Healthy Skepticism Library item: 17800

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Publication type: news

Alltucker K
Drug makers start to disclose payments to doctors
The Arizona Republic 2010 May 17
http://www.indystar.com/article/20100517/BUSINESS/5170378/1003/business/Drug-makers-start-to-disclose-payments-to-doctor

Full text:

Pharmaceutical companies long have used office calls, free lunches and drug samples as ways to promote their products to physicians.
These perks are well-known strategies that drug representatives use to get face time to market products to busy doctors. Perhaps less well known is that drug companies also use cash, paying millions to physicians who act as consultants or speak to other doctors about the latest brand-name drugs.

Now, under pressure from Congress and legal settlements, companies for the first time are beginning to disclose payments made nationwide to doctors and medical professionals.
Five pharmaceutical companies distributed more than $2.1 million in payments to 182 Arizona doctors and health professionals last year. Eli Lilly, GlaxoSmithKline, Merck, Cephalon and Pfizer all have disclosed 2009 payments made to doctors who serve as speakers, consultants, advisers or other purposes. Doctors also were reimbursed for travel and meals.
Drug representatives say the payment disclosures are part of the industry’s move to be more transparent about financial relationships with physicians. However, three of the five drug companies that have disclosed payments have done so as part of federal agreements involving improper marketing of drugs.
As disclosures trickle out, critics have raised the question of whether such payments have influenced doctors who dispense prescriptions to patients.
Doctors groups say the payments are necessary for physicians to get information about the benefits and proper use of drugs. Even doctors who receive payments say it doesn’t influence how they practice.
“It is not just pharmaceutical marketing,” said Chic Older, vice president of the Arizona Medical Association. “It is also providing the scientific information on why that drug is a preferable drug. It is a good source of information. It is not all bad.”
Critics warn that cozy ties between drug companies and doctors can help drive health costs higher as physicians prescribe more expensive brand-name drugs over cheaper generic versions. Academic medical-journal reports show that physicians who receive payments from pharmaceutical companies are more likely to write prescriptions for that company’s drugs.
“This is certainly not rocket science,” said Alan Cassels, a drug-policy researcher at the University of Victoria, British Columbia. “Studies have shown the more ties and closer contact to the pharmaceutical industry, the less objective and independent a physician will be.”
Going public
While only a handful of companies have made public their payments to doctors, more will soon follow.

Under the new health-reform law, drug makers, medical-device makers and others, beginning in 2012, will be required to track payments, fees or gifts worth $10 or more made to doctors and teaching hospitals. The federal government will collect the data and share it with the public beginning in 2013.
On their websites, Merck and GlaxoSmithKline have revealed some payments made over the past year. Pfizer, Cephalon and Eli Lilly revealed payments to doctors as part of settlements with the federal government to resolve allegations of improper marketing of drugs.
Although the disclosures have shed some light on the financial ties between drug companies and doctors, they are by no means comprehensive. Each company reports slightly different information, and all report data for limited time periods.
Pharmaceutical watchdog groups welcome the federal requirement that all drug companies fully disclose payments.
“For the first time, we will have real transparency about physician and industry relationships,” said Allan Coukell, director of the Pew Prescription Project, which has offices in Boston and Washington, D.C.
The drug industry said the federal standard is a “step in the right direction” because it trumps states that may request such disclosures, according to the Pharmaceutical Research and Manufacturers of America (PhRMA).
Doctors still need to receive timely information about treatment options, safety developments and drug interactions, according to Ken Johnson, PhRMA’s senior vice president.
“Ultimately, we believe this benefits patient care,” Johnson said.
Arizona doctor discloses payments
GlaxoSmithKline paid nine Arizona physicians $20,250 or more in speakers’ fees from April through December. Dr. Michael Manning, an allergy and asthma specialist in Scottsdale, Ariz., earned the most from Glaxo, $40,250. Merck paid $4,775 in fees to Manning.
Manning said the speakers’ fees do not influence how he practices medicine or how he recommends drugs.
“If a company wants me to speak, anything is fair game,” said Manning, adding that he will talk about a drug’s benefits and drawbacks.

Manning said he frequently talks to internists, pediatricians and family doctors – the types of medical doctors who may not have the time to keep up-to-date in their specialty field. During the talks, he discloses being paid by Glaxo, Merck or any other pharmaceutical company.
“I will answer any question,” Manning said of his drug talks. “I am honest. I am not going to toe the company line and say only this drug works or that drug works. That is a disservice to the medical community.”
Ethical boundaries
As pharmaceutical companies face heightened scrutiny, some say doctors also have ethical obligations when accepting cash from a drug company.
Medical experts say such payments are ethical as long as doctors properly disclose their relationships with pharmaceutical companies. Fellow doctors and patients can use such information to assess drug recommendations from a particular doctor.
“Making money is not the problem,” said Ivo Abraham, a University of Arizona College of Pharmacy professor. “It’s whether you are transparent about it.”
Abraham draws a distinction between physicians who speak at conferences to discuss the latest scientific findings of drugs and paid doctors who “hit the circuit and give the same talk over and over again to different audiences.”
Nevertheless, individual doctors and institutions ultimately must decide how comfortable they are accepting pharmaceutical cash. Some doctors establish their own rules when dealing with the industry.
Medical schools and universities increasingly are adopting strict guidelines on whether doctors can accept drug-company fees. The University of Arizona College of Medicine, for example, does not allow its faculty to accept free meals, gifts or travel funds from pharmaceutical companies.
However, the university does accept money from the pharmaceutical industry to research new drugs. Pfizer last year paid UA $124,373 for research purposes, the drug company’s records show. Such relationships are common. Drug companies often sponsor university research, and academic centers such as the Arizona Cancer Center routinely host clinical trials to test investigational drugs.
But UA scientists who conduct clinical trials are also prohibited from accepting drug-industry money for speaking engagements.
Future impact
As more ties between doctors and pharmaceutical companies are revealed, experts say physicians will become more selective about accepting drug-industry money. Some doctors may fear the perception that such payments represent a conflict of interest.
Patients will benefit because they will be allowed to check whether their doctors take drug-industry money.
Coukell said, “For the first time, patients will have a way to know if their doctors have a relationship (with a drug company). Right now, as a patient, you are really in the dark.”