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Pradaxa and Xarelto Manufacturers Spend Millions On Physicians To Promote Products

Ennis & Ennis, P.A Oct. 1, 2016

The practice of paying doctors to speak on behalf of medications and medical devices has grown more controversial in the past few years as many feel it is a conflict of interest. This conflict, coupled with some high profile scandals involving highly paid physicians, have critics concerned with the integrity of this practice. Despite denials from doctors, studies have proven what was commonly assumed; that prescribing habits change because of speaking contracts and dinner presentations. However, speaking fees and free lunches are not going away as pharmaceutical companies will use all methods to promote their products.

Two companies spending the most are Boehringer Ingelheim for Pradaxa and Bayer and Johnson& Johnson for Xarelto. Xarelto was quick to grab market share away from Pradaxa after it hit the market. Bayer and Johnson and Johnson, have paid nearly $7 million in speaking fees to educate doctors on Xarelto and grab a share of the booming anticoagulant market. Between these two drugs and competitor, Eliquis, these companies have spent more than $20 million on speaking programs to lure doctors away from warfarin. Many doctors are wary regarding the new anticoagulants. Although the new generation drugs don’t require the dietary restrictions or constant dosage monitoring of warfarin, they lack any FDA approved antidotes to handle excessive bleeding risks.

The marketing and speaking fees appear to be paying off for these pharmaceutical giants. Xarelto sales grew 76% from $864 million in 2013 to $1.5 billion in 2014 and 2015 numbers appear to be even higher. Boehringer Ingelheim spent nearly $5 million in its marketing of Pradaxa. Pradaxa was the forerunner in the new anticoagulant race as it was approved in 2010 with significant marketing behind it. However, due to safety concerns and litigation, many doctors are uneasy prescribing the drug. The FDA has reviewed the data and concluded Pradaxa is safe when used as directed. However, many doctors and multiple lawsuits, suggest that dosing with Pradaxa should be monitored as warfarin’s is.

Another major concern is doctors with financial interests to drug manufacturers creating guidelines for the use of the new drugs. For example, Gregory Lip, a British cardiologist, works as a paid speaker and consultant to companies that make drugs used to prevent strokes in people with a type of irregular heartbeat known as atrial fibrillation. Lip has served on treatment guideline panels, which have recommended a greater use of the new drugs. This resulted in an overnight jump over a million patients now “needing” the drugs. Some experts say the new scale leads to too many people at lower or intermediate risk for stroke being put on an unnecessary anticoagulant and exposing them to increased bleeding risks. Additionally, a 2012 investigation found that treatment guidelines for some of the nation’s most popular drugs were written by panels heavy with doctors with financial ties to the drug companies.

It is clear that controversial relationships between pharmaceutical companies and physicians will always exist that are potential conflicts of interest. Patients need to be aware of such conflicts prior to starting any medication regime. Ennis & Ennis, P.A. continues to offer free, nationwide, confidential consultations to anyone who received suffered an injury from Pradaxa, Xarelto or Eliquis by calling or by going to and completing an online case evaluation form.

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