Healthy Skepticism Library item: 14392

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Publication type: news

Carey B.
Drug Maker to Report Fees to Doctors
The New York Times 2008 Sep 24
http://www.nytimes.com/2008/09/25/health/policy/25drug.html

Full text:

Amid a national debate over the influence of industry money on medical research and practice, two pharmaceutical giants say they will begin publicly reporting payments they make to outside doctors.

John C. Lechleiter, chief executive of Eli Lilly & Company, announced on Wednesday that starting next year it intended to post in an online database all its payments to doctors for speaking and consulting services. The postings will “likely include” the names of the doctors, or will provide some other identifying information about them, along with the reason for the payments, the company said.

In the wake of Lilly’s announcement, Merck & Company said later Wednesday that it would disclose speaking fees it pays to doctors, also beginning in 2009.

Members of Congress have been pushing for a national registry of such payments. In the last year and a half, Senate investigations have found that prominent researchers at several institutions, including Harvard and the University of Cincinnati, failed to report millions of dollars in outside income from drug makers, contrary to the institutions’ reporting requirements.

University administrators and journal editors say they have no reliable way to verify doctors’ private income from industry. Research has found that industry money can bias doctors’ interpretation of study findings and may alter their prescribing habits.

A bipartisan bill called the Physician Payments Sunshine Act, expected to be taken up by Congress next year, would require such a registry. The Pharmaceutical Research and Manufacturers of America, the industry’s principal trade group, supports the legislation, as do the American Medical Association and a number of major drug makers.

“Though we remain hopeful that the Sunshine Act will be passed by Congress at some point, Lilly is taking action independently,” Dr. Lechleiter said Wednesday in a speech to the Economic Club of Indiana. “Being more transparent by opening up our business to the public is an important step to building trust and confidence.”

A Lilly spokesman said the company hoped others would follow its lead, a wish voiced by some independent experts.

“This is a good step, and one that should be emulated by other companies, even in the absence of legislation requiring it,” Dr. Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University and the New York State Psychiatric Institute, said in an e-mail message.

Dr. Appelbaum said the simplest way to achieve comprehensive disclosure was for the industry itself to maintain public records. “Any physician who believes that disclosure is likely to be embarrassing,” he said, “should not be accepting the money in the first place.”

As of late Wednesday, Merck was the only other drug company to have joined Lilly in announcing plans for disclosure of such payments.

A spokesman for Johnson & Johnson said on Tuesday that the company supported a revised version of the Sunshine Act and had committed to disclosing payments for educational grants and to patient-advocacy organizations by early 2009.

A spokesman for AstraZeneca said that it already posted educational grants and contributions to nonprofits but that it had not made a decision “on other areas just yet.”

A spokesman for Pfizer said it supported the Sunshine Act.

Lilly was the first drug maker to publish extensive clinical trial data online, beginning in 2004, and last year it began posting its educational grants and charitable contributions online. Its new database will record all payments it makes to doctors on or after next Jan. 1, and will be accessible online in June or July. If Congress passes a law requiring such reporting, the information will be brought into line with federal guidelines, the company said.

Through a spokeswoman, Senator Charles E. Grassley, Republican of Iowa, who has been leading the investigations into drug companies’ payment practices, said: “Disclosing information about financial relationships between industry and doctors is a good thing, and this announcement contributes to transparency. My effort for broad-based transparency and accountability will continue because a uniform reporting requirement is needed to get the full picture.”

Drug companies’ payments to doctors generally fall into one of two broad categories: speaking fees, to doctors who give presentations about products to other doctors, very often while the group dines at the company’s expense; and consulting fees, to experts who advise the company on new product development or help design clinical trials.

Commercial arrangements are common throughout medicine. In the last two decades, drug and device makers have made payments to tens of thousands of doctors and researchers in all specialties. Worried that this money could taint doctors’ research plans or clinical judgment, government agencies, medical journals and universities have been looking more closely at the deals.

Minnesota and Vermont are among the few states that have been keeping a record of those payments. From 1997, when Minnesota began its database, to 2005, drug makers made payments to more than 5,500 doctors, nurses and other health care providers in the state, totaling at least $57 million, the state found. An additional $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money.

Vermont reported last year that from July 2005 to June 2006, 81 drug manufacturers spent a total of $2.25 million on “fees, travel expenses and other direct payments to Vermont physicians, hospitals, universities and others for the purpose of marketing their products.”