In another ProPublica-created story, Fosters.com recently did a local piece using the Dollars for Docs database to cover “payments doctors receive from drug makers“—one of the more neutral titles we have seen in a long time, maybe ever (sadly). The article notes that companies paid more than $3.1 million to New Hampshire doctors over the past four years for speaking and consulting work—however, the figure does not include payments for meals, travel or research work.
More than 120 physicians in New Hampshire have earned at least $1,000 the data shows. Most received a relatively small sum — the median value was about $6,500 a piece — but some, like Exeter psychiatrist John Miller, were compensated significantly more. Miller received a combined $669,935 for speaking and consulting work between 2009 and 2012.
“Miller is a staff psychiatrist at Seacoast Mental Health Center in Exeter and a consultant for Exeter Hospital, according to his LinkedIn profile. He is also listed as the director of a company called Brain Health, which facilitates lectures on medical subjects across the country, according to its website, brain-health.co,” the article notes.
Miller is also paid to work for the so-called “speaker bureaus” of four drug companies: Pfizer, AstraZeneca, Sunovion and Forest. Miller could not be reached for comment by Foster’s Sunday Citizen. In an interview with New Hampshire Public Radio, he defended his work for the drug makers, calling himself a liaison for their products. “Everybody in that room knows I’m getting paid for that talk,” he told NHPR, “and they are coming to the talk knowing that it is being sponsored by the company of that drug. It’s all right there out front, it is all wide open.”
NHPR reported that in 2012, the highest-earning doctors in the state saw a noticeable decline in compensation.
Payment transparency has also been a focus at Dartmouth-Hitchcock, the well-regarded academic hospital in Lebanon, and Dartmouth’s Geisel School of Medicine. “A new conflict of interest policy has been in effect since the start of the year. It explicitly bans physicians from participating on speaker bureaus for pharmaceutical companies or medical device makers. It also prohibits physicians from ghostwriting articles.”
At least 37 Dartmouth professionals have been paid for speaking and consulting in the last four years, the authors report. Among them is Douglas Noordsy, who is listed on Dartmouth’s website as an associate psychiatry professor and member of Dartmouth-Hitchcock’s Psychiatry Associates. Noordsy received a combined $208,200 from AstraZeneca, Eli Lilly, Johnson & Johnson, Merck and Novartis, according to the ProPublica records.
Andrew R. Pachner, a Dartmouth-Hitchcock neurologist and professor at the Geisel School, received a combined $224,820 for work in New Hampshire and New Jersey, the records indicate.
The money included payments from Novartis of $88,350 for speaking engagements and $6,920 for consulting work between 2011 and 2012. During that same time period, Pachner was compensated $50,500 by Pfizer for speaking jobs.
James Bernat, professor of neurology at Dartmouth, was co-director of the institution’s updated conflict of interest policy. Bernat said the goal was to stimulate healthy relationships and monitor for signs of impropriety. “The idea here is that in contemporary academic medicine, there are, over the last decade, complicated relationships with researchers and practicing physicians … with industry, and it’s a symbiotic relationship — that is, it’s good for both sides.”
Dr. Mary P. McGowan, an expert on cholesterol metabolism, has experienced both sides of the industry/physician divide. McGowan established the former Cholesterol Treatment Center at Concord Hospital. She left in 2011, and is now senior medical director of clinical research at Genzyme. While she was practicing in Concord, McGowan was paid by pharmaceutical companies to design clinical trials. She also lectured to other physicians about cholesterol-lowering medications.
McGowan said the sessions required extensive preparation, and in each case, she believed in the efficacy of the product. “[With] that degree of expertise, you develop a national reputation, and you’re asked to give lectures,” she said. “I think there’s often the perception that you make this huge pot of money giving a lecture and it takes no effort. Really, in fact, you’re studying all the time.”
When dealing with patients, McGowan said it’s important to stay open-minded. In the past, a small number of companies were manufacturing cholesterol drugs, but many generic alternatives are now available. If a generic drug is the best option, it should be the first one a doctor recommends, McGowan said. “You have to balance that,” she said. “You have to know what you can expect from a particular drug, and hope that you will be able to get your patient to their cholesterol goal, in the case of my work. I think that, essentially, you just need to do the right thing for your patient.”
As with all Dollars for Doctors (Pew-ProPublica) sponsored articles there is little if any mention benefits for patients resulting from the work physicians are doing with industry. They ignore the exponential increase in life expectancy we have received which is largely a result of the collaboration in developing and promoting new therapeutic products.