Physician Payment Sunshine: Pfizer Discloses Payments to Physicians

Continuing the ongoing trend of transparency and disclosure in the pharmaceutical industry, Pfizer Inc. released its payment information for the second half of 2009. The Wall Street Journal reported that all together, the company paid $35 million to about 4,500 health-care professionals who consulted with the drug maker on the development and marketing of new drugs and other matters.

According to the New York Times, the payments were broken down as follows: $20 million to the 4,500 doctors and other medical professionals in the United States, and $15.3 million to 250 academic medical centers and other research groups for clinical trials. The numbers also reflected that of the $20 million, speakers received $9.6 million, advising received $7.5 million, and meals, travel and education items received $2.7 million.

The Times also noted that in addition to disclosing payments for speaking and consulting, “Pfizer is the first to disclose payments for clinical trials.” The payments cover activities like patient recruitment, and are a small portion of Pfizer's overall research-and-development spending.

Pfizer’s payment report does an extremely good job detailing exactly what health care providers (HCPs) were paid for. For example, next to each HCPs name, there is a column titled “Service Provided or Activity.” The following are some of the categories listed for payment: professional advising; meals, expert-led forums, business-related travel, and educational items. Overall, the payment report is very detailed and easy to use. You can search by the name of the provider or institution, the data is clearly portrayed, and there are clear instructions on how to use the website.

Pfizer notes on its website that the disclosures includes, among other things, payments to health care professionals in connection with clinical trials and, in that regard, only reflects amounts paid to clinical investigators in the U.S between July 1, 2009 and December 31st, 2009 for new clinical trials commenced during that same period and payments to large academic medical centers for ongoing trials started before July 1st, 2009.

The disclosure and Web site explains how expense and payment data are gathered from across Pfizer's financial systems. All transactions and payments that occurred between Pfizer and a licensed HCP or associated entity are collected in a single repository. Each transaction and entity paid (i.e., the person or organization who received the payment) is matched to an identifier that is unique to the healthcare provider. Each matched payment is then attributed to the HCP. Transactions are aggregated by transaction type.

It was noted that for some expenses, Pfizer's Standard Operating Procedure allow for a 90 day reconciliation post-program date to finalize all costs, which could include hotel, food and beverage costs, and other travel. Any transactions that were not fully reconciled at the time the disclosure database was finalized have not been included. These will be included in the next reporting cycle, set to occur during the first quarter of 2011.

Certain events Pfizer sponsors, such as open meals at a congress or large meeting, were conducted as open attendance activities that did not require participant registration. While attendees may receive an invitation, Pfizer noted that it is currently not possible to consistently monitor or track the value of food or drink consumed by attendees with necessary accuracy. During the reporting period of July 1 through December 31, 2009, there were 87 open attendance events conducted in the U.S., with an estimated average meal cost of $4.33 per person based on the estimated total attendance.

These numbers were part of Pfizer's first public release of physician payments to individual doctors, which were posted on Pfizer's Web site Wednesday. Pfizer noted that payments to physicians are important because these kinds of “relationships with doctors help foster medical innovation and improve patient care.”

It was also noted that Pfizer agreed to disclose such payments as the result of an integrity agreement to expand the companies reporting of physician payments to include the value of all financial interactions, including nonmonetary items such as meals and educational items, regardless of value. This includes data for health-care professionals who received payments, meals or nonmonetary educational items worth $25 or more, and totaling at least $500 during the six-month reporting period.

Pfizer spokeswoman Kristen E. Neese, also noted that the companies disclosures included payments not in the federal provisions such as payments to academic centers and to nurse practitioners and physician assistants. The reporting also goes beyond the requirements of the federal law, Pfizer said, by not imposing a delay of up to four years on financial support for clinical trials. Pfizer plans to report the payments without the delay.

Beginning in 2012 and reporting in 2013, all drug manufacturers will be required to disclose certain physician-payment information to the U.S. Department of Health and Human Services as part of the new health-care overhaul law. This will include payments made to physicians of $10 or more under the Physician Payment Sunshine Act, which was passed with the health care reform bill.

Ultimately, “the newly disclosed payments included an average of $5,000 each to about 1,500 health-care professionals to provide input and advice to ensure the company addresses the real needs of clinicians and payments." Also, about 2,800 professionals received an average of $3,400 apiece to serve as speakers who educate peers about the safe and appropriate use of Pfizer drugs.” The company plans to post its next report on March 31, 2011.

These kinds of payments hardly seem to warrant any sort of criticism as they barely cover the amount of money lost to a physician for a single day of private practice, or similar research and clinical activities. Despite the low averages, critics such as Dr. Marcia Angell, former acting editor of The New England Journal of Medicine, believed that such payments seemed low (now Dr. Angell wants to give these physicians a pay raise), although “she had no specific knowledge.”

Also criticizing Pfizer’s disclosure was Eric G. Campbell, PhD (he always is critical of industry) lead author of a 2007 study of physician-industry relationships published in The New England Journal of Medicine. Campbell, who is director of research at the Mongan Institute for Health Policy at Massachusetts General Hospital and an associate professor at Harvard Medical School, believes that the company is holding back information. (not sure what the information is that Eric feels they are holding back or what motivation they would have in doing so).

 Considering companies face large penalties and even the possibility of criminal charges and debarment, it seems unlikely that Pfizer would fail to report information especially since it is doing so largely out of a $2.3 billion settlement.

In the end, these payments to physicians represent legal and ethical work experience that helps create relationships with doctors that foster medical innovation and improve patient care.

 With companies such as Eli Lilly, Merck and GlaxoSmithKline already reporting such payments, and recent passage of a national reporting system, transparency seems to be the practice now rather than the exception.

People should regard such collaboration and payment as an investment into the future training of our doctors and better health of patients. If we do not educate our physicians with those who are experienced with new medicine and therapies, who will, and at what cost?