By Deborah L. Shelton, Tribune reporter
September 27, 2011
At least three dozen doctors in Illinois received payments and perks exceeding $100,000 from drug companies between 2009 and early 2011, according to an updated database that now includes information from a dozen pharmaceutical firms.
Doctors in the state received about $25 million in all from the companies for travel, meals, research, consulting and speaking engagements, the data show. Nationally, the eight companies who provided a full year's worth of payment information doled out more than $220 million in 2010 to promotional speakers for their products.
The database of drug company disclosures was compiled by ProPublica, a national investigative news organization, and allows the public to search for individual physicians to see whether they've been on a drug company's payroll.
The data provide a preview of what the public can expect to see in 2013, when all drug and medical-device companies — potentially hundreds — must report such figures to the federal government. As more information becomes available, a more complete picture is emerging of the perks and payments made to physicians.
The most controversial payments involve consulting arrangements and promotional speeches. Drug company officials say they are funding talks that provide much-needed medical education, led by physicians who are experts in their fields. Critics say financial relationships between doctors and drug companies can threaten patient care by influencing physicians to prescribe certain medications whether or not they are the best choice.
Some hospitals are tightening their rules to minimize possible conflicts of interest.
Among the Illinois physicians who received payments of more than $100,000 were a half-dozen physicians at Rush University Medical Center in Chicago. But Rush officials said a policy that goes into effect this month is expected to put a big dent in such payments.
The policy, which broadens existing rules, requires doctors to report all payments from drug companies annually and restricts them from participating in drug company speaker's bureaus, among other things. Physician disclosures are reviewed by a conflicts of interest committee.
"The idea here is we're always dealing with potential conflicts and what we wanted as an organization is to have a mechanism by which they are being managed," said Dr. David Ansell, chief medical officer at Rush.
Dr. John Zajecka, an associate professor of psychiatry at Rush, said he has already cut back on speaking events sponsored by drug companies because of the new policy. He received more than $222,000 from three companies between first-quarter 2009 and first-quarter 2011, most of it for speaking and travel.
"I might do medical consulting in compliance with Rush guidelines, but it will not be promotional," he said.
Until 2009, pharmaceutical company payments to health professionals were closely held trade secrets. But several companies began reporting the information publicly under pressure from lawmakers or as a condition of settling federal whistle-blower lawsuits.
ProPublica published a database called Dollars for Docs in October 2010 that included information from those companies, and it recently updated the database to include 12 companies in all. Eight provided data for all of 2010: Eli Lilly and Co., GlaxoSmithKline, Pfizer, Merck, Cephalon, Johnson & Johnson, ViiV Healthcare and AstraZeneca.
In addition to the payments made to speakers, some companies also disclosed how much they spent on consulting, travel, meals and research.
The payments to doctors and other health care providers in ProPublica's database total more than $760 million and cover reports from drug companies between 2009 and the second quarter of 2011.
The new data offer a glimpse of how the firms have adapted their strategies over time, both to changes in the marketplace and to increased scrutiny of their sales techniques. Many experts predict physicians will back away from working for the companies once their names and pay are publicly revealed.
While some relationships are appropriate — a company funding a doctor's research of new treatments, for example — payments for some activities can undermine trust in the medical profession, said Josephine Johnston, a research scholar at the Hastings Center, a bioethics research institute.
"They make it look like physicians are not impartial or are in the service of the drug companies, and can cause patients to wonder if physicians' recommendations for treatment are being made because it was the best option based on their clinical expertise or because they have a relationship with the company," Johnston said. "I don't think many physicians have taken that risk (of patient distrust) as seriously as they should."
Some doctors urged caution in the way the data are interpreted.
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.
"We feel it is a better use of resources to use fewer speakers more often. This cuts down on training costs as well as lessens the number of contracts needed," she wrote in an email.
Some companies also have replaced some in-person speaking events with teleconferences, webcasts and video conferences.
ProPublica's early analysis of the data is limited because so few companies report their spending and, even then, disclose different information. Lilly, for example, reports every health professional it pays to speak, while Pfizer includes only those who can prescribe.
"It's really unclear how much money is being spent in any one of these areas," said Vincent DeChellis, a principal at NHHS Healthcare Consulting, which has studied the data.
Scrutiny of speaker programs has prompted changes. After ProPublica reported last year that state medical boards had sanctioned some drug-company speakers, the firms pledged to toughen their screening procedures and exclude physicians with disciplinary records.
Separately, ProPublica found that universities were not enforcing their own policies barring physicians from giving promotional speeches. In response, a number of schools said they would begin using the payment rosters to check for rule-breakers.
Pharma's trade group said the focus of most companies right now is ensuring the accuracy of data that will be publicly released in 2013. But this information also must be put into context for patients, said Diane Bieri, executive vice president and general counsel for the Pharmaceutical Research and Manufacturers of America.
Doctors help develop new medicines, advise companies on marketing and help educate their peers about appropriate uses of new drugs, she said.
"If the only information that's available is that company A paid doctor B $75,000 for a consulting arrangement," she said, "that's typically not enough information to really educate the patient about what was involved in that relationship."
Tribune reporters Judith Graham and Brian Boyer contributed.
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