Physician Payment Sunshine: Lilly’s Disclosure Used Against Massachusetts Physicians

At least 60 Massachusetts doctors collectively have earned more than a half-million dollars this year as speakers paid by pharmaceutical giant Eli Lilly & Co. – including two Boston Medical Center physicians whose participation is being reviewed for possible violation of a hospital policy against marketing activities by its doctors. Was the lead for a story in this morning’s Boston Globe.   

The article focuses on the use of physicians in speakers programs or “bureaus” in which doctors generally use company prepared materials to materials to explain a drug’s uses and dosing to their colleagues, is widespread in the drug industry. But the practice is under growing scrutiny and some academic medical centers are barring their doctors from participating, believing that physicians essentially become hired advertising guns, with weakened credibility.

The article goes on to outline that the Lilly report, published last month includes payments to  more than 60 Massachusetts doctors, who were paid approximately $588,000 for its speakers programs in the first three months of 2009. Some doctors earned up to $50,000 giving talks to their colleagues.

At Boston Medical Center, Dr. Brian McGeeney, a neurologist, received $30,000 during that period, and Dr. Elliot Sternthal, an endocrinologist, was paid $11,587.50, according to a faculty registry on Lilly’s website.   There is a controversy that this may violate Boston Medical Center hospital policy (wonder who brought this to the papers attention — lets think “Prescription Project”). 

In e-mailed statements, the doctors defended their talks. Sternthal said he determines “the structure of the presentation by my choice of disease state and clinical trial slides, order of presentation and emphasis of teaching points. This is in compliance with BU/BMC policy.’’ McGeeney said he has “worked with Eli Lilly on their product Cymbalta,’’ a depression drug, “and have been compensated for this work in accordance with FDA’’ and industry guidelines.

Overall the article shows how “transparency” will be used against physicians to cast a shadow on their credibility and question their ethics as has been the case in several other cities and reports from states.

The Pharmascolds have not been shy about how they plan to use “transparency” In the MedPAC (Medicare Payment Advisory Commission) Report released earlier this last year, one of the key reasons for Sunshine “Helping media and researchers to shed light on physician industry relationships and explore whether manufacturers and physicians are complying with industry and professional standards.”

Early last year Peter Laurie, MD of Public Citizen (Ralph Nader) gave a presentation on the uses of transparency to the Prescription Project with basically the same talking points and instructions for reporters.

In addition to BMC, the region’s other academic medical centers also have or plan to adopt policies restricting physicians’ role as speakers for companies. These rules could force some doctors to withdraw from the Lilly program – though some hospitals essentially leave it up to physicians themselves to decide whether they are in violation.

In a hallmark of “fair” reporting the only sources quoted in the article are Eric Campbell “Academics who want to be drug salesmen should go be drug salesman. But don’t do it under the shroud of academia.’’  Steve Nissen – doctors in speakers bureaus “are actually acting as an agent for the pharmaceutical company. That does create divided loyalties, and universities are realizing the challenges that presents.’’ And of course the gadfly blogger Daniel Carlat who claims he was offered over $170,000/year from Schering Plough (I wonder if this was a plant).

This is not the first paper to report on the Lilly reports papers in Miami, and Kansas have used these against local physicians.  In addition newspapers in Vermont and Minnesota regularly report on payments to physicians without any consideration to the value that those services and payments provide to physician learners, patients and new innovations.

Just last week WCVB Boston ran a unflattering story in which Dan Carlat calls himself a drug whore.  I would question the use of this language as most people having sex are not whores in the same way the vast majority of physicians working with industry are not whores but providing beneficial services for the healthcare system as a whole. 

Thomas Stossel outlines in the story how he sees working with industry as beneficial for innovation and is hopeful in the future that those physicians working with industry will speak out on the benefits of what they are doing.   There. is however a certain amount of “fear” in the medical community that they are being shamed away from working with industry.

Next year when the Massachusetts statewide reporting of all payments to physicians begins expect to see allot more of these types of stories.

Unfortunately in the eyes of the naive press disclosure of payments to physicians will be used against them in what could be considered almost vial attacks with little understanding of the value that these often FDA mandated “promotional” talks give to physicians in the non-academic settings.