Using public reports from seven drug companies about their payments to doctors, a wide-ranging investigative report by ProPublica revealed this week that tens of thousands of U.S. doctors and health practitioners were paid over $250 million by pharmaceutical companies since 2009, much of it to give promotional talks for the companies. Among them, ProPublica found that hundreds have been cited for serious sanctions and misconduct, lack expertise such as publications or even board certification, or are in violation of their medical institution’s or hospital's conflict-of-interest policies.
This report, in cooperation with the Boston Globe, the Chicago Tribune, NPR, PBS Nightly Business Report and Consumer Reports, suggests that when it comes to selecting opinion leaders, drug companies have often created their own from sheer volume of talks a doctor is hired for. The report also suggests a eye-opening failure to perform due diligence in investigating the records of those speaking to other physicians about their products. ProPublica reports:
A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.
Only two of the seven companies said they looked routinely into state licensing boards before hiring doctors to speak for them.
These frightening findings—made possible by the fraction of payment data currently available from companies--remind us that complete and mandatory disclosure of payments made to doctors is a critical crosscheck for consumers who want to know whether their doctor has been paid by industry, and for public and private payers and institutions interested in the compliance of health practitioners with state or institutional policies. ProPublica collected the data from the seven companies that publicly report some physician payments—AstraZeneca, Cephalon, GlaxoSmithKline, Eli Lilly, Johnson & Johnson, Merck and Pfizer—in a database that consumers and medical school compliance officers can use to make these searches.
That’s a good thing, but these companies represent just over a third of prescription drug sales in the U.S.; extrapolating, significantly more money trading hands isn’t being captured. That’s why the Physician Payments Sunshine law, which will require all U.S. drug, device and biotech companies to disclose all payments over $10 to physicians beginning in 2013, is so critical to completing the picture.
Despite the hundreds of millions of dollars that doctors are being paid to give drug talks—many making the equivalent of a second salary to do so—a survey done by Consumer Reports as part of the series suggests that consumers are clearly fed up and understand the dangers of bias that attend marketing relationships between industry and physicians: Nearly three-quarters of Americans are concerned that taking pharma money affects patient care, and more than two-thirds think that their doctor should tell them if he or she has been paid by a company whose drug they plan to prescribe.
The survey underscores a 2008 Pew Prescription Project consumer survey (pdf) that showed the public was similarly concerned that being paid to talk about a company’s drug could bias their health provider. In the absence of professionwide self-regulation by physicians, many of whom continue to take these large sums, medical schools, hospitals, and states have stepped forward, creating new policies and regulations that put distance between doctors and drug marketing departments.
The American Medical Student Association Scorecard, which assesses the conflict-of-interest policies of every U.S. medical school each year, is a powerful tool that consumers and administrators can use alongside ProPublica’s database to check compliance of their doctor with his or her school’s policy, and to get ideas for how some medical centers have gone about strengthening their policies.
One example is Harvard Medical School's new policy banning faculty from doing industry speaking gigs, which goes into effect early next year. Using the 2009-2010 data, the Boston Globe found that nearly half of the $6.3 million paid to Massachusetts physicians went to those affiliated with Harvard, and several doctors told the Globe they had stopped the speaking arrangements in order to comply with Harvard’s new rules.
But the Globe story also showed that just having a rule or strong policy isn’t enough. The Globe found that numerous clinicians whose Massachusetts hospitals had rules against giving promotional talks, including Beth Israel Deaconess Medical Center and Boston Medical Center, continued to perform such talks for drug companies. These institutional policies and state laws need diligent and rigorous enforcement. Having good intra-institutional compliance structures and information-sharing among medical schools about implementation are key to the success of these policies. Disclosure tools like Sunshine database, when it is complete, and others like ProPublica will reveal health providers who violate these rules.
One final point: the fact that the news outlets here found so much misconduct connected to drug company money in the incomplete records they have suggests there may be much more that remains undiscovered. Rigorous enforcement of existing policies and laws, and comprehensive disclosure from good work like ProPublica’s database and the future Sunshine Act, have never been more important in making sure that patients are getting the best medicine from their doctors, and that physicians are getting the best unbiased information about drugs.
Find the full series and searchable database at: http://www.propublica.org/topic/dollars-for-doctor
--Kate Petersen, PostScript blogger