Medical device and pharmaceutical companies are gearing up for a big change in the way they deal with their most important middlemen: doctors. Beginning in 2013, they'll be required to report every dime they pay out to physicians in speaking fees, consulting, research, meals and business travel to the federal government. You say you didn't know your doctor was on a pharmaceutical company's payroll? Neither did I -- until this morning, when I searched a new database created by ProPublica, a nonprofit journalism organization, and discovered that one of mine has received money from two drug companies.
Doctors benefiting from relationships with drug or medical device companies is nothing new. Remember all the pens and stuffed animals and other branded tchotchkes that used to be scattered about doctors' offices? All those trinkets began disappearing a few years ago, after the pharmaceutical industry in 2009 voluntarily agreed to stop producing them, an effort to "try to counter the impression that gifts to doctors are intended to unduly influence medicine," reports The New York Times.
"But some critics said the code did not go far enough to address the influence of drug marketing on the practice of medicine,"
the newspaper goes on to say. "The guidelines, for example, still permit drug makers to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations."
It's these "educational presentations" that are now gaining attention. According to ProPublica, "Eight pharmaceutical companies, including the nation's three largest, doled out more than $220 million last year to promotional speakers for their products." The slides used in the presentations are created by the drug and medical device companies, and these speakers are doctors that the companies pay to make presentations to other doctors about the benefits of various products.
And they can make serious money doing it. Nam Dang, a cancer specialist and speaker for drug manufacturer Cephalon (CEPH), raked in $131,250 in 2009 alone. Zale Bernstein, a Buffalo hematologist, banked $177,800 on the Cephalon circuit in 2010, and that's excluding the additional $35,000 for travel. Gerald M. Sacks, a Santa Monica, Calif., pain specialist, earned just shy of $500,000 in the last two years for his speaking and consulting gigs with four companies. And again, that excludes whatever he received in reimbursement for travel costs and meals.
"We continue to believe in the benefits and value that educational programs led by physicians provide to patient care," Eli Lilly (LLY) spokesman J. Scott MacGregor wrote in an email to ProPublica. But others are concerned that paying doctors to promote products creates a conflict of interest in which a patient's best interests may come second to a doctor's bank account.
The Hard Sell for the Wrong Drugs
Tracy Weber, one of the ProPublica reporters leading the organization's investigation, explains. "A lot of brand name drugs are not only super-expensive, but also have more severe side effects than older drugs. So it's important to ask if there is something safer or cheaper? Another drug I should be using? Or non-drug alternatives? Especially with devices. It's good to know if your physician is speaking on behalf of the company that makes a hip implant or heart device. Are they prescribing it based more on their relationship with the manufacturer rather than what's best for you?"
Weber is surprised by which doctors have earned the most money lecturing to other physicians. "When we started putting this together, we thought the highest paid, the top speakers, would be really brilliant physicians with lots of research in their specialty area. Many of the highest paid speakers had none of that, very little or no published research, no affiliation with academic centers. So their speakers are chosen for some other reason than their expertise."
Of course, there are legitimate reasons a doctor would receive funding from a medical device company or drug manufacturer. These companies offer critical research dollars to physicians to help finance laboratory space, staff, and other costs associated with medical science. And while it's easy to hear that a physician is on the company payroll and immediately assume the worst, Weber says that many of the doctors "feel very strongly that they are providing a valuable education service by talking about drugs they believe in." Consider, for example, doctors in rural areas who may have limited access to cutting-edge medical developments. They speakers can help to keep those doctors informed.
So what are consumers to make of ProPublica's database of doctors and the payments they've received? Well, its a straightforward search engine, so if you're at all curious, you should check it out: Simply enter your doctor's last name and state. And if something does pop up, as it did with my doctor, take a look to see how the funds are classified. My doctor received almost $25,000, but the vast majority of it was research money. Given that my doctor works at a major research institution, and has publicly acknowledged this financing previously, I decided I was comfortable with it. But if you're unsure how you feel, just ask your doctor for a few details about the relationship. As Weber says: "If your doctor doesn't want to talk to you about it, I think that's something worth noting."
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