With ProPublica set to release its second report on pharmaceutical company payments on Thursday to physicians, continuing its “campaign of shame,” a recent article from the Financial Times noted that twelve companies have paid doctors in the US nearly $150 million so far this year, suggesting an increase in these “marketing and support practices.”
The article however is incorrect in some of its assertions – hardly surprising. First, the article claims that these “figures highlight the extent of entertainment, travel, consulting, education and research support to doctors.” While the majority of these categories are correct, entertainment is explicitly prohibited by the AdvaMed and PhRMA Code of Ethics, and accordingly, is not a cost included in the above numbers.
The author does at least note industry’s firm belief in such payments, noting that companies believe they are “ethical and enhance health outcomes.” Critics believe such payments can influence prescribing practices.
While some large companies have so far not released any data, those that did collectively reported payments of $437 million to 262,000 doctors last year. That breaks down to less than $1,700 on average per physician, hardly anything to be concerned about, especially since that probably represents the fair market value of the services physicians provided to industry—whether they be consulting, education, research, etc.
The data mainly from the first quarter of this year shows $148 million has been given to 165,000 doctors so far, including $48 million from Eli Lilly and $42 million from Pfizer. Again, this number should not be shocking because on average, this is less than $1,000 per physician.
This analysis by the Financial Times, prepared in conjunction with PharmaShine, a data provider, comes at a time of intensifying scrutiny of – and prosecutions concerning – pharmaceutical groups’ marketing practices. Government agencies are finalizing guidelines that will make the publication of industry support compulsory by 2013 as part of US healthcare reforms, known as the Physician Payment Sunshine Act.
According to the article, publication of such payments “is designed to allow regulators, medical institutions and patients to better scrutinize doctors’ links with companies, but the extent of current disclosures and the way they are presented varies widely – making comparisons and analysis difficult.” What is problematic about this assertion is that there is no evidence that the use of such payments will do anything to improve patient outcomes, make research and drug approval more efficient, or save more lives.
The article goes on to quote industry critic Allan Coukell, head of the Pew Prescription Project, who said that: “We need the medical community to work with the industry on research, but the marketing model is problematic. The first step is transparency and we are not even there yet.”
Eli Lilly is one of a few companies to include funding for medical research at doctors’ institutes in its figures. Others list only support directly to individual doctors.
A spokesman said: “Lilly is committed to ensuring that our relationships with healthcare providers are conducted in a manner that complies with applicable legal and ethical standards. Our collaboration with healthcare providers is essential to our ability to provide innovative medicines, improve health education, better understand patients’ needs and improve individual patient outcomes.”
Among the individual doctors receiving the highest level of support was Zale Bernstein, an associate professor from the Roswell Park Cancer Institute in Buffalo, New York, who received $234,000 in 2010 from Cephalon, Eli Lilly and Pfizer. He has received more than $57,000 already this year.
Dr. Bernstein received most of his money in speaker fees as part of extensive industry-supported medical education programs targeting other doctors. Despite this larger sum, which clearly recognizes Dr. Bernstein’s expertise, the Financial Times recognized that, “the vast majority of physicians received far smaller sums – often limited to a small gift or a sandwich lunch of a few dollars.”
Ultimately, as more and more local and national news sources begin to publish stories on physician payments from industry, it will be crucial to scrutinize the biased and negative portrayals of such payments.
Stories that only explain the “potential influence” that such payments will bring are not objective and should be largely ignored because they do not offer balance or insight from the doctors and researchers who value the collaboration they experience with industry, and the positive outcomes it brings to their patients and colleagues through better education and training.