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May 24, 2011

Massachusetts Physician Stands Up to Local Media

Physician-standing up 
In an effort to support the “gift ban” which is costing Massachusetts small business millions in revenue and continuing the crusade to publish the “investigative” work of  ProPublica, a local news story from Massachusetts recently discussed the payments made to several practicing physicians in the area.

The article, published in the Telegram, pulled data from the ProPublica database to find that “five Central Massachusetts doctors earned more than $50,000 each — with one making nearly $225,000 — in speaking and consulting fees from eight pharmaceutical companies last year and in part of 2009.”  News must have been slow this week, given this database has been available now for several months.

The first problem with the article is that it editorializes the story, instead of actually presenting news, by using terms such as “lucrative” and “pay off big.”  This is irresponsible journalism. 

For example, the article noted that 48 Worcester County doctors received more than $750,000 in payments for speaking, consulting, educational programs, food, travel, and marketing studies, from Eli Lilly, GlaxoSmithKline, Pfizer, AstraZeneca, Merck, Johnson & Johnson, Cephalon and ViiV, all of which voluntarily disclosed payments nationwide.  That is roughly $15,500 on average per physician, hardly a “lucrative” salary or “big pay off.”  This probably barely covers the amount of time and efforts the doctors spent away from their practices, let alone the fair market value of the educational and consulting services they provided.

Following in the footsteps of ProPublica, the author of the local newspaper article discusses none of the benefits that come from physician-industry collaboration, nor how many physicians received training and education from the programs or how many thousands of patients these physicians helped.  The article does however quote many of the physicians who emphasize the important educational value such payments provide.

According to the article, the top Worcester County earner was Dr. Lawrence M. DuBuske, an allergy-asthma specialist, who received $224,675 from GlaxoSmithKline and AstraZeneca.  We noted last year that Dr. DuBuske resigned from his job at the Brigham and Women’s Hospital in Boston because of a policy they instituted that banned faculty from essentially working with industry.

Dr. DuBuske was paid $199,175 by the company alone for speaking engagements last year, at one point giving talks nearly every other day to fellow doctors as far away as Russia and Argentina.  Given the fact that Dr. DuBuske was speaking almost every other day, simple math would show that he was making less than $2,000 per day, probably less than the amount of money a physician would earn in one day for seeing patients.
Dr. Chettupuzha J. Mathew, a pediatrician, was paid $64,901 by six of the drug companies, including separate payments of $27,300 and $13,300 in speaking fees from GSK.  The fact that Dr. Mathew works for six of the companies not only shows his clear expertise, but that he has no specific allegiance to one company, and most likely, his main motivation is to educate his colleagues and peers.

In fact, Dr. Mathew said the money is “fair compensation for his hours of research in preparation for the seminars, most of which are on diabetes — a disease he himself was diagnosed with five years ago. Another part of the compensation is for lost office time, travel and accommodations.”

Additionally, Dr. Mathew said that about 90 percent of each lecture is about a disease or medical condition, with the last 10 minutes spent talking about medication from whichever pharmaceutical company is paying him. Slides used in the presentation are U.S. Food and Drug Administration-approved.  Dr. Mathew noted that he “would never say OK to talking only about a product. The (drug) companies want doctors to talk, because they are authorities and have to be up to date on things.”

Dr. Amjad Bahnassi and Dr. Richard C. Tomb, both Worcester psychiatrists; and Dr. Mohammad R. Och, a forensic psychiatrist in Worcester, came close to Dr. Mathew with each receiving payments greater than $50,000 from four companies.

Dr. Bahnassi explained to the Telegram, “that the fees were for giving seminars to other doctors on new psychotrophic (central nervous system) medications.”  What exactly is wrong with paying a highly trained and experienced expert fair market value for his services to educate other doctors?  Many physicians feel strongly that it is their duty to do so.

Dr. Bhalchandra Parulkar, a urological surgeon in Worcester who received approximately $20,000 in speaking fees, said seminars are necessary as continuing education for doctors.  Dr. Parulkar, explained that as a surgeon, “there is no peer-to-peer interaction for us, so we need to use our private time to educate ourselves.”  He asserted that the programs “do not reflect on his prescription pattern. It is the only way to talk to other doctors, and it is the only way to educate people about new drugs.”

Dr. Parulkar, who gives talks on the treatment of prostate cancer and urinary incontinence, pointed out that most patients have health insurance provider restrictions that require prescribing generic forms of medications.


What makes this story interesting is that Dr. Mathew himself has diabetes.  When Dr. Mathew learned he had diabetes, “even though he knew about it as a physician, he had to do a lot of research. He attended a seminar in Dallas with 300 doctors, and found out how much knowledge these people have. It opened his eyes.”  From this conference, he recognized the crucial importance of doctors knowing “all of the up-to-date information on the disease from world-known authorities.”

It does not take one health professional being inflicted with a chronic or serious disease to realize that there is a tremendous amount of data and clinical information surrounding the diseases and illnesses doctors and health care practitioners deal with each day.  Basic knowledge is never enough for complex and chronic or serious diseases, especially when there are experts all over the world who know this information and data because they helped participate in creating it one way or another.  As a result, many in those positions feel obligated, as scientists and doctors attempting to progress medicine and patient care, to educate others, and their services should be fairly compensated.

Ultimately, Dr. Mathew told the Telegram that “his seminars, of which other topics have been hypertension and asthma, are given to other doctors and health professionals as continuing education” and that he himself “often attends seminars given by other doctors to learn about the latest practices and medications.” 

Accordingly, the programs that Dr. Mathew both teaches at and attends have value because they provide physicians with further education and training about chronic and serious diseases, the treatments for which are constantly evolving and changing, demanding constant updates.  News media should stop focusing on the value of money physicians are compensate for, and instead try to do some real investigating and see how many lives these educational programs are saving, and how much money to the health care system is being saved. 

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Great to see physicians finally speaking up for themselves!

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