Doctors in the United States are being paid hundreds of millions of dollars a year to prescribe drugs for anemia produced by the pharmaceutical companies Amgen Inc. and Johnson & Johnson, the New York Times reports.

These payments come in the form of substantial rebates, by which the companies cover a significant part of the doctors’ cost for purchasing those particular pills (called EPOs) and dispensing them in their offices. Such payments are legal, and the companies insist that they are completely proper. According to Johnson & Johnson, the rebates “reflect intense competition,” and are not intended to encourage doctors to prescribe the drugs. But critics have charged that the rebates amount to bribery, and may encourage doctors to prescribe EPOs at unsafe levels or when they are not really required.

According to the New York Times, Amgen paid $2.7 million in rebates in 2006 to a single Northwest practice, which prescribed $9 million worth of Amgen products.

Anemia drugs are given to approximately one million U.S. patients yearly, providing a major source of revenue for medical companies. Amgen and Johnson & Johnson made $10 billion off of anemia drugs in 2006; the medicines account for a quarter of the income for DaVita, the country’s largest owner of dialysis clinics. Likewise, they represent Medicare’s single biggest drug expense.

But the drugs have come under increased scrutiny amid worries that they might increase the risks of heart attack and stroke even at commonly prescribed levels. The day after the Times report, an FDA panel recommended that the agency strengthen the warnings on the drugs and require Amgen and Johnson & Johnson to conduct additional safety tests.

In particular, the panel wants stronger warnings that the drugs may cause side effects including blood clots and death if used in unapproved contexts.

The FDA usually ends up following the recommendations of such panels, but is not ultimately required to do so.

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