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THE "NOVARTIS GREECE SCANDAL"

UNVEILS THE PERMANENT SCANDAL OF


THE PHARMA INDUSTRY
First published in English in August 31, 2018

The alleged long-standing involvement of Greek politicians, suspected of having


received very high bribes from Novartis - a sprawling scandal, causing quakes in a failing
political system in crisis - is not just about Novartis, nor is it an isolated "Greek case". It
expresses the diffuse collusion and corruption of the system. A full scale solution is
required.

Dr. Theodoros Megaloeconomou is a pioneering


psychiatrist, a leading figure in psychiatric reform in
Greece, former head of the 9th Department of
Psychiatry at the Psychiatric Hospital in Athens, and an
activist for the unconditional acceptance of refugees
and health care for all.

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

French language version at: https://www.uspsy.fr/Scandale-Novartis-Grece-La-


2425.html

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
caricatural cartoon, by definition, is an exaggeration intending 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".
The "Novartis scandal" is not 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
GlaxoSmithKlinee was promoting Plaxil to treat depression
in patients under 18 years old

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 [1] 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 now talk about congresses fully paid for 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.
Greece is a privileged destination for pharma companies to organize conferences

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 [2] ?

The newly elected board of the Association of Pharmaceutical Companies of Greece (ΣΦΕΕ / SFEE) is
meant to pursue the policies of its predecessors

 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 big permanent scandal of the pharma industry is it treats medicines
as if they were commodities and patients as profitable resources

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.
The streamer of the European Network for Democratic Mental Health (ENDMH/RESMD)
hangs above the main gate of the Psychiatric Hospital of Athens (PHA/ΨΝΑ - Dafni).
ENDMH/RESMD promotes activism against commoditization of health,
for humane and emancipatory mental health care

Notes of the translator:

[1] FDA: Food and Drug Administration (the US Supreme Drug Authority)

[2] 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.

[3] 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

Further reading:

 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 - antony.barnett@observer.co.uk - web publication of the
12/07/2003) https://www.theguardian.com/society/2003/dec/07/health.businessofresearch

URL source: https://blogs.mediapart.fr/emmanuel-kosadinos/blog/310818/novartis-greece-


scandal-unveils-permanent-scandal-pharma-industry