Healthy Skepticism Library item: 15781

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Olson J.
Pharmaceutical companies spending less on Minnesota doctors
TwinCities.com 2009 Jun 12
http://www.twincities.com/ci_12573822?nclick_check=1

Full text:

Minnesota doctors received millions of dollars less from pharmaceutical companies in 2008 for research, lectures and consulting than they did in each of the five previous years, according to a Pioneer Press analysis of newly released state data.

A convergence of several pressures may have reduced the drug company spending, which, depending on whom you ask, either drives pharmaceutical innovation or buys off doctors so they’ll prescribe more brand-name medications.

Clinic groups tightened rules on when doctors can accept industry funding. A few even outlawed company-sponsored luncheons, speeches and gifts. The bad economy also might have reduced drug-company spending on marketing and lecture sponsorships.

A key question is whether more public scrutiny of these payments had any effect.

The Minnesota Board of Pharmacy has collected this information for 15 years but the paper records received little attention until a watchdog group and journalists published reports about them in 2007.

The total payments that year amounted to $16.6 million, according to a Pioneer Press analysis, but the total dropped to $13 million in 2008. The amount mostly reflects payments to doctors but also includes dentists, nurses and health care institutions.

“Across the whole state, I think people are becoming more aware of the potential conflict of interest” for doctors with financial ties to drug companies, said Dr. Kenneth Irons, the community clinics director for Duluth-based

SMDC Health Systems, which last year banned all drug company gifts and paraphernalia.
Among the Minnesota doctors who voluntarily cut back some industry funding was Dr. S. Charles Schulz, chairman of the University of Minnesota’s psychiatry department. Schulz’s ties to drugmaker AstraZeneca have been scrutinized amid lawsuits over the company’s use of academic research to promote Seroquel, an expensive antipsychotic.

Schulz’s only reported payment in 2008 was from Eli Lilly – $9,546
for speaking fees and expenses. Between 2003 and 2007, more than $500,000 in payments was listed under his name, though Schulz has argued that much of the money was in grants passed directly to the university. He declined to comment Thursday.
A task force at the university proposed guidelines restricting the relationships doctors could have with industry, but those guidelines have lingered in draft form for months.

Discussion of these new restrictions could have discouraged some doctors from accepting industry money, said Dr. Frank Cerra, the U’s senior vice president for health sciences. Final drafting of an official university policy is weeks away, he said.

SMDC’s gift ban was dramatic, as doctors filled trash bins with pens, thermometers and any other items with drug company logos on them. The health system still appears in state records, though. A lecture at St. Mary’s Medical Center received $6,856 in support from Hospira, a provider of medications and drug delivery and monitoring systems.

Irons said drug companies such as Pfizer have been meeting with Minnesota health care leaders to arrange new partnerships that don’t present conflicts for their doctors.

The 2008 payment records have been added to a database at twincities.com that allows users to search by doctors’ names for their industry ties.

The database has limits. It can’t distinguish between payments to a doctor for an unbiased lecture or for a questionable marketing pitch. Vague descriptions in reports make it difficult to distinguish payments that go to doctors versus those passed to institutions.

Minnesota needs to do a better job of defining how payments should be reported and holding companies accountable when their reports are late or incomplete, said Dr. Peter Lurie of Public Citizen, a Washington, D.C.-based consumer advocacy group.

“Because the companies have reported so erratically, the data are hard to interpret,” said Lurie, who was among the first to analyze Minnesota’s data in 2007.

A previous study estimated that one in six Minnesota doctors receive some form of industry support.

State Sen. John Marty, DFL-Roseville, tried to update the law this session by requiring medical device manufacturers to report this information as well, but the bill never received a vote amid resistance from locally based manufacturers.

The Minnesota data have helped generate more public attention to the issue. In April, the U.S. Institute of Medicine recommended an end to “unacceptable conflicts of interest” through tighter hospital and clinic restrictions on industry relationships and by requiring drug companies to report their financial ties to doctors nationwide.

U.S. Sen. Chuck Grassley, R-Iowa, has held hearings on the issue and proposed legislation that would require national-level reporting.

Twenty Minnesota doctors received more than $100,000 from pharmaceutical companies last year. An ophthalmologist, Dr. Richard Lindstrom of Minnesota Eye Consultants, received more than $350,000 for consulting and research activities with Alcon, Allergan and Bausch & Lomb.

A psychiatrist, Dr. Tracy Tomac, received more than $110,000 in speaking expenses and fees from Eli Lilly, which sells Zyprexa for psychotic disorders and Cymbalta for depression. She was recently appointed to the Minnesota Board of Medical Practice, the licensing group for physicians.

The state pharmacy board has taken steps to make the payment data more accessible, including requiring the companies to file their reports electronically. Director Cody Wiberg said some board policies may have influenced drug company spending as well.

In early 2006, the board ruled that even nominal meals and luncheons to doctors are gifts. As a result, these meals counted toward the state’s limit of no more than $50 in gifts by a drugmaker to a doctor per year. The board also prevented drugmakers from paying doctors to complete marketing surveys.