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Friday, January 24, 2014

"Dollars for Docs" Site Reveals Doctor/Pharm Relationships

The Ohio medical board found that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue. 

Yet that finding, posted on the board’s public website, didn’t prevent Eli Lilly and Company from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.

(Lisa Schwartz and Nicholas Kusnetz. "Docs on Pharma Payroll Have Blemished Records, 
Limited Credentials." ProPublica. October 18, 2010)

Just who receives money from drug companies? Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.
But, an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, who had been disciplined by state boards or who had lacked credentials as researchers or specialists.

"A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.

"More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites."

(Lisa Schwartz and Nicholas Kusnetz. "Docs on Pharma Payroll Have Blemished Records, 
Limited Credentials." ProPublica. October 18, 2010)

To investigate the industry’s handpicked speakers, ProPublica created a comprehensive database that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

In interviews and written statements, five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.

The resulting project, called "Dollars for Docs" revealed that about $258 million worth of compensation from seven companies went to health care providers in 2009 and 2010.

The team of investigative journalists found that 17,700 providers received such payments. Most of the money went to physicians, but nurses and pharmacists were also included, ProPublica said. The reasons for this money included speaking, consulting, business travel and meals.

Payments made to practitioners and institutions in Ohio totaled $83,344,844.

Why Does This Payment Occur?

Nothing is necessarily wrong or illegal with physicians giving speeches... UNLESS the payment causes the physician to prescribe one drug or device over another because of the compensation.

Is it ethical? This is a very different question. One might ask this question in response: "Does the physician always do what’s best for the patient or what’s best for his or her benefactor?" 

Here is an example:

"If Bristol-Meyers Squibb makes a high blood pressure medication that costs $25 a tablet and Abbot Labs makes one that sells for $2 each and both medications do the same thing does the physician prescribe the $2 pill or the more expensive one from the company that pays him an extra $100,000 a year to speak on their behalf?"

(Bob Aronson. "Does Your Doctor Work for You or for the Drug Companies" Bob's NewHeart Blog. January 24, 2014.)

Doctors In Debt Or In Financial Crunches

Of course becoming a physician is extremely expensive. The medical school debt incurred by a doctor is staggering.  MedPage Today estimates the average debt facing graduating medical students is about $156,000.  The Wall Street Journal's report on the worst case scenario for med school tuition debt is a whopping $550,000 tab run up by a family practitioner.

Add to this cost, the high price of malpractice insurance. Bob Aronson reports internists in Dade County, Fla., paid $48,245 annually in 2010, while general surgeons paid $192,982. In comparison, internists in the lowest-cost areas of California paid only $3,200 and general surgeons had the lowest premiums in Minnesota at $11,306 annually.

(“Medical Liability Monitor.” 2010)

In addition a new physician will not be able to earn much money during his five years of residency training either. Aronson cites the average salary for a surgical resident is about $56,000 per year, which will force him to defer paying the principal on his loans while the interest keeps on accruing.

BUT, physicians do make great money on average. A Time Magazine survey of 24, 216 physicians across 25 categories showed doctors’ earnings ranged from about $156,000 a year for pediatricians to about $315,000 for radiologists and orthopedic surgeons. The highest earners — orthopedic surgeons and radiologists — were followed by cardiologists who earned $314,000 and anesthesiologists who made $309,000. Of course, many make much more than average pay. 

There is a shortage of family physicians and pediatricians, so physicians assistants and nurse practitioners now routinely perform some of the functions traditionally handled only by licensed physicians.

The Bottom Line

Has your health professional received drug company money? You can use this website and write "Portsmouth" or whatever locasion in the "search box" to check ProPublica data:

No matter what you think about who is receiving money from whom, public access to this information may prove vital for your understanding of how the medical profession and pharmaceutical companies influence each other. The positive aspects may outweigh the negative aspects when proper medical ethics are observed.

I am not condemning professionals for getting paid well for speaking at engagements that promote benefits for patients. At the same time, the connections between doctors and Big Pharma have long been the subject of ethical and business concerns, particularly when it comes to the financial ties between those doctors and the drug companies.

Dr. James H. Scully Jr., chief executive of the American Psychiatric Association, referring to the big money paid to some psychiatrists for what are billed as educational talks, confesses the following:
("Paid speaking) is perfectly legal, and if people want to work for drug companies, this is America. But everybody needs to be clear — this is marketing.”

For some companies it may be hard to provide objective information when their very existence may be tied to drug company grant money. Some drug companies actually tie salesperson compensation to the number of prescriptions written for its products.

Until now, doctors' prescribing habits have been secret from all but pharmaceutical companies, which pay millions of dollars for such information from other firms that collect it.
Here is the real potential for problems:

* In many cases, the slides and the content and script are actually prepared by the drug company, and the doctor presents this information as the latest information about diabetes or blood pressure or whatever.

* It's not always clear to the audience that the material used by the doctor was really scripted completely by the drug company that was paying him or her to give the talk. 

* A joint investigation by ProPublica and NPR reveals that the top prescribers of certain brand-name drugs are also among those paid by the manufacturer of those drugs. The study looked at the prescription rates of certain drugs and payments made by pharmaceutical companies to doctors, and noted in one case “at least 17 of the top 20… prescribers… [of Bystolic] have been paid by [the manufacturer]…”

* Many of the drugs prescribed by doctors who speak for drug companies are significantly more expensive than their generic counter-parts and offer little additional benefit. If financial relationships influence physicians to choose pricier brand-name drugs that have little benefit over generics, everyone pays the cost — particularly taxpayers, who spent $62 billion last year subsidizing Medicare Part D.

"I've never heard a doctor that said they were influenced, but obviously the companies are interested in doing it because the evidence overwhelmingly suggests that doctors are influenced," said Rita Redberg, a cardiologist at the University of California, San Francisco, and editor of the journal JAMA-Internal Medicine. "Companies are not doing it for any reason except it improves their bottom line," she said.

* Arthur Caplan, Ph.D., head of the division of bioethics at New York University Langone Medical Center, in New York City, and a respected medical ethicist. “There are some continuing medical education and research activities that will suffer because the disclosures may appear to look bad, even if they’re not bad.”

* “How do these folks have time to do their real jobs if they’re speaking so much?” Susan Chimonas, a research scholar at the Center on Medicine as a Profession at Columbia University said. Hospital administrators, she predicted, would be “concerned not only about the conflict of interest, but also the conflict of commitment.”

* Some doctors say the drug company money can undermine patients' trust. Dr. Steve Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said: "I don't want the patient sitting opposite to me in the exam room to have to worry about whether I am prescribing a drug because I am being paid by the company that makes the drug."

Jerry Avorn, professor of Medicine at Harvard Medical School  and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital thinks it's much better for doctors to learn about drugs from somebody who is an expert in the field, but who is not being paid to teach them by the company making the product that he or she is teaching about.
Avorn says, "I think it's much better to have impartial, noncommercial, unbiased sources giving us our information, because that way it's much more likely to tell us what we need to do to take better care of patients, not to be part of a marketing apparatus to increase sales of a given drug."

Then, of course, we can extend some advice to those of you who believe we can live in a perfect world where health always takes precedence over money and perks of the job.

Perhaps the best way to insulate yourself from the influence of Big Pharma is to work with physicians that focus on preventing and curing problems, not just on prescribing medications. You may want to look for those that don’t accept money, gifts, stipends, grants, etc. from drug companies.

Also, you may want to look for physicians that place significant restrictions on sales rep access to themselves and their practices. Ask them about their policies so you are comfortable that their advice is medically-sound and not motivated by other reasons.

Like I've said before, when it comes to shady, crooked doctors, their love of money leads straight to the path of evil. We can certainly attest to that in the cradle of the Pill Mills. Maybe we can also use some of this information to boost our ranking as the unhealthiest county in the State of Ohio.

"My doctor told me I shouldn't work out until I'm in better shape. I told him, 'All right; don't send me a bill until I pay you.'" 

--Steven Wright

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