Reuben Guttman: The lawyer pharma loves to hate

Reuben Guttman wants us all to be concerned about what’s in our medicine cabinets. A Washington lawyer who specializes in prosecuting pharmaceutical fraud, Guttman has gone after Pfizer, Abbott, GlaxoSmithKline, and several other top drug makers — and he usually wins big, recouping billions of dollars for federal and state governments.

STAT talked with Guttman about bad behavior in the drug industry, and whom he trusts for his own medical care.

The lawsuits you’ve won often center on unlawful marketing and kickback schemes. How widespread are these practices? 

The problem is pervasive and exists throughout the entire health care system. It starts when the captains of publicly traded health care companies make promises to Wall Street with regard to revenue projections. Those promises result in compromises to pure medical decision-making. Drugs are marketed to patients — that is to say, put in patients’ bodies — not for reasons of medical necessity but because the pharmaceutical company needs to make its revenue mark.

How does your work as a lawyer impact the health care system?

I think that we bring litigation which surfaces information demonstrating how medical decision-making has been tainted by economic drivers, including bonuses and promises to Wall Street.

And the consequence for patients?

The collateral damage is a huge amount of health care dollars wasted and patients put at risk through drugs that are marketed without regard to their safety and efficacy.

Is there anything patients can do to protect themselves?

We’re in an era where people have to ask questions — really hard questions — especially if you’re a parent and a kid’s getting a drug or a procedure.

Knowing what you know, do you avoid doctors and hospitals?

I don’t think anybody has the luxury of avoiding doctors and hospitals.

What’s the next big pharma scam? 

The market for medical information has been poisoned. The evidence with Risperdal [an antipsychotic medication] indicated that Janssen used aghostwriter to help generate journal articles signed by doctors, then placed [those articles] in the hands of sales representatives or into the stream of medical information so they would influence prescription-writing behavior.

What do you do in your spare time?

I follow the Washington Capitols.

Are you an athlete yourself? 

I play in an ice hockey league in suburban Maryland, just outside of D.C. Some of the guys I play [against] show up defending some of the pharma companies.

As a litigator, you have to see the negative in everyone. Is it hard to go through life that way, always taking the cynical view?

There’s going to be greed and discrimination. If you’re going to be on the public interest side, you’re always figuring out how to monitor and how to challenge.

When you were a kid, did you fantasize about being a whistleblower attorney?

What I really wanted to do was be an investigative journalist, but when I got out of college those jobs were hard to find.

Reuben Guttman is a founding partner at Guttman, Buschner & Brooks. This interview has been edited and condensed. 

Spotlight on privatisation of the courts

As debate in the US continues over mandatory arbitration clauses that have led to private adjudications, a new film focuses attention on the use of private forums and sealed proceedings to resolve matters of potential public importance.

Spotlight, starring Michael Keaton, focuses on the team of investigative journalists from The Boston Globe who exposed sexual abuse by Roman Catholic priests. The movie takes its name from The Globe’s ‘Spotlight Team’ of investigative reporters.

As stories about investigative journalism go, Spotlight is not All the President’s Men. It is not so much about a team of reporters finding the facts on their own as it is a story about reporters struggling to pry the facts – and story – loose from attorneys who have settled their cases in private forums or who are litigating with key documents sealed by confidentiality orders.  In Spotlight, it is the lawyers who have put the facts and story together; but it is a story that they must keep to themselves.

In a line that explains the rationale for transparency of the judicial and legislative process, Justice Brandeis notes that sunshine is the best disinfectant. Court proceedings that seemingly involve only private interests may very well have public import. For example, cases alleging sexual harassment and employment discrimination, even when brought by a single plaintiff, may involve conduct that is pervasive and thus relevant to others who might muster the courage to step forward and vindicate their own rights. Matters litigated in the sunshine may cause private entities and government oversight bodies to take action to protect against prospective injury. But for the work of the Spotlight Team, the pervasive nature of egregious conduct would not have seen the light of day.

Public litigation in the United States has brought to the surface facts that make cars safer, workplaces more tolerable for protected classes and the air we breathe less dangerous to human health. It does not even take a court ruling or jury verdict to make the point – information that comes to light during the litigation process may fuel legislative oversight and/or regulation. This is not merely a collateral benefit; it is the way the system is supposed to work. And – as Spotlight reminds us – there is a real benefit to a transparent system of justice.

Reuben Guttman is a prominent trial lawyer and founding partner at Washington, DC-based firm Guttman, Buschner & Brooks.

What is a kickback?

Federal law makes it a felony to provide remuneration to someone to order or recommend a product or service paid for with federal health care dollars. It also makes it a felony to receive money for the purpose of recommending or ordering a product that is paid for with federal health care dollars. The law is known as the antikickback statute and it places drug companies, device manufacturers, doctors and even nurses within the orbit of liability.

Payments that do not appear on their face to be bribes may indeed be problematic. Consulting agreements, promotional speakers events, and even grants can violate  the law. Promotional speakers events are highly likely to violate the law.

Losing Opportunities to Recover Money for Worker Health and Welfare Funds

In settling False Claims Cases involving pharmaceutical industry misbranding and kickbacks, are State Attorney Generals leaving money on the table? The answer is maybe.

Most FCA settlements compensate for lost Medicaid and Medicare dollars. Left out of the mix are losses incurred by state and municipal health and welfare funds. Undoubtedly the money left on the table is not insignificant.

Why does this occur? One reason is that most state AG’s assign investigation of pharma fraud to Medicaid Fraud Control units. And larger investigations are coordinated among state AG’s through the National Association of Medicaid Fraud Control Units (NAMFCU). The result seems to be that no one is watching out for the interests of  public employee health and welfare funds at the state and federal level.

With public employee health and welfare funds strapped for cash and looking to meet rising drug costs, the oversight is not immaterial. It is an oversight that should raise questions from health and welfare fund trustees. Public employee unions which bargain for dollars to fund healthcare costs should pay particular attention. Where a municipal fund needs cash to make ends meet, the shortfall generally means that workers will get the short end of the stick when it comes time to negotiating a new labor agreement.

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