Occasionally the media misses the point on important stories. This is clearly the case with ProPulica’s Dollars for Docs campaign. By focusing on “payments to physicians,” they continue to miss the mark that a vast majority of those payments will one day lead to improved lives for perhaps millions of patients.
Previously we reported on local and regional news outlets that are using ProPubica’s updated payment data to write articles about physician payments. Below is a summary to several States that have worked with ProPublica and their Dollars for Docs database to produce such articles.
Several articles in California were published using the Dollars for Docs database. The Contra Costa Times reported that companies paid doctors in California more than $241 million from 2009 to 2012 (the most of any state). The beginning of the article lists Dr. Moshe Lewis, who was paid $224,000 from five drug makers for speaking, consulting, travel and meals between 2009-2012.
Lewis said he lectures to doctors about new medications on the horizon. “I don’t over-endorse one product over another. I try to align myself with companies that I find to be ethical, that have not had multiple products pulled from the market.” He supports the transparency and insists the money does not influence him.
“Pharmaceutical companies used to take doctors to dinner, but that was banned years ago,” said Dr. Arthur Chanzel Jeng, an infection control specialist at UCLA-Olive View Medical Center in Sylmar. “Now they must provide some educational content.”
The database links Dr. Gurkirpal Singh to more than $248,000 in Pfizer payments it lists for speaking, consulting, travel and meals since 2009. He said all the money went to Institute of Clinical Outcomes Research and Education in Palo Alto, where he is the chief scientific officer. Singh said the money paid for research. “I receive nothing -- let me be very clear on that,” said Singh, who is an adjunct clinical professor at Stanford University. “There’s absolutely issues of conflict that you have to be careful about,” he said. “That's why our contracts are written in such a way that we have 100 percent control over what we do.”
In 2006, Stanford’s medical school banned its physicians from accepting gifts from companies, including free meals and drug samples. It also limited industry marketing at the medical center. In 2009, Stanford required its medical school faculty to publicly disclose on their website profiles if they received $5,000 or more for consulting activities from outside firms. “Stanford has been concerned that the integrity of research and patient care” not be influenced by private financial interests, said Kathryn Gillam, who since January has directed Stanford's conflict of interest program.
UC San Francisco requires its faculty to report funds from outside of the university and limits such payments to $20,000 per year, or less in some departments. Faculty members cannot spend more than 21 days per year on outside industry activities.
The Oroville Mercury-Register also wrote a story covering payments to physicians in Chico, California, noting that doctors in the area received payments totaling up to about $143,000. A greater number of Chico doctors received smaller payments in the form of meals provided by the companies. The article lists seven doctors that received payments, some of which told the newspaper that giving such talks is an important way of educating other physicians about medications and diseases.
Dr. Abouesh said he’s been doing work for drug companies — speaking to groups of doctors — for about 10 years. He makes presentations locally about once or twice a year. “I talk about different illnesses and medications, about my personal experience and what research has shown,” he said. “It’s an educational process for the other doctors. I don’t feel there is a conflict (of interest). I keep a very strict boundary. They don’t influence me in what I prescribe.”
“I am selective,” said Dr. Forner. “I only speak for companies where I feel I am an expert in that area.” Dr. Schwartz said, “I only speak for products I believe in and I find useful. I’ve had many opportunities where (companies) asked me to speak and I declined because I like other medicine better.” Forner said at present he only works for one drug company, Allergan, and he only talks about the use of its product Botox to treat chronic migraine.
He said he worked for Allergan, helping conduct clinical studies to obtain FDA approval for using Botox to treat chronic migraine. As a result, he said, he has expertise in this treatment, which he said is the only FDA-approved treatment for chronic migraine. He said he travels around the country, teaching other doctors how to use Botox to get the best results. Forner said he sees the work he does for drug companies as an important way to promote good medicine.
If doctors were prevented from giving such presentations, “it would really be to the detriment of education about new pharmacalogic approaches,” Forner said.
The techniques he describes conform strictly to FDA guidelines, which is important because in the past, there were abuses where doctors working for pharmaceutical companies talked about using medications in “off-label” treatments that weren’t approved by the FDA.
Schwartz said he appreciates the opportunity to speak to other doctors about medications and diseases. He likes to think he’s helped non-specialists better understand how to treat illnesses like hypertension, he said. Also, preparing these talks motivates him to study and stay on top of issues in medicine.
But Schwartz said he thinks the relationship between physicians and the industry benefits medicine. “To just presume the whole thing is evil, is just not right,” he said. There are now “very careful guidelines” that prevent unethical practices, he said. “I am sure bad things have happened. I remember an era when pharmaceutical companies could offer all sorts of things — more than just dinners. They might give gifts out. All those things have been done away with.”
The Inland Valley Daily Bulletin also reported payments to physicians in San Bernardino County, in California, noting at least three that received more than $100,000. One physician was Jeffrey Unger of Catalina Research Institute in Chino, said that speaking engagements, “are a vital part of his continuing education as a doctor and that there's nothing wrong being paid for the work those events require.” "We’re not playing golf. We’re not getting massages. This makes me a better doctor,” he said.
Unger said he is preparing for an event in Mexico that will require him to work up to 20 hours to prepare his remarks. “I’ve never had any patient ask me, ‘Hey, doctor, when have you gotten any money from these pharmaceutical companies?’ They don’t ask. They don’t care as long as they’re getting the best possible treatment from their doctor,” Unger added.
Suman Thakker, who is affiliated with Desert Valley Medical Center in Victorville, and also received payments above $100,000, said he speaks to general and professional audiences and discloses when he receives payments from a drug company. Thakker said new medications can provide significant relief to arthritis patients, but his speaking fees don’t dictate treatment.
The Orgonian reported that Orgeon doctors received more than $21 million from drug companies since 2009. The article—like many others—begins by noting the negative implication such payments may have, such as skewing research or payments for promoting off-label uses of drugs.
Pritham Raj a specialist in psychosomatic medicine at Oregon Health & Science University (OSHU), took in the most in promotional speaking fees of all doctors in Oregon last year: $99,500. OSHU recently banned faculty from accepting drugmaker payments for marketing talks – but not research and consulting – due to the perception of a conflict of interest.
Though the school recently banned faculty from promoting drugs, Raj says there’s nothing wrong with sharing knowledge: without paid speakers, some doctors wouldn’t get needed education.
Raj gave about two dozen talks last year about a particular anti-psychotic medication on behalf of AstraZeneca but says the information he gives is unbiased – it’s just a good drug. “I’m not ashamed of what I do,” he says.
Jay Rosenbloom, a Lake Oswego pediatrician, stopped taking funds from vaccine manufacturers after he pursued state legislation that would make it harder for parents to opt out of child vaccinations. Previously, he had received more than $58,000 from the vaccine and pharmaceutical company Merck. Rosenbloom clarified, however, that his education and speaking payments do not influence his position. He says what he believes, regardless of who is paying him.
Bill Wilson, a psychiatrist who also teaches at OHSU, received $56,828 from Janssen Pharmaceuticals for consulting – on software that will help psychiatrists be better prescribers with certain types of injectable anti-psychotic drugs. He agrees the increased publicity of such payments could make doctors less likely to do such work, hurting innovation. He wishes the public had better tools to tell which funding is for promotional purposes, and which is simply education. But he says he welcomes the scrutiny nonetheless. “I wouldn’t want people to think that I’m a pitchman,” he said. “I don’t mind the sunshine. That’s probably the best way for people to have confidence.”
The Salt Lake Tribune reported that drug companies paid Utah physicians $25.8 million since 2009. Unfortunately, the article appears to be outdated and uniformed on the current nature and regulations governing such relationships. For example, entertainment and travel have been prohibited and extinct for several years, yet the article claims that some payments are for “trips and entertainment.” The article, likely is referring to payments for travel for physicians to conduct research or speaking and education—lavish trips or entertainment have been banned for years—but this escapes the author, who refers to companies that make life saving drugs as “Big Pharma.”
Moreover, the author claims that “common sense” indicates that such payments “can influence doctors’ choices of costly brand-name therapies and contribute to higher medical costs.” However, the author acknowledges that no “malpractice” case or the “prescribing of unnecessary treatments” have been cited.
The Record, reporting for NorthJersey.com, reported that more than 13,000 physicians in New Jersey received payments. In Bergen and Passaic counties, 38 doctors and two hospitals received more than $25,000 from pharmaceutical companies – making a combined $4.5 million.
“We believe speaker programs are a good method to facilitate peer-to-peer education on topics of importance for the health of patients,” said Mary Anne Rhyne, a spokeswoman for GlaxoSmithKline. In North Jersey, Hackensack University Medical Center and The Valley Hospital in Ridgewood received nearly $1.2 million and almost $200,000, respectively, for research and clinical trials.
“Valley has a robust portfolio of clinical trials, particularly in the areas of cancer, heart and vascular disease, and neurology,” said Anastasios Kozaitis, president of the hospital’s foundation and responsible for its enterprise research program. “Clinical studies can be sponsored, or funded, by pharmaceutical companies, volunteer groups and federal agencies. Many — if not all — major medical advancements have resulted from sponsored clinical research.”
Hackensack also conducts a number of clinical trials, said Nancy Radwin, a hospital spokeswoman. “Hackensack partners with industries to conduct research and clinical trials that focus on evaluating the safety and effectiveness of new medications, treatment methods, surgical techniques, medical and surgical technology, imaging studies, and protocols for treatments — ultimately resulting in life-saving methods of treatments,” Radwin said.