by Michele Bocci and Fabio Tonacci
«Dear Honorable… ». Thus begins the letter that Italian deputies and senators found in e-mail 24 hours after the beating of the maxi fine of 180 million euros imposed by the Antitrust on Novartis and Roche for the Avastin scandal. «I would like to share with you, waiting to be able to do it in person, that we are in strong disagreement with the assumptions of that investigation…». Big Pharma needed to talk, to explain, to convince. And Parliament is just one of the places to "press". Perhaps the most important, but not the only one.
Hospital lanes, clinics, conferences, university classrooms: every place is useful when it comes to promoting a new bottle, an innovative molecule, a lotion.
Just identify the people or entities whose voice has a certain weight at the time of purchases. First of all the doctors. From the scholarship paid to give a salary to the associated professor to the scientific appointment in the summer in a tourist resort. «The doctors are all studied and filed – a manager of one of the largest companies in the sector tells Repubblica, with the guarantee of anonymity – to identify those on whom to put pressure. There are the "authoritative", who have the ability to persuade others, "the useless", the "sensitive to novelties", who just present them with the same drops with a different name and you have already convinced them». Not bad if, as in the Avastin-Lucentis affair, there are studies that have demonstrated its equal efficacy.
"Dear Honorable..." writes Novartis. Two folders signed by the managing director Georg Schroeckenfuchs to say that «our work has always been correct» and that he is «available to give all the necessary answers». Going as far as the mild advice to avoid any reform of the off-label practice «made on emotional grounds». That's right, on an emotional basis. In short, a showy excusatio non petita.
Directed to parliamentarians, it acquires a subtext that sounds more or less like this: you have scuttled that paragraph 3 of the Balduzzi decree which modified the regime of the "off-label" use of medicines, here are the consequences. The drug lobby knows this. Who voted for those amendments, as well.
The Avastin, for example. Made by Roche for some forms of colon cancer. Since 2005, ophthalmologists from all over Europe began to use it off label, ie
