Drug companies pay $25 million to Illinois doctors

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Zajecka said it was "disturbing" to see research funding and travel and meal reimbursement included in the database. He pointed out, for example, that he is reimbursed for travel to training conferences.

"That's not profit," he said.

Dr. Israel Rubinstein, a pulmonologist at Jesse Brown VA Medical Center in Chicago, said he is not biased in favor of drugs manufactured by companies that have paid him, and he has no problem with public disclosures of how much he is paid. He received more than $117,000 from two companies for speaking and travel between third-quarter 2009 and first-quarter 2011.

"I take a generic approach (when speaking about treatments) based on the published guidelines where those drugs are indicated," he said.

ProPublica's analysis shows that firms with the highest U.S. sales last year didn't spend the most on physician marketers. Industry leader Pfizer, with sales of $26.2 billion, spent $34.4 million on speakers, ranking third among the eight companies. By comparison, Lilly spent the most on speakers, $61.5 million, even though its sales were about half of Pfizer's.

"We continue to believe in the benefits and value that educational programs led by physicians provide to patient care," Lilly spokesman J. Scott MacGregor said in an email.

The analysis also found that the payouts to dozens of doctors and other health professionals took a steep dive last year.

Pulmonologist Veena Antony, for example, was paid at least $88,000 to give promotional talks for GlaxoSmithKline in 2009. But last year, the Birmingham, Ala., doctor gave them up out of concern that patients might think her advice was tainted.

"You don't even want the appearance that I might be influenced by anything that a company gave," she said.

Cancer specialist Nam Dang was a regular on Cephalon's speaking circuit, pulling in $131,250 in 2009. But those promotional gigs stopped, he said, after he took a job at the University of Florida in Gainesville, which bans such talks. In 2010, he received $10,000 from Cephalon and Pfizer for consulting.

Nurse practitioner Terri Warren, who runs a Portland, Ore., health clinic, earned at least $113,000 from Glaxo in 2009, mostly talking about its herpes drug Valtrex. In 2010, that dropped to $300 after the drug went off patent and Glaxo no longer had a financial incentive to promote it.

"It's a business decision, clearly," said Warren, who felt her talks helped educate other health professionals about treating a taboo illness. "My money (from Glaxo) went into keeping this little clinic alive, and now we have to figure out some other way to do that."

Other physicians, however, have ramped up speaking engagements and consulting.

For example, pain specialist Gerald M. Sacks spoke and consulted for four companies in the database and was among the highest paid. The Santa Monica, Calif., doctor earned $270,825 from Pfizer, Johnson & Johnson, Lilly and Cephalon in 2010, up from $225,575 in 2009. Those figures do not include travel costs and meals.

Over 18 months, Pfizer alone paid Sacks $318,250 for speaking. He did not return repeated calls for comment.

Some companies apparently have used fewer physician speakers and consultants since they began posting their data publicly.

Cephalon, a relatively small Pennsylvania company that specializes in pain, cancer and central nervous system drugs, paid physicians nearly $9.3 million in 2009 for speaking and consulting. That figure dropped to $5 million last year.

Spokeswoman Jenifer Antonacci said the company's marketing strategies for its brands changed.

Another example is Glaxo, whose spending on speakers averaged about $13.2 million per quarter in 2010, down 15 percent from the last three quarters of 2009. (Glaxo did not report data in the first quarter of 2009.)

Company spokeswoman Mary Anne Rhyne said the company is working to reduce its speaker rolls by 50 percent.