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Dollars for Docs Mints a Millionaire

New data show drugmakers’ payments to hundreds of thousands of doctors, and some have made well over $500,000.

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(Image: iStockPhoto)

Update Mar. 11, 2013, 4:55 pm: This post has been updated to reflect a response by Dr. Vladimir Maletic to questions from ProPublica.

Dr. Jon W. Draud, the medical director of psychiatric and addiction medicine at two Tennessee hospitals, pursues some eclectic passions. He’s bred sleek Basenji hunting dogs for show. And last summer, the Tennessee State Museum featured “African Art: The Collection of Jon Draud.”

But the Nashville psychiatrist is also notable for a professional pursuit: During the last four years, the 47-year-old Draud has earned more than $1 million for delivering promotional talks and consulting for seven drug companies.

By a wide margin, Draud’s earnings make him the best-paid speaker in ProPublica’s Dollars for Docs database, which has been updated to include more than $2 billion in payments from 15 drugmakers for promotional speaking, research, consulting, travel, meals and related expenses from 2009 to 2012.

Payouts to hundreds of thousands physicians are now included.

Draud is not the only high earner: 21 other doctors have made more than $500,000 since 2009 giving talks and consulting for drugmakers, the database shows. And half of the top earners are from a single specialty: psychiatry.

“It boggles my mind,” said Dr. James H. Scully Jr., chief executive of the American Psychiatric Association, referring to the big money paid to some psychiatrists for what are billed as educational talks.

Paid speaking “is perfectly legal, and if people want to work for drug companies, this is America,” said Scully, whose specialty has often been criticized for its over-reliance on medications. “But everybody needs to be clear — this is marketing.”

When Dollars for Docs launched in 2010, it gave the first comprehensive look at the money that drug companies spend to enlist doctors as a sales force. The new data show how payouts to psychiatrists like Draud and other doctors have added up over time. And they underscore the key role physicians play for drugmaker profits even as scrutiny and criticism of such payments grows.

The companies say physician speakers are the best messengers to teach their peers about new and effective treatments. But critics counter that the speakers are little more than highly credentialed pitchmen who typically use the drug companies’ slides and talking points to sell rather than educate.

Attention to the issue has prompted prominent medical schools to tighten rules on faculty acceptance of drug company money for such talks. Questions about undue industry influence also have bedeviled medical journals and professional groups representing physician specialists.

Susan Chimonas, a research scholar at the Center on Medicine as a Profession at Columbia University, said many medical centers that regulate interactions between drug companies and their doctors would be “alarmed” by the high tallies in the updated Dollars for Docs.

“How do these folks have time to do their real jobs if they’re speaking so much?” Chimonas said. Hospital administrators, she predicted, would be “concerned not only about the conflict of interest, but also the conflict of commitment.”

Draud’s $1 million in drug company earnings is probably a minimum figure. Some of the seven companies he represented have reported their payouts for only a short time. And Draud has separately disclosed ties with at least four additional companies that haven’t revealed how much they pay speakers.

Draud has friends among the other highest-paid doctors in the database. He teaches continuing medical education courses with fellow psychiatrists Rakesh Jain and Vladimir Maletic. Jain, of Lake Jackson, Texas, has earned $582,049. Maletic, of Greer, S.C., made $527,850 , according to Dollars for Docs. Both also speak for other companies that keep their payments private.

Draud did not return several messages seeking comment. But in an interview, Jain said he loves teaching and delivers the same lectures about drugs and medical conditions regardless of whether a drug company is paying him.

“I am not a marketer, I am an educator,” Jain said.

In a later email, Jain said he is proud of his collaboration with Draud. “He’s been fair, balanced and is wickedly smart. And I like smart people who serve community needs.”

In written responses provided after this story published, Maletic said he speaks about treatments for mood disorders, schizophrenia and sleep-wakefulness disorders because he believes that “good quality education about pharmaceutical products may be beneficial to both physicians and their patients.”

Maletic said he uses company-prepared presentations because they are required to ensure compliance with federal rules. Asked how often he speaks, he replied, “The frequency of speaking varies, but based on the numbers that you have quoted, it may possibly be too often.”

Jain, Maletic and many top earners also have active clinical or research practices.

Next year, every drug and medical device maker that pays physicians will have to report such spending to a federal database as part of the Affordable Care Act health reform law. The first disclosure, scheduled for public release in September 2014, will include payments from August to December of this year.

The companies in Dollars for Docs accounted for about 47 percent of U.S. prescription drug sales in 2011. It’s unclear what percentage of total industry spending on doctors they represent, because dozens of companies do not publicize what they pay individual doctors. Most companies in Dollars for Docs are required to report under legal settlements with the federal government.

Even the $2 billion total underrepresents spending by these companies. Some in the database have begun reporting only in the past year, and others report spending in only a few categories. In addition, two companies reported some payments in ranges, so that spending was excluded from the total.

Overall, roughly half the payments were for research. A third went to speakers and the rest was for consulting, educational materials, meals and travel.

 

For Some Docs, An Earnings Drop

The push for transparency on physician payments started years ago.

Studies began showing that even trinkets doled out by drug sales reps could affect physician attitudes. At the same time, drugmakers were settling federal lawsuits alleging that they paid kickbacks and encouraged doctors to push drugs for unapproved uses. Two U.S. senators began calling out prominent physicians for not properly disclosing financial ties to the companies.

Dollars for Docs took transparency a step further by putting the available payment disclosures in one place and making them easy to search.

In 2010, many universities and teaching hospitals were surprised to find that their faculty members were engaged in promotional speaking. ProPublica compared the faculty lists of institutions with conflict-of-interest policies barring such speaking with the database and found a number of physicians in violation.

Drug firms, too, learned of problems with their chosen speakers. ProPublica found their rosters peppered with some physicians who had serious disciplinary actions against their medical licenses.

Both the drug companies and academia tightened their policies.

Only a handful of doctors who were among the 20 highest-paid in 2010 have maintained their level of income from speaking, the new data show.

Ten of the doctors dropped from making about $100,000 a year to less than $20,000 in 2012. Some doctors whose payments declined spoke about drugs the companies are no longer pushing. Others, like prominent cancer expert David Rizzieri at Duke University School of Medicine, faced new restrictions from their employers.

Rizzieri had been a speaker for Cephalon, GlaxoSmithKline and Novartis in 2010 and 2011. But after Duke restricted participation in speakers’ bureaus, his speaking pay dropped markedly in 2012, the new data show. All told, Rizzieri has received at least $567,300 in speaking and consulting payments since 2009.

Dr. Ross McKinney Jr., director of the Trent Center for Bioethics, Humanities and History of Medicine at Duke, said university officials “had multiple discussions” with Rizzieri, who “is getting more restrained.”

McKinney said Duke physicians can deliver paid talks about diseases, but only if they use their own slides and presentation materials. “The general tone is a little bit more distant and less cozy than it used to be,” he said.

In an email, Rizzieri said he still did some paid speaking that is allowable within Duke’s new guidelines, but has focused his attention on a series of educational talks developed by the Division of Cellular Therapy at Duke.

 

New Drugs, New Dollars

Drug companies say their spending often reflects market realities — not a changing opinion on the use of physician speakers. Should a top-selling drug lose its patent, allowing cheaper generics to compete, there’s no impetus to push sales. A new drug or a new approved use for an existing drug, conversely, may prompt a burst of speakers.

New York’s Forest Laboratories, for example, is a fraction the size of its Big Pharma brethren Pfizer, AstraZeneca and Merck. But when it comes to paying doctors to promote its products, the drugmaker has recently dwarfed its rivals.

During the first three quarters of 2012, Forest spent $31 million on doctors who touted the virtues of such drugs as Bystolic for high blood pressure, the antidepressant Viibryd, and Daliresp for chronic obstructive pulmonary disease. Nine doctors each made nearly $100,000 from Forest in that time alone, the data show.

Pfizer — whose U.S. sales are five times greater than Forest’s — spent a fifth of Forest’s total, paying out $6.2 million to promotional speakers during the same period. AstraZeneca, second to Pfizer in sales, spent $12.2 million.

Forest spokesman Frank Murdolo said in an email that the company spends more on speakers because it doesn’t use pricey direct-to-consumer TV marketing. It also has more new drugs than its competitors, Murdolo said.

In contrast, GlaxoSmithKline spent $52.8 million on speakers in 2010. That fell to $24.1 million in 2011 and $7.6 million in the first three quarters of last year.

Glaxo spokeswoman Mary Anne Rhyne wrote in an email that the company’s spending tracks with new drugs or new uses for existing products. “That activity has been relatively low in the past year, so spending for speaker programs has been lower, too,” she said.

The top recent speaking programs for Glaxo involved Advair, a drug for asthma and chronic obstructive pulmonary disease, and Jalyn, which treats problems with urination for men with enlarged prostates, Rhyne said.

Glaxo and other top pharmaceutical companies have laid off thousands of workers in the past couple of years as their top drugs have lost patent protections, the pipeline of new drug approvals has slowed and cost pressures arose.

Other companies contacted by ProPublica about their spending would not reveal which products they paid speakers to extol or why.

“We don’t disclose how we allocate our speaker program budget,” Tony Jewell, a spokesman for AstraZeneca, said in an email. AstraZeneca’s spending on promotional speakers decreased from $31.6 million in 2010 to $17.6 million the following year and $12.2 million in the first three quarters of 2012.

“The decrease in spending is based on a variety of factors, including where our medicines are in their life cycles and brand budgets and strategies,” Jewell wrote.

The company’s blockbuster antipsychotic drug Seroquel went off patent last year. Another top drug, Nexium, which treats acid reflux, goes off patent in 2014.

Because each company is in a different stage with its blockbuster drugs, it’s difficult to compare their outlay on speakers and consultants head to head.

It may be too soon to tell whether continued publicity over the spending will cause companies to cut back further, said Chimonas, of the Center on Medicine as a Profession. But transparency might be having some effect.

At a recent conference, Chimonas said she heard that pharmaceutical companies themselves are using the disclosures about payments to “push back on doctors who are greedy.”

“They can say, ‘No. We see you’re taking this amount of money from our competitor. Why should we give you more than that?’” she said.

 

A Harder Sell For Antipsychotics

Once a reliable profit machine for drug companies, psychiatric drugs are now a challenge. And drugmakers are fighting hard to stanch the losses.

Starting in the 1990s, when the second generation of antipsychotics hit the market, drugmakers enjoyed a period of wild profitability. Doctors embraced these new drugs, such as Risperdal, Seroquel and Zyprexa, as safer and causing fewer of the troubling side effects of older psychiatric drugs. Domestic sales of Seroquel hit $4.7 billion in 2011, the year before it went off patent.

But as the drugs lost their patent protection, their makers have tried to shift the market to newer drugs in their stables. Critics say these new drugs are not appreciably different, but the drug companies claim they are easier to take or have fewer side effects.

Johnson & Johnson, for example, lost its Risperdal patent in 2008 but now markets Risperdal Consta, a long-acting injection, and Invega, another antipsychotic. AstraZeneca lost Seroquel but is now marketing Seroquel XR, which works for an extended period.

The pressure to reclaim sales is great. Overall, the market for antipsychotics dropped from $18.5 billion in 2011 to $13.7 billion last year, according to IMS Health, which closely tracks the industry’s ups and downs.

The newer drugs, like their predecessors, need someone to explain their benefits, several doctors said.

“I actually enjoy the aspect of educating my counterparts about developments in the field,” said Dr. Gustavo Alva, a California psychiatrist.

Alva has received $663,751 speaking and consulting since 2009 for the companies in Dollars for Docs. He separately discloses speaking for other companies as well.

Tighter restrictions on speaking and consulting mean doctors will be less up to date on new treatments, according to several current physician speakers.

Psychiatrists aren’t always among the highest-paid. In 2010, when Dollars for Docs first launched, endocrinologists represented 11 of the 43 top money-making speakers. From year to year, the in-demand specialists are largely a function of the market.

But critics say psychiatrists are a particular concern because of their controversial role when the first waves of new antipsychotics hit the market.

AstraZeneca, Johnson & Johnson and Eli Lilly have paid billions in settlements to the federal government over allegations that they paid doctors to push these drugs for unapproved uses from children to seniors with dementia. One lawsuit alleged that a Florida psychiatrist switched patients from drug to drug based on his relationships with companies.

Texas psychiatrist Jain acknowledges the excesses of the past and said he does not excuse them. But he said he sees real value in the new brands because they give psychiatrists options if their patients are not responding to older drugs.

He said he has recently spoken on behalf of Forest’s antidepressant Viibryd, Merck’s antipsychotic Saphris, Lilly’s ADHD drug Strattera, Pfizer’s antipsychotic Geodon and its antidepressant Pristiq.

Having the financial support of drug companies does not lessen the value of this teaching, he said.

Jain’s tally in Dollars for Docs does not reflect his work with another group that is heavily sponsored by drugmakers.

Jain, top-paid speaker Draud and Maletic all serve on the advisory board and steering committee of the U.S. Psychiatric and Mental Health Congress, which will hold its annual convention in Las Vegas in September and October. Maletic is the 2013 program chairman.

The convention receives financial support from several drug companies, and some of its presentations are sponsored by the firms, according to information on its website. Much like professional medical societies, the congress also collects fees for drug company ads on things attendees see at their conventions, from tote bags to hotel room keys.

The congress is owned by North American Center for Continuing Medical Education, LLC, a for-profit New Jersey company that provides continuing medical education courses. Health professionals must take such classes periodically to retain their licenses. Draud, Jain and Maletic also teach classes for the company.

In response to written questions, Randy P. Robbin, president of the company, said members of the steering committee have “demonstrated experience and expertise in mental health and commitment to providing the highest quality education possible.”

The trio are paid for their work for the congress, but the money does not come from pharmaceutical sponsors, Robbin said. In continuing medical education courses, he said, drug companies don’t have a say in the educational content or speaker selection.

Jain said in an interview that his talks for the company are reviewed for bias before and after he speaks. “I cannot present anything at the Psych Congress that hasn’t been vetted repeatedly,” he said. “Pharma is not able to influence anything that I do at the Psych Congress.”

Scully, of the American Psychiatric Association, said he hopes all the drug company money doesn’t taint relationships between patients and their doctors.

“The public trust,” he said, “is too important.”

Frank Giramonti

March 11, 2013, 12:32 p.m.

One million dollars is a large sum of money, no question. But the editor in chief of propublica makes close to half million dollars a year. Most investment bankers makes that in a month. If the doctors in your story have done unethical acts, they should not only be reported by propublica, but be brought before their state medical boards, sanctioned or have their licenses suspende . But, if their only offense is to make money from pharma,that just seems like good old capitalist mentality most Americans subscribe to. I think a bigger issue is lack of access to quality health care,in particular mental health care.  It might be nice if propublica reported a bit more on those issues.

I think the sentiment of Mr. Giramonti is shared by many, in that many will suspect or hear in the reporting of people getting big money for working for a drug company by news media as an attempt of “liberal media” to make it a morality issue.  There is nothing immoral about big salaries.  But one can’t help, but wonder if the doctors here are under full disclosure.  And there is a difference in paying for an “official objective expert endorsement” and regular marketing like a commercial. 

As a citizen of a democratic society, I have the responsibility to elect officials and engage those officials when necessary to support legislation and/or policies that can improve America.  I cannot do this effectively without knowing the difference in a commercial (a paid for endorsement) and objective professional assessment.  The Big tobacco case should be enough of a lesson for all of us.  But if not, reference the paid for economics opinions of some academics that that supported deregulation that bankrupted Iceland.

In addition, if full disclosure were required, the cost of these endorsements might be less thereby reducing the cost of sales for Pharmaceutical companies and either reduce cost of the drugs or improve profits available for further research.  Since it is liely thre is no “silver bullet” that will fix the 2X premium Americans pay for health care while getting poorer care by nearly all objective measures, everything much count.

Doctors have contracts with overseas pharmaceutical companies and some VA pharmacists list their home address as their business address for tax reasons.  Doctors in Colorado that were on the list previously and had a HIGH number of kickbacks and was in the Denver Post investigation are not found on this current list.
You can search any advisory board and clinical trials and disease data bases for Primary Investigator, researchers, clinical trials and pharmaceutical sponsorships.  Use their names. expose them for what they are.

Goes a long way to explain why there are people who have to eat cat food to be able to afford their prescriptions, doesn’t it? Because the cost of all this has to be paid by someone, more than likely the product. This is why so many in the medical profession are against Medical marijuana… Because who is gonna pay them millons to teach someone how to roll a joint?

The medical industry is like the mafia, the real business in conducted behind closed doors and under the table.

Sounds like Bill Clinton’s whopping fees while his wife is a senator and then Secretary of State.  Guess everbody needs to make a dollar.

Make all the money you want, the way it is obtained is immoral, through persuasion, payoffs and the damage done to unwitting people and those who don’t need the pharmacide to begin with is immoral.
Even for a dollar.

the mafia was gutted at one time, too.

fACTS LIKE THIS ONE are the causes behind the debt crisis of the West.

The spirit of Morris Fishbein is alive and well.

It’s not what you get , it’s what you ask for speaking .

I think a lot of comments miss the point.  There is an inherent conflict of interest between a doctor’s duty to his or her patient and patient efficacy, and pitching and pushing drugs for pharma.  While I’m sure there are good intentions abound, there is a loss of objectivity when a doctor is lavishly compensated for an opinion, similar to economists, he is placed in a position where he is beholden to the paymaster. 

And, the real question that no one asked is: why does pharma need doctors to go push its products to other doctors?  The answer is quite simply: legitimacy.  Pharma clothes the efficacy of its drugs in the M.D. of the messenger, as if that messenger is actually well versed in the underlying biochemistry of the drug and its interactions.  This also goes to a larger problem with medicine generally; doctors are not scientists, and should not be treated as such. 

Missing from this article is also how doctors are lured to these conferences to hear these speakers.  The circle of marketing becomes complete, where doctors are made evangelizers, pharma commercials make health consumers evangelizers, and in the doctor’s office they will meet.

This is about greed and lack of a moral compass.

The drug companies have brought us AIDs and Cancer too https://www.youtube.com/watch?feature=player_embedded&v=13QiSV_lrDQ#t=161s

The article indicates that “every drug and medical device maker that pays physicians will have to report such spending to a federal database as part of the Affordable Care Act health reform law.”
Will this disclosure include the names of the specific drugs the doctor is being paid to support in some way?
If not then we should ask our legislators to require it so that we can see which drugs our doctors have an incentive to prescribe—and we can then choose to decline the prescription or select another doctor…

I spent 39 years as a pharmaceutical sales representative and I can honestly state that the idea of paying doctors a fee to shill for a specific product needs to put under very strict control… even more so than currently. I found this practice nothing more than a free meal for the attendees, a windfall for the restaurants where they are held and of no really educational use what so ever. Personally I found this practice unacceptable and tried to avoid them as much as possible and still keep my job. Please also forget the term “fair balance”... you want that?... don’t pay the speaker.

Frank and Eric, when you buy a computer, do you ask an Apple employee what brand of computer you should get?  Probably not, because you already know their answer, and you wouldn’t trust someone with an obvious stake in your decision.

Now, if you’re paying a doctor to advise you through an illness, what does it do to your confidence in the relationship, if your doctor is also accepting payments to sell drugs to his patients?

Keep in mind that we’re talking about pharmaceutical companies like Bayer.  Back in the ‘80s, Bayer was found to have used HIV-tainted plasma in medication for hemophiliacs.  See a good overview of the story in Wikipedia’s “Contaminated hemophilia blood products” article, but it might surprise some to learn that the story doesn’t end by destroying the tainted batch as soon as they learned there was a problem.

I’d also point out that you seem to misunderstand capitalism.  That’s about being paid to create value.  If you’re getting money for scamming people, ignoring conflicts of interest, or doing nothing, that’s usually a strong indicator of socialism or other planned economy.

What d’ya think the Doctor Phil show is all about? He’s always getting people, especially the young, ‘help’ but it’s all about psychological tests, and the drugs that go with them. The audience laps it all up, can’t believe how generous and caring he is but he’s actually conditioning his audience to accept psychiatry and drugs as the only means to help a youngster with problems, usually with just behavioral problems resulting from lousy parents and school pressures. But Phil wants you ‘In The System.’ He actually tells people there is something wrong with them and they need help, and folks do not open themselves up to any other options or possibilities.

.... or my new favorite, that windbag Dr. Oz!!!!

see CCHRINT org , they deal with these monsters and psychiatric abuses, they investigated the MKUltra mind control experiment and more, they have compassion re these abuses. If not, let me know.
I can’t stand Dr. Phil, oprah, OZ or any of that psychobabble and clinical trials which is abusing the public with these deceptions and dangerous pharmacides.  no one needs to take these poisons,
see radiobiology of xrays, CT and the dangerous MRI metal Gadolinium, it gets into your cells and radiation damages 67% of your cells DNA in 1mS with that flash photons, high energy,  xrays are biologically damaging and accumulate cellular damage, see web rad train org columbia edu, radiation interaction w matter, we are NOT matter, see abused by the research scientists who knowingly did radiation experiments and denied it, interviews with researchers open gov doe acre report radiation experiments.  They are no different then, but they are worse, See Freddie Boyle and Fernald School, survivors of the radiation experiments/quaker oats,  read The Plutonium Files by Eileen Welsome, good indication of the healthcare SYSTEM today and even the congressional hearing in The Treatment by Martha Stephens and BEIR VII report and the ACHRE report, if you think radiation is not damaging, you are wrong,  ever wonder why Kligman, Sanger and Carl Heller lived so long to ages 90 and made millions? they avoided xrays and they denied they caused harm.  They CAUSED harm and still are,  glad they are gone.

Thank you for the youtube video on the African Green monkey and the AIDS virus and how they laughed about it.  and cancers, too. Everyone should see this, wait for it to load, can say it won’t, but it will come up.

In 2007, Dr. Daniel Carlat, a psychiatrist, had an interesting column in the New York Times about his experiences as a doctor educating other doctors about a particular drug and why he decided to stop doing so.  Check it out at http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html.

The Dr. Carlat article in the NY Times should be required reading (by law if necessary) before any medical provider can speak for a pharmaceutical company. The same criteria should apply to medical device companies who up until recently had controls managed by the companies themselves. That was like putting the fox in charge of hen house security. When you mix unlimited earning potential with the practice of medicine no good will come from it…..!

Just to show how corrupt and unbalanced this scam perpetrated by Pharma is, realise that no doctor would ever accept any liability for the ill-effects caused by the industry poisons. The victims are simply those young who cannot defend themselves, the elderly who have blindly accepted the counsel of proven liars, and those who have been actually “frightened to death” to take so-called medicines. These doctors are simply immoral shills who take no responsibility for their actions, and like politicians, are probably courted far more lavishly behind the scenes.

here you go, RedCap
NHIS National Health Interview Survey population based interview

NAMCS Nat’l Ambulatory Medical Case Survey
NHAMES National Hosp Ambulatory Medical Care Survey
Meps Medical Expenditure Panel Survey
HCUPS Inpatient Based Health Care Utilization Project
NSFG women based expanding to men Nat’l Survey on Family Growth
BRFSS population based (telephone) Behavioral Risk Factor Surveillence Survey this should have gone to the data mining article, but still applies.

NHANES pop based Interview and Exam
national Health and Nutrition Examination Survey

NHCHA agency based National Home Care and Hospice survey

Two words….snake oil.

Ellen, despite my dislike of the pharmaceutical companies, I wouldn’t go that far.

I think their products are undertested, overprescribed, overpriced, and exploitative, and I think the companies themselves are highly unethical, but I don’t think they’re worthless.  The problem isn’t the drug, it’s in convincing doctors (and paying them to convince other doctors) that the drug is a panacea…at least until the patent expires, at which point it’s crap and a new drug is the panacea.

There are people who are helped by Prozac.  There are many more people whose lives are destroyed by it.  As long as it only goes to the former group, I’m all for it.  The problem is the degree that’s not happening.

Can you say “paid whore”?

It seems easy for the “Tims” of the world to call names and interject comments that have nothing to do with facts.  Physician educators have as much right as you or I do to make a living and to make money doing it.  We live in a capitalistic country.  Drug companies are primarily publically owned and traded on the stock market.  These companies are beholden to their investors, some of whom have likely been critical of doctors in the Propublica story.  These companies hire great speakers to educate other physicians about their products.  Without this, billions of dollars that are spent in the development of treatments of mental and physical illness would not be recouped by the drug companies.  These companies would eventually stop developing newer, more effective drugs.  How are physicians to learn of newer treatments if not through continuing medical education?  Would it be less of an issue if I taught physicians about new medications?  I have no medical background.  Would you want your doctor trained by anyone other than another physician?  I would rather receive treatment from a physician who is cognizant of the latest treatments, not one whose knowledge is based on treatments 20 years ago.

Go Pharma!  My 401 K has you in it!  For those of you reading this, your’s does too.

@dean:

Why is it the refrain “we live in a [capitalist] country” a good justification for the behavior of these doctors and the pharma companies that pay them?  Does your definition of “capitalism” allow for unethical behavior, compromise of patient efficacy all in the name of a return on investment? 

While I think Tim’s comment is a bit strong, your comments ignore all of the problems outlined by the comments and the article.  And, drug companies already have armies of sales people to “educate” doctors about their drugs.  In fact, drug companies spend a whopping 33% of their revenue on advertising, while they spend a pitiful 6% on research.  And, many of the new drugs are actually old ones for which they have patented new uses, which in turn have extended their patents.

Who cares if pharma is in your’s or my 401k?  Are you willing to compromise the greater good for your retirement? And, by the way, one consequence will be that you will pay higher drug costs while in your retirement. Interesting notion.

Psychiatry is a HUGE scam. It is that simple.

other data bases to search your information:
www ahrq gov
www cdc gov /nchs/
don’t do any survey monkey online or in schools, nutrition centers, grocery stores, nothing, this is a data base and widely exploited though they say hipaa restrictions, they share info like you wouldn’t believe, not just on their data sites, but old fashion gossip, too.

What a bogus report.  ProPublica is pursuing an ancient, out of date angle in regards to the thesis of this series. 

Doctors do not make decisions about what medication they prescribe just on what they hear at a drug sponsored lecture.  The attendance at such lectures and the frequency of such lectures has become almost nil in recent years.  Drug companies have moved from direct marketing to physicians to direct marketing to consumers.  Sightings of drug company field sales people at a doctor’s office have become as rare as dodo bird sightings.  Just open any Lady’s Home Journal or Readers Digest and you will see more ads for pharmaceuticals than for any other sales item.

Physicans are too busy trying to keep their practices open in a medical market of more government regulation and lower and lower reimbursments. They don’t have time for such frivolous events.  With the demands on their time to see more patients faster because of diminishing profit margins, listening to Big Pharma propaganda is a waste of time.  You are guilty of white washing all US physicians with the motivations of a excedingly small fraction of the total number of US physicians, most of which are academics. I seriously doubt that my local Family Physician or Internist is pulling down such income numbers.  In my opinion this whole series is nothing more than muckraking.

Your article implies that Big Pharma’s speakers in some way hypnotize the physicians during the lecture who then immediately walk out of the lecture in mass blank eyed, automatically writing new prescriptions for that company’s drug.  Nothing can be farther from the truth.  Physicians prescribe medications based on what they read in medical articles about the success and effectiveness rate of mediations.  They read independent publications such as The Medical Letter.  They consider the opinion of colleagues.  They take note of how their own patients respond to a particular medication. 

The real entity that governs what physicians prescribe is not Big Pharma but Pharmaceutical Benefit Programs.  If a patient’s Pharmacy Benefit Program does not cover a drug then the doctor cannot prescribe it; no matter how deeply he may have been hypnotized by a Big Pharma lecturer.  Over the past several years Pharmacy Benefit Programs have been increasing the number of drugs that physicians have to obtain prior authorizations for.  Such an action forceably directs the physicians prescription writing to certain drugs that are financially advantageous to the Pharmacy Benefit Program.  Where is Pro Publica in reporting on this issue??

@J. Preston:

I don’t think you really understand how your physician operates, based on your comments.  Also, even when a drug is not approved under your health insurance plan, your doc will have a handy coupon for the drug.  Your statements are also contradictory: if physicians are too busy with their practices to attend these seminars (which, by they way, from first hand knowledge, they are not), then they are certainly too busy to swim through mounds of medical literature about various new drugs coming out. 

Some physicians are academics, but the vast majority are not.  And, even the few that are academics are not a substitute for a researcher in biochemistry, biophysics, or molecular biology.  In fact, their actual knowledge about biochemistry pales in comparison. 

And, I’ve seen a drug rep in my doc’s office every other visit.  The perfect marketing/messaging is to get consumer’s to become proponents, and when they enter the doc’s office and name the drug, the doc then says,“Oh yeah, I’ve heard of that. Yes, that might help you.” 

This article is not frivolous.  It should go farther to show the big picture and show the context of these programs with regard to patient care.

First of all can any of you name one product that isn’t “marketed” whether it be Coca-Cola or the Democrat Party?  I didn’t think so!  Drugs are no different.
Next, the reason physicians who speak on behalf of pharmaceutical companies use company slides, is called GOVERNMENT REGULATION!  The federal government agencies (FDA, OIG, CMS etc) highly regulate EVERYTHING the ethical pharmaceutical industry does.  Those slides are required to be approved by the government before a presentation is given.  (There was a day that physicians could make their own slides on their own topics to educate, unfortunately, government regulation ruined that practice.). 
Next, after the many years of research, and billions spent on R&D, in identifying potential therapeutic candidates to help allieve and cure human suffering and disease, is the reason drugs are expensive, not the small marketing budgets.  The average new product takes greater than 10 years and over $2 billion dollars to bring it to market.  I think it’s important for folks to educate themselves before they believe the lies told by the political class (and the clueless liberals) who spew their vitriolic lies solely for political gain and regulatory control of an industry.  I guess lies sell well to the ignorant and low-information voters.

@ Jon Publius
“the ethical pharmaceutical industry”? LOL. How much is Eli Lilly paying you? And what the hell do liberals have to do with “doctors” being paid shills for big pharma?

@Jon Publius:

Thanks for equivocating . Drugs are very different from Coca Cola and the Democratic Party.  When did Coca Cola promise to cure your ailments?  That is a much more powerful allure than bubbly, fizzy, tastes great.  People buy these drugs because they have serious health problems, or have health issues they feel serious about.  To have the doctor-patient relationship compromised to change a doctor into a pusher of a drug company is irresponsible and unethical, plain and simple.  If given the choice, would you seriously start taking your medical advice from someone who works for Phizer or Merck?

“[S]mall marketing budgets”?  How much do you think it costs for ad time to assail you with Cialis commercials?  If you add up all those commercials, it’s not a “small marketing” budget.  Not to mention the thousands of sales reps pushing this stuff, what is spent on marketing isn’t chump change.  But, why should doctors be allowed to participate in their advertising schemes?  Don’t they have enough advertising? Shouldn’t somebody be left to speak on behalf of the patient’s health?

@ Sam in Texas

You must be time traveling your opinions in from the 1950’s.  In the 21st century drug companies have been firing pharmaceutical field reps by the thousands.  Big Pharma decided 10 years go that it was no longer economical to market drugs directly to physicians. 

How did you obtain your “first hand knowledge” on seminar attendance???  According to this series, the only individuals who are invited to the lectures have MD behind their name.  Based on the views you have voiced I doubt that you are a MD and so doubt your claim.

In regards to your comment “When did Coca Cola promise to cure your ailments” such claims were indeed made by the pharmacist who originally developed the beverage in 1886.  Coca-Cola originally contained the extract of coca leaves which by the way are used in producing cocaine.  This is where “Coca” portion of the name comes from.  Original marketing claims included headache relief and a tonic for the brain and nerves.  You need to become a better historian.

Why do you and Pro Publica want to begrudge US physicians a decent return on their educational investments?? It takes from 11 to 16 years of college, medical school, residency training and fellowship training to become a practicing physician. This is a long time to put one’s life and earning potential on hold.  Those who choose to become physicians spend much more money than they earn during their educational years on tuition, lab fees, books, living and travel expenses.  You and Pro Publica (and Medicare and the Managed Care Industry) seem to imply that physicians should only earn minimum wage.  Comparing the low reimbursement rates physicians are now being paid against the high dollar education loans that medical students have to take out and later pay back, it has become cost prohibitive for anyone to entertain the notion of becoming a doctor. 

Your reference to physician’s lack of knowledge about biochemistry is irrelevant. There is a big difference between the theory of a subject and the actual daily practice of that subject.  That is why it is called “the practice of medicine”.  It takes more than just knowledge of the theory of biochemistry to treat a patient’s disease.  A physician has to be knowledgeable about physiology, anatomy, pathology, pharmacology, microbiology to name a few as well as the limitations of the healthcare market he works in, in order to develop a treatment plan for a patient’s illness. 

This series, by its own admission sights 22 physicians that it says are MD’s who has “earned at least $500,000 since 2009”.  According to the Kaiser Family Foundation (http://www.statehealthfacts.org/profileind.jsp?ind=934&cat=8&rgn=1&cmprgn=2), in November 2012 there were a total of 834,769 “Total Professionally Active Physicians” in the USA.  According to my calculations the 22 physicians that this bogus ProPublica series sites represent 0.0026% of this total.  I have a hard time believing that 0.0026% of the physicians in the US have any direct influence over the prescribing habits of the remaining 99.9974 %.

@J. Preston:

I guess you’re the time traveler, since you decided to pull advertising from the 1800s, before there was any FDA or regulation of any kind, and before modern medicine.  I am quite familiar with the history of Coca Cola, and I saw the same documentary on the History channel.

You got me.  I am not an M.D., and neither are you, but I have several friends who are M.D.s, and they continually get invited to these conferences.  The ones in private practice get regular visits from pharma reps.  In fact, some of their practices have gone to the lengths to adopt the Mayo Clinic protocols on dealing with reps, and the gripe from the M.D.s is they won’t get as many free dinners now. 

No one is saying doctors should earn a minimum wage, and that’s really a dramatic argument not based in any sort of reality.  Going to school for 16 years is a choice, and a choice I would hope based on one’s desire to heal people.  But, of course, having been around a lot of pre-meds, this isn’t the case, and thus the refrain.  And, if being a doctor is such a tough gig, why are there still droves of them going to med school and going into practice?  It’s because doctors still make a very comfortable living.  But, while paying off hefty med school loans might be a good argument, why should doctors be entitled to a lavish life style?

With regard to your statement that biochemistry expertise is irrelevant, you simply don’t know what you’re talking about when it comes to pharmaceuticals, and most doctors don’t either.  Drug interactions are very specific, and, one would hope, designed to target a specific problem.  This is a biochemistry problem, pure and simple, thus very relevant.  Nothing to do with diagnosis or checking for other diseases.  It would follow, then, that a person with actual expertise in the biochemical reaction of the drug is better suited to talk about its efficacy.  Yes, docs deal with all sorts of problems, and have a great cursory knowledge about a great many things, but they are not experts in the science behind the medicine by any stretch.  Ask your doctor about the signal receptors that your prescription drugs interact with the next time you see him or her.  They won’t have a good answer.

Finally, your comment on the database seems to completely pretend that the database is not a work in progress.  This information is not readily available to the public, and Propublica is doing a service in attempting to gather this information.  Your calculations are irrelevant.

I am a pain management physician, and have been to many medical talks over the years.  I went to one recently, where we had a nice dinner, and had an expert in the field discuss new techniques to inject knees with Synvisc.  It was wonderful.  I learned alot. My patients have benefitted from these injection techniques. Do I use Synvisc? Sometimes.  Usually, I use the generic equivalent. 
I also went to one put on by the makers of Seraquel XR.  We spent an hour discussing mental illness.  It was also excellent.  I learned all about the medication, and will try it my patients that have failed conventional therapy. 
Where else am I going to learn about cutting edge techniques and new medications? There are hundreds of new medications that come out every year.  I try to attend conferences whenever I can.  The dinner meetings allow me to interact with collegues, and and find out about new treatments and therapies.  Do we talk about the medication that sponsored the dinner? Yes, but it is part of a larger discussion, such at ways to treat depression or pain.
The speakers I have met are doctors that are experts in their field.  This gives us a chance to interact with them one on, asking questions that no textbook answers.
One of the doctors in my office refuses to see the pharmaceutical reps. I truly feel sorry for him.  He is years behind the rest of us in knowledge about current treatment for pain.

Dr. Matt,

There are plenty of resources that your partner who never sees drug reps can use for the latest treatments.  UpToDate is an excellent example of an evidence based approach to illness that is constantly updated to reflect the latest research. MedScape CME is another free resource that keeps physicians up to date on the latest treatments. 

On the other hand, your drug rep is paid to tell you about their medications using research that has been paid for and often written by the company he or she works for.  They are not as well educated as you and certainly don’t have the interest you do in helping their patients.

I stopped seeing drug reps 25 years ago when I found out that they were tracking my prescriptions and focusing in on the drugs I was not prescribing.  The studies are very clear that any physician who is a “thought leader” (i.e. paid to speak) will significantly increase his or her use of the drug(s) that he is paid to tout.  Most of them will say that the money has no effect on their prescribing practices, but the pharmacy monitoring shows differently in every study ever done.

You may be a case in point.  You state that you learned that you could use Seorquel XR and “will try it my patients that have failed conventional therapy” in an hour session. Would it not be more efficient to send your patients to a psychiatrist who knows a lot more about mental illness and medications than you do?  Also, Seroquel XR is a long acting Quetiapine (which has a half life of 12 hours counting the active metabolite) and is much more expensive than the generic which can be taken BID.  It also has significant side effects that you might not be aware of from an hour lecture.

You are probably not aware that AstraSeneca paid a $520 million fine for falsely marketing the drug or that it is abused significantly intranasally especially in prisons where it is known as “Q-Ball.”  I doubt that your rep told you these things either.

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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