I spent the last five days in Maui, thanks in large part to Gilead Sciences, Alios BioPharma, Merck, and Abbvie. This was a pharmaceutical-sponsored conference for medical doctors to learn about the results of clinical trials. And I’m not a medical doctor, but I happen to be related to one.

Some doctors were sponsored by their medical facilities as part of Continuing Medical Education. Whether bankrolled by drug company or hospital, all of it is ultimately tacked onto medical bills paid by your health insurance provider, so that’s something to feel good about.

Stuff I learned:

Clinical trials are conducted by neutral third parties. Neutral third parties whose clients sometimes treat them to lavish vacations in Maui.

Patents are weird. In the United States, a pharmaceutical company that patents a new drug is granted a 20-year term of exclusivity. Later, a second pharmaceutical company could discover a new use for the drug, and obtain a second patent. Now we have the same exact drug with two different patents. Each company can only market the drug for their own patented use case.

Thalidomide was patented in 1954 by a company called Chemie Grünenthal. It was used to treat morning sickness until a bunch of babies were born with missing appendages.

Decades later, Celgene discovered that thalidomide could be used to treat leprosy, which is apparently still a problem. Celgene obtained a new patent and now sells thalidomide under the brand name Thalomid.

Doctors have little incentive to prescribe cheap drugs. The first thalidomide patent has long expired, and someone could make a cheap generic. But the generic can only be used to treat morning sickness, because the leprosy use case is still protected.

A particularly charitable doctor could prescribe generic thalidomide for leprosy and call it “off-label use”. But did the generic manufacturer fly him to Maui?

It’s all about marketing. BigPharma invests heavily in marketing to make sure their drugs get prescribed. By “marketing”, I mean visiting doctors and showering them with gifts.

Oops, I don’t mean gifts. Medical institutions have policies against physicians receiving gifts. However, if a sales rep wants to take a doctor out to dinner at French Laundry, or invite his family to an all-expense-paid trip to Maui, that’s totally cool.

Moral of the story: Marry a doctor. Ideally one that specializes in infectious diseases requiring expensive drug therapy.

*The FDA permits physicians to prescribe medications for other than their intended use. So a generic substitute for a patented use case is okay. However, this opens the physician’s medical facility to lawsuits from both the patent-holder and the patient.