Last week we reported about the widely publicized criminal behavior of pharmaceutical giant GlaxoSmithKline, and the $3 billion fine it will pay for its crimes. Thanks to Kaiser Health News (KHN), consumers can get the gory details of just how Big Pharma inflates drug sales and the cost of health care.

It’s about doctors who leverage their medical celebrity into roles as drug shills. It’s about doctors who accept fancy trips and recreational pursuits from the companies who supply their wares It’s about spinning research results into fictional scenarios that make a great story and really bad patient care.

Courtesy of KHN, here are some of the players and their playgrounds with which Glaxo promoted the depression drugs Paxil and Wellbutrin and the diabetes drug Avandia.

• Glaxo paid Dr. Drew Pinsky (radio call-in show “Loveline,” reality TV show “Celebrity Rehab with Dr. Drew”) $275,000 to promote Wellbutrin “in settings where it did not appear that Dr. Pinsky was speaking for” Glaxo.
• On a radio show Pinsky said the active substance in Wellbutrin “could explain a woman suddenly having 60 orgasms in one night” even though Wellbutrin was approved to treat only major depression.
• Glaxo promoted Wellbutrin “knowing that much of the cost of the unapproved, nonmedically accepted and/or inappropriate uses would be borne by federal health care programs.”
• In 2000 and 2001, Glaxo flew psychiatrists to resorts (El Conquistador in Puerto Rico and Renaissance Esmeralda in Palm Springs, Calif.) to promote Paxil for children, even though it was unapproved for that use. “Results suggest that the Paxil Forum had a significant impact on Paxil market share in the months after attendance,” according to a Glaxo memo.
• Glaxo paid what prosecutors described as kickbacks to doctors in the form of consulting fees, entertainment, travel and “sham advisory boards.” It tracked their prescribing habits. A Glaxo memo emphasized that only “KEY Customers” (high-prescribing doctors) should get free tickets to Boston Bruins and Celtics games.
• “When I asked for the business he laughed,” one Glaxo sales rep said of a doctor whom he had treated to a St. Louis Cardinals baseball game. “I didn’t really see the humor in it. How could he think I wouldn’t ask for the business when I’ve treated his family to a day at the ball park.”

Most doctors who accept this graft would say that they wouldn’t prescribe a drug they didn’t believe in, so as long as they do anyway, what’s the harm in being treated well by its makers? We think it’s the patient’s decision, not the provider’s, as to what is and isn’t a conflict of interest.

So if you’re going to accept gifts, people should know about it. The 2010 health-care reform legislation supports that notion, and as of next year, the Physician Payment Sunshine Act will require doctors to disclose such activity.

In the meantime, you can look up any number of palm-crossing transactions between doctors/researchers and the medical drug and device industry on the “Dollars for Doctors” page of ProPublica, a nonprofit investigative news operation.

Should anyone doubt that these professional courtesies have the potential to affect someone’s health adversely, consider this comment posted at the end of the KHN story earlier this month:

“I’m on a brand medicine that has a generic. The brand drug is at least ten times the cost of the generic. I have asked my doctor to switch me to the generic and he refuses. He always says to me, ‘I’m the doctor. If you don’t like how I do things, there’s the door.’ The trouble with making my exit is that I’m not sure I can find another doctor that takes Medicare and I’m sure my current doctor will put me on the black list. He’s done to his other patients and I’m sure he’ll do it to me.”