected affability while addressing the NIH's conflicts of

interest.

When he was appointed by President Bush in March 2002, Zerhouni

inherited an agency whose scientists were avidly pursuing private

consulting.

Although historically separate from industry, the NIH by the late

1980s was allowing some limited outside arrangements. In November

1995, the consulting gate was swung wide open by then-Director

Harold E. Varmus in an internal memo, which was first made public in

December 2003 by The Times.

The Varmus memo " immediately " lifted all limits on outside income,

reversed the prohibition against taking stock or stock options, and

freed the top leaders — the directors of the research institutes

and

centers — to start making personal deals with companies.

At the same time, arcane rules wielded by NIH administrators were

allowing more and more of the deals to remain confidential.

Following The Times' report, Zerhouni was summoned to Capitol Hill

on Jan. 22 by the Senate appropriations subcommittee for health

issues.

Zerhouni initially told the panel that the NIH had " not identified

any situations where outside activities resulted in undue influence "

on official decisions. The subcommittee's chairman, Sen. Arlen

Specter (R-Pa.), warned Zerhouni that far-reaching, internal

investigations would be needed to ensure that conflicts of interest

did not exist.

Zerhouni said he would impose tighter controls. Henceforth, he said,

the consulting deals of all NIH employees would be subjected

to " independent peer review " by a newly created ethics committee.

He also said he was appointing a blue-ribbon committee

to " completely review " the NIH's policies on conflicts of interest.

But Zerhouni added that " instead of having a complete one-size-fits-

all rule, I think the rules should be different " depending on the

employee's rank or authority to oversee research grants.

Zerhouni's position sought to keep the agency's many influential

laboratory or branch chiefs, such as Brewer, Sunderland, Liotta and

Klein, eligible for outside consulting.

Two months later, Zerhouni's blue-ribbon panel recommended what he

wanted. It called for barring the institute directors and their top

administrators from outside consulting — while allowing 5,000 or

more staff scientists, including all the laboratory and branch

chiefs — to take payments from industry. The panel also

recommended,

and Zerhouni said he supported, an agencywide ban on taking stock or

stock options from biomedical companies.

Most NIH scientists should be allowed to consult, Zerhouni said,

because such arrangements helped " translate " discoveries from NIH

labs into products that could help patients.

" You can have a policy that says, 'All right, all prohibited.' But

how does that help the public, in terms of translating the

discoveries in our laboratories into real things? " Zerhouni told

reporters.

For years, the agency has had procedures for formal collaborations

with industry — but they prohibit NIH scientists from taking the

companies' money. The formal agreements have resulted in at least

1,300 collaborations with biomedical companies over the last 20

years, agency records show.

On the other hand, the public record is bereft of

products " translated " from NIH labs to patients through private

consulting contracts. No such evidence was presented during days of

testimony this year before the NIH blue-ribbon panel or

congressional subcommittees.

By midyear, the failure of the NIH to produce a full accounting of

its ties to industry had spurred bipartisan criticism in the House.

On May 12, the new chairman of the House Energy and Commerce

Committee, Rep. Joe Barton (R-Texas), warned Zerhouni to lift the

agency's secrecy and to relinquish all records documenting drug

industry payments to NIH scientists.

The panel's senior Democrat, Rep. Deutsch of Florida, told

Zerhouni at the same hearing: " I would urge you in the strongest

possible terms to end the practice today of NIH researchers taking

anything of value from a drug or a biotech company. "

Zerhouni endorsed some additional restrictions, including ceilings

on compensation that employees could accept from industry and the

amount of time they could devote to outside activities. While NIH

employees could still accept fees to sit on companies' scientific

advisory boards, they would be barred from serving on boards of

directors.

But a July report by the U.S. Office of Government Ethics concluded

that the NIH was beset by a " permissive culture. " The office found

that 40% of the 155 outside payments to NIH employees it sampled

randomly had not been approved in advance or accounted for within

the agency.

Zerhouni proposed another compromise: a one-year " moratorium " on

industry consulting. Details of the moratorium have not been

completed.

Last month, nearly 200 NIH researchers said in a letter to Zerhouni

that a permanent ban would make the scientific staff — who are

paid

between $130,000 and $200,000 a year by the government — " second-

class citizens in the biomedical community. "

Dr. Raynard S. Kington, a deputy NIH director, said Tuesday that the

agency had " moved actually quite fast " to carry out tougher

restrictions. Yet he acknowledged that unless new rules were put

into effect, perhaps in the new year, the scientists were free to

continue collecting stock options and consulting fees from drug

companies.

" Fundamentally, " Kington said, " we are operating under the same

rules. "

Times researcher Janet Lundblad in Los Angeles contributed to this

report.

>

> Hi Everyone,

>

> In the continuing saga, here is another example of the conflicts

of

> interest in the medical profession. Today's Wall Street Journal

> reported that 6 regional sales directors of a biotechnology firm

> pleaded guilty to violating antikickback laws. Senior employees

> targeted top-prescribing doctors to induce them to write more

> prescriptions. For writing the prescriptions doctors would

receive

> a free trip to an AIDS conference in Cannes, France, a trip valued

> at $5,000 to $10,000.

>

> Jean

[Guest guest]

Sadly, this has been going on for years. The sad fact is that with

insurance companies paying less than nothing for checkups, sometimes

pediatricians are the worse culprits, from what I am hearing!!!

CIGNA and Aetna pay on average $25 for a pediatric checkup. Hello.

The pediatrician pays for herself, her receptionist, her nurse and

not counting whoever does her billing. Her malpractice is probably

40% of the $25. Plus her rent, electricity, etc. At $15 leftover

of my $25 payment, she is supposed to pay all the salaries and rent,

electricity, etc?

Many pediatricians have gone in-house for running labs, etc. because

that is where more profit can be made. Endocrinologists simply can

not make money at all -- hence many endocrinologists now are

associated with a hospital, and the money is made by the testing

that is required.

It is sad world that we have come to. I absolutely do NOT condone

the pharmaceutical companies' incentive programs. It scares me to

death. And I am not naive to think that those same incentive

programs are everywhere in today's world. Companies providing

incentives to referring people in many different companies. But few

have a direct impact on our HEALTH!

Some physicians have gone to a " no insurance accepted at all "

policy. Instead, they charge you the consumer the actual price of

their doing business. More expensive, but in exchange, you get a

physician who takes the time to talk to you, who isn't rushed, etc.

Somehow some type of changes must occur.

>

> Hi Everyone,

>

> In the continuing saga, here is another example of the conflicts

of

> interest in the medical profession. Today's Wall Street Journal

> reported that 6 regional sales directors of a biotechnology firm

> pleaded guilty to violating antikickback laws. Senior employees

> targeted top-prescribing doctors to induce them to write more

> prescriptions. For writing the prescriptions doctors would

receive

> a free trip to an AIDS conference in Cannes, France, a trip valued

> at $5,000 to $10,000.

>

> Jean

[Guest guest]

Yes, things like this have ben happening for years. I'll share a little story

with you. When

was a baby, I had many serious complaints with his insurance company, so

I

finally filed a complaint with the insurance commissioner. Before I get to the

point of this

posting, you need a brief history. was in the hospital for the first

7.5 months of

his life, so he never saw the pediatrician until he was discharged. However,

since you are

required to choose a primary care provider at birth, I did. All of the

surgeries, tests,

specialists visits, therapies, etc. were " charged " under the pediatrician during

that time,

though he never saw him until he was disacharged (he was really under the care

of a

neonatologist). Months later when I was having problems with the insurance

company,

's pediatrician made an innocent comment about not earning his yearly

bonus

from the insurance company, because of all the medical care that had

received

while he was still in the hospital. I added this comment to my list of

complaints about the

insurance company, and though I didn't mean to, I ended up getting the

pediatrician in

trouble with the insurance company for sharing that information. It turned out

that the

less tests, procedures, medical care, etc. that the primary care doctor ordered

for a

patient, the better off he was when it came to bonus time. I am not sure if

this practice

still exists today (this was over 10 years ago), but from the postings I have

seen, I wouldn't

be surprised...

Kim C.

> Sadly, this has been going on for years. The sad fact is that with

> insurance companies paying less than nothing for checkups, sometimes

> pediatricians are the worse culprits, from what I am hearing!!!

>

> CIGNA and Aetna pay on average $25 for a pediatric checkup. Hello.

> The pediatrician pays for herself, her receptionist, her nurse and

> not counting whoever does her billing. Her malpractice is probably

> 40% of the $25. Plus her rent, electricity, etc. At $15 leftover

> of my $25 payment, she is supposed to pay all the salaries and rent,

> electricity, etc?

>

> Many pediatricians have gone in-house for running labs, etc. because

> that is where more profit can be made. Endocrinologists simply can

> not make money at all -- hence many endocrinologists now are

> associated with a hospital, and the money is made by the testing

> that is required.

>

> It is sad world that we have come to. I absolutely do NOT condone

> the pharmaceutical companies' incentive programs. It scares me to

> death. And I am not naive to think that those same incentive

> programs are everywhere in today's world. Companies providing

> incentives to referring people in many different companies. But few

> have a direct impact on our HEALTH!

>

> Some physicians have gone to a " no insurance accepted at all "

> policy. Instead, they charge you the consumer the actual price of

> their doing business. More expensive, but in exchange, you get a

> physician who takes the time to talk to you, who isn't rushed, etc.

>

> Somehow some type of changes must occur.

>

>

>

>

> >

> > Hi Everyone,

> >

> > In the continuing saga, here is another example of the conflicts

> of

> > interest in the medical profession. Today's Wall Street Journal

> > reported that 6 regional sales directors of a biotechnology firm

> > pleaded guilty to violating antikickback laws. Senior employees

> > targeted top-prescribing doctors to induce them to write more

> > prescriptions. For writing the prescriptions doctors would

> receive

> > a free trip to an AIDS conference in Cannes, France, a trip valued

> > at $5,000 to $10,000.

> >

> > Jean