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Chatting With the Reporters Behind Dollars for Docs

Charlie Ornstein and Tracy Weber talk about the money docs get from drug companies, and why it matters.

Since 2010, ProPublica reporters Charles Ornstein and Tracy Weber have been investigating the influence of pharmaceutical companies on medicine. Their reporting exposed the financial ties between medical societies and drug and device makers, led to the tightening of conflict-of-interest policies at universities and ignited debate over these relationships.

We asked them to share some of their findings with our recently started Patient Harm Facebook community, and we are sharing it here as well.

1. How common is it for doctors to get money from drug companies?

Until recently, drug companies considered this a trade secret and didn’t release it, other than vague disclosures in lectures or medical journals. That changed a couple years ago as companies began settling federal whistleblower lawsuits (http://bit.ly/JQfalZ) alleging that companies unlawfully marketed their products for uses not allowed by the U.S. Food and Drug Administration (FDA).

In 2011, a dozen drug companies released some information about their payments to doctors. Although they represent about 40 percent of U.S. prescription drug sales, there are dozens or hundreds of companies out there that have yet to disclose this information. These records show that hundreds of thousands of doctors receive money, meals and educational items to speak or consult on behalf of these companies.

2. How much money are we talking about?

$761 million in disclosed payments so far.

3. Why are doctors getting money from pharmaceutical companies and why is that allowed?

Doctor relationships with drug companies can take many forms, some of which are vital to the drug discovery process. Doctors can conduct research or clinical trials on behalf of companies, consult with them, deliver promotional talks on their behalf, and more.

Federal law prohibits direct kickbacks or rewards from companies to doctors to prescribe their products. The government also requires that when doctors do promotional speaking for drug companies, they must follow the same rules as the companies and may not promote the products for uses that are not authorized by the FDA. So, doctors often use company produced slides and talking points to guide their presentation. Doctors, however, may legally prescribe drugs for any reason they want, even if the use is not FDA approved.

4. How do I find out if my doctor is getting money from drug makers?

Search Dollars for Docs on ProPublica’s website, where our colleague Dan Nguyen pulled all of the information together: http://projects.propublica.org/docdollars/.

5. Should I be concerned if my doctor is getting this money?

This is a personal decision. You certainly have the right to ask your doctor about a payment and what he/she did to receive it. Some patients have told us that they feel more confident about their doctors knowing that companies consider them experts. Other patients have said that the payments raise doubts about their doctor because they don’t know whether the drugs they are receiving are appropriate for them. Talking to your doctor is a good idea.

What should I do if my doctor is getting drug company money?

One of our colleagues put together a list of questions that you can ask your doctor. These include asking about a drug’s side effects, whether a cheaper version is available and whether there are non-drug alternatives that you can try first.

6. What are you working on now?

We are curious about doctors’ prescribing practices and whether patients have concerns about drugs that were prescribed to them by their doctors. Were the drugs you were prescribed appropriate, both therapeutically and financially? Let us know. Our emails are charles.ornstein@propublica.org and tracy.weber@propublica.org.

If you or a loved one has been harmed while undergoing medical care, you can also contribute to our reporting by filling out our Patient Harm Questionnaire.

My heart doctor was taken over by a large hospital complex and if he had gone with them, he would have had to give them his patient list built up over many years and subjected himself and his staff to all the big pharma reps that bring drugs in to use on their patients. He refused and went with another group of heart specialists.Many of the heart drugs on the market have many side effects and that is not told to the doctors when they push drugs. Doctors are offered huge perks like vacations , cars and other influences. My doctor is for single payer health care system as are many in my State. They are all sick and tired of having to hire pencil pushers who know the hundreds of codes every insurance company has as non are standard. He is fed up with for profit hospitals refusing to let YOUR doctor come to the hospital to treat you, because many hospitals are using residents under the stupervision of a “doctor” and are slow to report to your primary care doctor what new tests were done or any medicaton changes.

Doctors and nurses are in the majority for a single payer health care system. The see how the for profit hospitals are cutting back on staff and cutting back on mersa cleaning products to the point where most patients are fearful entering a hospital for fear of contracting other diseases.

Mother of Diabetic

May 30, 2012, 1:50 p.m.

Importing insulin now, but shouldn’t have to. I left this comment on the internet:
I just read that George H.W.Bush & Dan Quayle with ties to Eli Lilly encouraged the fast track of the rDNA synthetic insulin through the FDA & then the Bush administration tried to limit the public’s ability to sue drug companies. The profits from rDNA synthetic insulin affords the powerful to purchase new cars for their children, while we parents of diabetic children are left to purchase coffins or worse for our children, because of the defective insulin that we are forced to buy in America.
This was the reply to that comment:
She is right. Cloned insulin is a defective product. In Eli Lilly’s cloned insulin’s phase 2 clinical trials in England in 1982, there was a 30% adverse reaction rate. But Eli Lilly covered that percentage up and had their own doctors report a 2 to 3% adverse reaction rate. Again, Eli Lilly wanted to raise the price of insulin & couldn’t do so unless they “improved” it. But cloned insulin IS NOT an improvement, just another defective product from Eli Lilly. End of their reply.
rDNA synthetic human ( not human ) insulin is the only insulin that you can get in America now, even though Eli Lilly stated that rDNA synthetic insulin wouldn’t work for many diabetics.
If you go to ” Dollars for Docs ” you will find that many doctors are paid by drug companies which is a conflict of interest to say the least. Many doctors have gone from healers to short-sighted business people. Many doctors, for a few shiny beads from the drug companies, will throw their patients under the bus.
Any drug company that can knowingly profit from a drug that they know will cause death or worse is in my book a sociopath. These sociopaths become wealthy & use their wealth to shape this country for their benefit. The irony is, that if they seek psychological help from many American psychologist who accept shiny beads from the drug companies, they will find themselves under a bus.

I’m thrilled my doc lectures & does research because it means he gets samples! Being a younger disabled NYer, I’m ineligible for the state EPIC plan that protects seniors from falling into & having to buy their way out of Part D’s uninsured donut hole. I use 4-6 bottles of insulin each month & 1 bottle of a second insulin. The cost of insulin has put me in the donut hole every year. Right now I’m only taking the primary insulin because mt doc had no samples of the second. I carefully assess my prescriptions and decide what not to fill if no one has samples.

I’m going to take insulin, neither my doc or I care which I take so I take whatever he has in their fridge. I understand the premise of the issue but without insulin my prognosis is pretty shaky!

First, I am not an apologist for the drug industry.  There is very much with which to take issue.  However on the subject of Human Insulin (official name) and Eli Lilly, Mother of Diabetic is off base, though I wish no one had to deal with the problems she faces.  Reactions to current Human Insulin are rare.  Improvements in purification since the introduction in the early 1980’s have improved the product.  Remember that when Human Insulin was introduced there was a growing concern that we could be running out of animal based product – inadequate supply to meet the growing demand.  There is much to disapprove of with Bush the elder, but facilitating the introduction of Human Insulin would not be on my list.  As far as Lilly is concerned, in 40 years of some form of pharmacy practice, I have found the company and their representatives to be among the most ethical in the business.  Have they had some problems – sure.  Do I wish some of their products were offered at lower prices – yes.  Do we need to be vigilant to be sure that they play within the rules – absolutely.  But, are they among the worst of bad actors – hardly.

Mother of Diabetic

May 30, 2012, 5:33 p.m.

You really need to read ” INSULIN: A VOICE FOR VOICE ” and watch the movie ” Puncture”. The running out of animal based insulin was a lie and there has been a lot of that. More and more diabetics are importing beef and pork insulin from Canada and England. Eli Lilly stated that rDNA would not work for all diabetics. rDNA Human ( not human insulin ) was number 8 for side effect with the FDA. Only people who don’t have diabetes or people who have never been on beef or pork insulin think that rDNA synthetic human ( not human ) insulin is a safe product. Lets talk about dead in bed, car crash deaths & unexplained deaths from low blood sugars from rDNA synthetic human ( not human insulin ) because of no warning which is one of the side effects. You must work for Eli Lilly.

Mother of Diabetic and others - Nope, do not work for Lilly, never have.
As you know there are many types of insulins most made by Lilly or Novo Nordisk.  All the human insulin products are designated by the food and drug administration (FDA) as Human Insulin (rDNA origin).  The latter designation to indicate that the process for manufacture is by a recombinant DNA process.  The product is called human since it chemically identical to the insulin that is manufactured in humans and differs slightly from insulin manufactured in cows or pigs.  So, you call human insulin “rDNA synthetic human ( not human ) insulin” if you want, it is just not the FDA approved name.  I hope that importing beef/pork products is reasonably safe and the FDA has some Q&A on the subject at the FDA website.  There are quite a few hoops to jump through. As far as insulin side effects are concerned, the wide majority are due to low blood sugar which can be catastrophic but I am unaware of information demonstrating that this is worse or better with human insulin vs. the beef/pork combination.  It is inaccurate to say that there is no warning about hypoglycemia by an insulin manufacturer.  This is a prominent part of the patient package insert for insulin products.  I appreciate the reading and viewing suggestions.

I have been a practising Canadian family physician for 36 years. I have never taken a penny from pharmaceutical manufacturers, because it places a physician in an obvious conflict of interest. But in addition, I have a) had no visits from drug company reps; b) not accepted literature or doodads from drug company salespeople, including material from 3rd party marketers with drug names or company logos on them; c) have found out how to block 99% of drug company direct mail advertising, including the famous “throw-away” journals, also called “advertising vehicles”; d) as president of our hospital’s medical staff for a time, managed to eliminate drug company salespeople setting up a table at our hospital; e) most importantly, made it my active professional responsibility to find out about the myriad non-pharmaceutical, non-surgical remedies, therapies and interventions, including most particularly primary preventive approaches (e.g. diet, exercise, and community and other governmental steps and regulations that make healthy living easier to achieve) and included the promotion, of and advocacy for, these practices and approaches in my list of professional responsibilities, both in my clinical practice, and in the community at large (and globally as well). That is what any responsible primary care practitioner should be doing, as I see it.

This article is part of an ongoing investigation:
Dollars for Doctors

Dollars for Doctors: How Industry Money Reaches Physicians

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

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