Doctors draw payments from drug companies
Follow drug company money in Illinois, and it leads to the psychiatry department at Rush University Medical Center, a prominent headache clinic on the North Side of Chicago, a busy suburban urology practice and a psychiatric hospital accused of overmedicating kids.

In each of these settings, doctors are drawing an extra paycheck — worth tens of thousands of dollars a year or more — for speaking to other medical professionals about pharmaceutical products at company-sponsored, company-scripted events in Illinois and across the country.

The extent of these activities is only now coming to light as drug companies start publicly releasing data about their relationships with physicians, information that until now has been a closely guarded secret.

The pharmaceutical data show that 11 Illinois physicians each earned more than $100,000 between January 2009 and June 2010 from seven companies, according to a new database compiled by the national investigative news organization ProPublica. An additional 13 medical providers earned between $75,000 and $100,000, primarily for participating in speakers' bureaus and educational forums. Most doctors received far lesser sums.

This medical moonlighting is perfectly legal but highly controversial.

Doctors and drug companies say their collaborations provide time-pressed medical professionals with much-needed education about how best to treat illnesses and how various drugs work. But other medical and policy experts say physicians involved in the activities have crossed an important line, straying into the realm of product promotion and potentially compromising their independence and patient care.

"Let's be honest: The purpose of these talks is to influence doctors to buy a company's drugs," said Eric Campbell, an associate professor of health policy at Harvard Medical School.

That may raise potential problems if patients are prescribed medications that are not necessary, are needlessly expensive or are not appropriate for their conditions.

Dr. Catherine DeAngelis, editor of the Journal of the American Medical Association, criticized the speaking arrangements, saying they posed "a conflict of interest" and threatened to put doctors' "own financial benefit before that of the patients who trust them."

More than a dozen physicians interviewed by the Tribune explained that they work with drug companies because they enjoy teaching other practitioners about important medications and the research behind them. None of the physicians routinely tells patients about his or her drug company-sponsored activities, and all said they believe such ties have no effect on their medical practices.

"To me, it's always been about helping physicians understand the treatments that are available for migraine," said Dr. Merle Diamond, president of the Diamond Headache Clinic on the North Side.

Diamond received $148,300 this year and last, mostly for speaking on behalf of GlaxoSmithKline. Four colleagues listed on her headache clinic's Web site received lesser sums from Glaxo.

Dr. David Guthman, a urologist who practices in Arlington Heights, earned more from these pharmaceutical firms than any other Illinois physician — $210,091 this year and last. The sum includes $195,750 from Glaxo for discussing medications for enlarged prostates and bladder dysfunction.

"I will not speak for a drug that I don't believe in wholeheartedly," Guthman said. "I would argue we're helping health care by avoiding misuse of drugs."

Tribune reporter Judith Graham traces the origins of this reporting on Trib Nation ...

The ProPublica database draws from information posted online by Eli Lilly and Co., Pfizer Inc., AstraZeneca, GlaxoSmithKline, Merck & Co. Inc., Johnson & Johnson and Cephalon Inc. Several companies released data about their relationship with physicians in the wake of legal settlements related to allegedly fraudulent marketing activities. ProPublica gathered the information in one place and made it easy to search by a doctor's name or home state.

All pharmaceutical and medical device firms will be required to make similar disclosures by 2013 under the Physician Payments Sunshine Act, passed as part of national health reform earlier this year. Because dozens of drug companies haven't reported data yet, some doctors may be making much more than the sums disclosed to date.

In Illinois, Eli Lilly spent the most money — nearly $4 million — on doctors and a small number of nurses who speak for the company.

"When it comes to this kind of expert scientific and product knowledge, physicians really like to hear from other physicians," spokesman J. Scott MacGregor said.