September 8th, 2011

Dollars For Doctors, Aggravation For PhRMA


Is it possible that a little sunshine is having an effect on how the pharmaceutical industry pays doctors for promotional speaking engagements? A new analysis finds drugmakers with the highest US sales last year did not spend the most on doctors who are retained for marketing. Nonetheless, eight drugmakers that disclose such data spent more than $200 million in 2010 for promotional speaking.

The comparisons are possible because this marks the first time that these drugmakers reported a full year of payments, according to ProPublica, which analyzed payments last year and today has updated its database (read the story). The ‘Dollars For Docs’ analysis makes it possible to explore specific payments by these eight drugmakers to individual doctors in all 50 states (look them up right here).

So who spent what? Well, Pfizer, with sales of $26.2 billion, spent $34.4 million on speakers, ranking third among the eight drugmakers. By comparison, Eli Lilly spent the most on speakers, $61.5 million, even though its sales were about half of what Pfizer reported. The trend suggests some drugmakers may be using fewer docs as speakers and consultants since they began posting their data publicly.

Overall, though, payments to doctors and other health-care providers in the ProPublica database total more than $760 million and cover reports from drugmakers between 2009, when such disclosures first began, and the second quarter of 2011. Besides offering tallies and names, though, the data may offer a glimpse of what such payments will look like after 2013, when such disclosure becomes mandatory.

For instance, AstraZeneca cut its spending on speakers from roughly $22.8 million in the first half of 2010 to about $9.2 million in the second half. Some in-person speaking events are being replaced with teleconferences, webcasts and video conferences. “We’re in a period now where we don’t have a lot of new indications or new products that have been introduced in recent months, and that really is the fundamental explanation for what you’re seeing,” US compliance officer Marie Martino tells ProPublica.

Similarly, Glaxo spent less on speakers last year, averaging about $13.2 million per quarter, down 15 percent from the last three quarters of 2009. “We feel it is a better use of resources to use fewer speakers more often. This cuts down on training costs as well as lessens the number of contracts needed,” a Glaxo spokeswoman wrote ProPublica. And Lilly speaker payments fell 10 percent from 2009.

Not surprisingly, this update makes the PhRMA trade group uncomfortable. For years, its representatives have been arguing that interactions with physicians offer necessary and instructive information that busy docs may not have time to readily access elsewhere. And the trade group complains that, by focusing on payments, the value in providing educational opportunities is derided.

“Over the coming days and even weeks, there will be attention in the press to a database and series of articles called ‘Dollars for Docs,’ which claims to promote transparency by compiling already-public information about company payments to physicians,” PhRMA wrote today on its site. “Unfortunately, it does so without any context, clearly to raise questions about the propriety of these interactions.” The trade group also offers links to its policies here and here.

Meanwhile, ProPublica notes that experts predict that some docs will back away from working for drugmakers as their names and paydays are released on publicly accessible websites. For now, this is only speculation, but the ProPublica analysis does show that payouts to dozens of docs and other health professionals took a steep dive last year.

One example cited was pulmonologist Veena Antony, who was paid at least $88,000 to in 2009 give promotional talks for GlaxoSmithKline. But last year, the Birmingham, Alabama doc eschewed the opportunity over concern that patients might think her advice was tainted. “You don’t even want the appearance that I might be influenced by anything that a company gave,” she tells ProPublica.

But some docs are still collecting. Gerald Sacks, a Santa Monica, California, pain specialist, was among the highest paid, earnings $270,825 from Pfizer, Johnson & Johnson, Lilly and Cephalon last year for speaking and consulting. That was up from $225,575 in 2009, not including travel costs and meals. In fact, over 18 months, Pfizer alone paid him $318,250 for speaking. He did not return calls for comment.

The database also reveals that hundreds of thousands of docs are listed simply for eating lunch or dinner that is paid for by a drugmaker. For instance, 80 percent of the 200,000 docs included in Pfizer payments last year were listed only because they had received one or more meals. Semyon Isakovich Emert of West Hollywood, California, received $3,065 worth of meals from Pfizer in 2010 and $1,046 worth in the first half of 2011, but did not perform any services, according to Pfizer data.

A provision in the healthcare reform law requires all drug and device makers to publicly report all payments to docs, including food, beginning in 2013. However, the PhRMA trade group has a voluntary code that says “it is appropriate for occasional meals to be offered as a business courtesy” to docs and members of their staffs attending information presentations by sales reps, ProPublica writes.

In such cases, the guidelines say, the presentations have to “provide scientific or educational value,” and the meals should be “modest” by local standards and not part of an entertainment or recreational event. Meals for spouses and take-out meals are not appropriate, the guide says. For some doctors, the meals don’t appear modest, according to this story by ProPublica.

At least 20 doctors, including Emert, received meals worth $2,000 or more from Pfizer between July 2009 and March of this year. None served as a speaker, consultant or researcher. Similarly, six docs, mostly in New York City, received more than $1,000 in meals from Lilly during the first quarter of this year and performed no services for the company, records show.

A Lilly spokesman tells ProPublica that the spending reflects a mix of in-office business meals and meals at educational events. A Pfizer spokeswoman tells the news site that docs attended “at least one, if not two” programs a month in which experts talked about particular diseases or Pfizer products. The drugmaker has a limit of $135 per person on meals at each doc, suggesting Emert had 22 meals.

How might patients react to such disclosure? The issue may weigh more heavily on the docs, says George Loewenstein, a professor of economics and psychology at Carnegie Mellon University and an advocate for full disclosure of drug-company payments to doctors. “It’s much more likely to have a kind of ‘Tell-Tale Heart’ effect on the physicians,” he tells ProPublica. “A doctor is very likely to say it’s not worth it to take a $15 meal because it’s going to get listed on the website.”

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