As more payment data from drugmakers to physicians went public this week, it seems that both industry and doctors are easing off the gas in promotional speaking and other marketing-related payments. With Propublica data, the Boston Globe compared several companies’ payments to Massachusetts providers in 2009 and 2010:
Eli Lilly and Co., one of the nation’s largest drug makers, paid health care providers here $866,919 in 2010 for speaking about their drugs, a 46 percent drop from 2009, according to an analysis by the Boston Globe and ProPublica, a nonprofit online investigative journalism organization. Payments from GlaxoSmithKline fell at least 29 percent to $884,850, and probably more because the company’s 2009 data did not include the first quarter.And Propublica showed that payments by Cephalon, one of the companies required to disclose payments under a corporate integrity agreement with the U.S. Department of Justice, dropped from almost $9.3 million nationally in 2009 to $5 million last year.
But $5 million -- part of the $220 million paid to providers last year by just eight companies -- is still a chunk of change for an industry that's owed billions of dollars over the last five years for illegally marketing to docs and is still struggling to reinvigorate its pipeline.
And though many medical schools around the U.S. have barred or limited faculty members from joining pharma speakers bureaus out of concern that the practice (in which physicians are paid to deliver company-generated talks to other doctors) creates bias or the appearance of it, some providers are still very willing to sign on. Pain physician Jeffrey Gudin from New Jersey, a speaker for J&J last year, talked to the Star-Ledger.
"I support education from any source,’’ Gudin told the Star-Ledger, "even when it’s pharmaceutically funded.’’
And even, one might note, when that pharma-funded “education” is supporting him back.
But as trends go, hard and fast correlations here are murky to untangle, mostly because the data is a very incomplete set – different amounts and categories of payments are publicly available only from about 12 of the more than 70 drug makers that market in the U.S.
The Globe and Propublica stories today point to some other complicating factors: the shift from a largely in-person marketing game to one focused more and more around online and electronic interaction with prescribers; industry contract and conference cycles that may skew comparisons of quarter-by-quarter financials; the disinfecting disincentive for a physician to be publicly linked to a company’s marketing team; and companies’ own efforts to make sure they’re being recognized for their innovation and legitimate scientific collaborations, not for their speakers bureaus.
From the data in Massachusetts, it does seem like a combination of stronger conflict of interest policies at the leading medical schools and teaching hospitals there, as well as the state’s own disclosure law, may have combined to reduce the number of physicians willing to sign on to drug companies’ payrolls, or the amount companies are willing to pay those who do.
But as Allan Coukell of the Pew Health Group pointed out to the Star-Ledger, this database of court-ordered and voluntary disclosures is still only a fraction of the story -- a few frames of a much larger picture we'll need Sunshine to develop.
--Kate Petersen, PostScript blogger