Physician Payment Sunshine: Local Papers Get in The Act
Taking advantage of the new transparency and disclosure guidelines of several companies (Eli Lilly, Pfizer, GlaxoSmithKline, Cephalon and Merck), two recent articles discussed payments to doctors for their work with industry. Starting September 30, 2013, all payments made to physicians and teaching hospitals from U.S. manufacturers of drugs, biologics and medical devices and supplies will be posted on a public, searchable online database for the Department of Health and Human Services (HHS).
Ithaca, New York
The Ithaca Journal noted that since the reporting periods were published, “at least 17 medical professionals” in Ithaca have worked with industry to give speeches to their peers, educate patients on products and give companies advice. With all this important work, why is it any surprise that physicians are paid for it? Are the authors surprised they get paid to write stories about the subject or to go online to a public database where anyone with a computer and internet access could get the same information?
Using the databases, the article was able to calculate that at least $14.9 million was paid to New York health care workers for their work with the five drug companies. The article noted however, that payouts in the
Accordingly, the fact that one doctor made $32,600 during the first nine months of 2009 (less than $4,000 a month) for serving on an advisory board and giving speeches about the Attention Deficit Disorder drug, atomoxetine, is hardly newsworthy. As Dr. Richard John Baron, a pulmonologist for United Medical Associates in Endwell, pointed out, payment “is appropriate because doctors often have to take the day off from work when giving lectures.”
Some of these payments were even associated directly with patients, such as one nurse practitioner who conducted 40 patient education programs. This type of work should be applauded because it specifically focuses on educating patients about the risks and benefits of new treatments and therapies.
While critics believe that doctors who are paid by drug companies can develop a bias that can cause them to prescribe brand-name medications, there is no clear evidence which suggests a causal connection. In fact, one large study we previously covered (Cleveland Clinic) found no evidence that commercial support results in perceived bias in CME activities. This data is true for many physicians who defend the practice of working with industry for various reasons, all of which focus on creating better health outcomes for patients and stronger training for physicians.
As Dr. Timothy Howland, a Vestal doctor noted, "companies make sure physicians are knowledgeable about their drugs,” because "if a new drug is brought to market, it's very much in the interest of the company to make sure physicians are well informed." In fact, physicians gain critical knowledge about new drugs because many industry funded presentations often include a discussion of all treatments, without regard to pharmaceutical company.
The article noted how several area doctors “insisted” that they were not biased from accepting payments from drug companies. Instead, physicians like Dr. Lloyd Darlow noted how his “opportunity to speak on behalf of Eli Lilly allowed him to network with other experts in his field.” This was particularly important for physicians in specific geographic regions because there are few contacts for doctors in fields like “psychiatry, especially child psychology.” As a result, by attending and speaking at these programs and serving on the board, Dr. Darlow was able to establish contacts that helped him serve his patients better."
Without pharmaceutical companies funding such programs, “the medical community would suffer.” Medicine would be hurt because the process of medical education, research, and efforts needed to make innovations all need money, and when the government is not going to sponsor it, physicians are happy to ask industry. In response, industry provides 50 percent of the funding for accredited CME providers’, and without such support, where do critics propose we get money from?
Physicians enjoy working with industry because they make positive comments about their drugs and endorse products “that they believe in because they use it in their practice.” As Dr. Sanjiv Patel, a family practitioner for Lourdes noted, “pharmaceutical companies look for people that already prescribe the product,” and doctors are not encouraged by companies to prescribe their medication.
The process is very regulated and transparent because "the FDA places a lot of restrictions on what happens at these educational sessions," said Schenone, who worked for Lilly. In addition, “all doctors stressed the companies' compliance with FDA guidelines.” These guidelines help maintain the integrity of industry funded programs because “educators can only use FDA-approved slides and can only discuss what's on the slides.” Moreover, speakers cannot “answer questions that are not based on the material they are presenting."
With all of these guidelines in place, the notion that “money can influence ones judgment without realizing it” is troublesome, especially when payments barely cover the time off physicians take. And the idea that physicians “fail to realize the extent to which a relationship influences prescribing decisions” is inapplicable in cases where physicians are already prescribing the medication.
The reality is, when physicians choose between medications, they choose based on the clinical experience they have with a drug and a patient’s history and physical examination. Industry funded programs only give doctors more information to discuss with their patients to weigh the risks and benefits associated with various options.
St. Louis, Missouri
Dr. Robert Belshe, head of Saint Louis University’s Center for Vaccine Development, spoke on behalf of drug companies because of his “deep background in vaccines and because of his training.” For 20 educational forums, he was paid roughly $18,000 in speaker’s fees and travel expenses ($900 each).
In total, the St. Louis Business Journal noted that 186 health-care professionals, medical institutions and medical practices in St. Louis received compensation last year from Merck, GlaxoSmithKline, Eli Lilly and Pfizer Inc. for a combined $2.5 million (less than $14,000 per person). The article did note the total could be higher since data covered only certain months.
Dr. Belshe asserted that “forums sponsored by drug companies not only gave continuing education on new drugs to rural physicians, they also provided community feedback on the challenges of providing effective health care, such as vaccinating children in rural communities.” He further added that universities encouraged their faculty with “very deep expertise to provide this type of education for community doctors, because it gives physicians quality information with the least amount of bias possible.”
Critics like Eric Campbell, an associate professor at Mass General Hospital’s Institute for Health Policy, believe that “speaking at forums or leading continuing education seminars on particular products, were essentially marketing-related relationships.” His criticism however, ignores the fact that drug companies provide essential treatments and drugs, which ultimately benefit the population’s health.
As Dr. Robert Heaney, senior associate dean of Saint Louis University School of Medicine and assistant vice president for the university’s Medical Center noted, “companies do wonderful things with medicine, and new products are developed through these companies being good stewards but also effective business people.”
While such relationships have the potential for influence, SLU and Washington University School of Medicine enforce policies to limit the interactions of practicing physicians and medical students with drug companies to avoid undue influence. These regulations allow the schools to “continue to nurture academic-industry collaboration in medical discovery and scientific advancement,” while the institutions “continue to refine and update their policies to ensure the highest standards of ethical and professional behavior and research integrity.”
Conclusion
Ultimately, as the various physicians and members of academia cited above, industry funded programs are beneficial because they keep doctors "abreast of all the new information, and all the new studies that are being done." As a result, these programs leave doctors feeling like they can “improve the quality they provide to their patients."