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Docs on Pharma Payroll Have Blemished Records, Limited Credentials

Hundreds of doctors paid by pharmaceutical companies to promote their drugs have been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists, ProPublica has found. We compiled data from seven companies, covering $257.8 million in payouts since 2009 for speaking, consulting and other duties

The Ohio medical board concluded that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue.

Yet the finding, posted on the board’s public website, didn’t prevent Eli Lilly and Co. from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.

In 2001, the U.S. Food and Drug Administration ordered Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.

And in Georgia, a state appeals court in 2004 upheld a hospital’s decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I am a pervert, I honestly don’t know,” according to the appellate court ruling.

Last year, Taylor was Cephalon's third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

Leak, McMillen and Taylor are part of the pharmaceutical industry’s white-coat sales force, doctors paid to promote brand-name drugs to their peers — and if they’re convincing enough, get more physicians to prescribe them.

Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.

But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.

This story is the first of several planned by ProPublica examining the high-stakes pursuit of the nation’s physicians and their prescription pads. The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged.

"Without question the public should care," said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry’s influence on physicians. "You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor, someone who hasn’t displayed good judgment in the past?"

To vet the industry’s handpicked speakers, ProPublica created a comprehensive database that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

Although these companies have posted payments on their websites — some as a result of legal settlements — they make it difficult to spot trends or even learn who has earned the most. ProPublica combined the data and identified the highest-paid doctors, then checked their credentials and disciplinary records.

That is something not all companies do.

A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.

More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.

In interviews and written statements, five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.

ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.

“They are representatives of the company,” said Dr. Jack Harris, vice president of Lilly’s U.S. medical division. “It would be very concerning that one of our speakers was someone who had these other things going on.”

Leak, the pain doctor, and his attorney did not respond to multiple messages. The Ohio medical board voted to revoke Leak’s license in 2008. It remains active as he appeals in court, arguing that the evidence against him was old, the witnesses unreliable and the sentence too harsh.

In an interview, McMillen denied nearly all of the allegations in the FDA letter and blamed his troubles on a rival firm whose drug he had criticized in his presentations.

“I’m more cautious now than I ever was,” said McMillen, who said he also does research. “That’s why I think a lot of the companies use me. I’m not taking any risks.”

Taylor said that the allegations against him were “old news” from the 1990s and that regulators had not sanctioned him. “It had nothing to do with my skills as a physician,” said Taylor, noting that he speaks every other week around the country and sometimes abroad. “Even my biggest detractors in that situation lauded my skills as a physician. That’s what’s most important.”

Disclosures are just the start

Payments to doctors for promotional work are not illegal and can be beneficial. Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments.

There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress.

All told, 384 of the approximately 17,700 individuals in ProPublica’s database earned more than $100,000 for their promotional and consulting work on behalf of one or more of the seven companies in 2009 and 2010. Nearly all were physicians, but a handful of pharmacists, nurse practitioners and dietitians also made the list. Forty-three physicians made more than $200,000 — including two who topped $300,000.

Physicians also received money from some of the 70-plus drug companies that have not disclosed their payments. Some of those interviewed could not recall all the companies that paid them, and certainly not how much they made. By 2013, the health care reform law requires all drug companies to report this information to the federal government, which will post it on the Web.

The busiest — and best compensated — doctors gave dozens of speeches a year, according to the data and interviews. The work can mean a significant salary boost — enough for the kids’ college tuition, a nicer home, a better vacation.

Among the top-paid speakers, some had impressive resumes, clearly demonstrating their expertise as researchers or specialists. But others did not –contrary to the standards the companies say they follow.

Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.

Experts say the fact that some companies are disclosing their payments is merely a start. The disclosures do not fully explain what the doctors do for the money — and what the companies get in return.

In a raft of federal whistleblower lawsuits, former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.

The disclosures also leave unanswered what impact these payments have on patients or the health care system as a whole. Are dinner talks prompting doctors to prescribe risky drugs when there are safer alternatives? Or are effective generics overlooked in favor of pricey brand-name drugs?

"The pressure is enormous. The investment in these drugs is massive,” said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. “Are any of us surprised they’re trying to maximize their markets in almost any way they can?”

From drug reps to doc reps

For years, drug companies bombarded doctors with pens, rulers, sticky notes, even stuffed animals emblazoned with the names of the latest remedies for acid reflux, hypertension or erectile dysfunction. They wooed physicians with fancy dinners, resort vacations and personalized stethoscopes.

Concerns that this pharma-funded bounty amounted to bribery led the industry to ban most gifts voluntarily. Some hospitals and physicians also banned the gift-givers: the legions of drug sales reps who once freely roamed their halls.

So the industry has relied more heavily on the people trusted most by doctors — their peers. Today, tens of thousands of U.S. physicians are paid to spread the word about pharma’s favored pills and to advise the companies about research and marketing.

Recruited and trained by the drug companies, the physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.

These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.

Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases “in the boonies,” he said. On a recent trip, he said, he drove to “a little bar 40 miles from Odessa,” Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.

Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are “a calling,” and he is booking them for 2011.

The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.

Dr. Samuel Dagogo-Jack has a resume that would burnish any company’s sales force: He is chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center. Dagogo-Jack conducts research funded by the National Institutes of Health, has edited medical journals and continues to see patients.

While most people are going home to dinner with their families, he said, he is leaving to hop on a plane to bring news of fresh diabetes treatments to non-specialist physicians “in the trenches” who see the vast majority of cases.

Since 2009, Dagogo-Jack has been paid at least $257,000 by Glaxo, Lilly and Merck.

“If you actually prorate that by the hours put in, it is barely more than minimum wage,” he said. (A person earning the federal minimum wage of $7.25 would have to work 24 hours a day, seven days a week for more than four years to earn Dagogo-Jack’s fees.)

For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.

Glaxo’s drug to treat enlarged prostates, Avodart — locked in a battle with a more popular competitor — is the topic of more lectures than any of the firm’s other drugs, a company spokeswoman said. Glaxo’s promotional push has helped quadruple Avodart’s revenue to $559 million in five years and double its market share, according to IMS.

Favored speakers like St. Louis pain doctor Anthony Guarino earn $1,500 to $2,000 for a local dinner talk to a group of physicians.

Guarino, who made $243,457 from Cephalon, Lilly and Johnson & Johnson since 2009, considers himself a valued communicator. A big part of his job, he said, is educating the generalists, family practitioners and internists about diseases like fibromyalgia, which causes chronic, widespread pain — and to let them know that Lilly has a drug to treat it.

“Somebody like myself may be able to give a better understanding of how to recognize it,” Guarino said. Then, he offers them a solution: “And by the way, there is a product that has an on-label indication for treating it.’’

Guarino said he is worth the fees pharma pays him on top of his salary as director of a pain clinic affiliated with Washington University. Guarino likened his standing in the pharma industry to that of St. Louis Cardinals first baseman Albert Pujols, named baseball player of the decade last year by Sports Illustrated. Both earn what the market will bear, he said: “I know I get paid really well.”

Is anyone checking out there?

Simple searches of government websites turned up disciplinary actions against many pharma speakers in ProPublica’s database.

The Medical Board of California filed a public accusation against psychiatrist Karin Hastik in 2008 and placed her on five years’ probation in May for gross negligence in her care of a patient. A monitor must observe her practice.

Kentucky’s medical board placed Dr. Van Breeding on probation from 2005 to 2008. In a stipulation filed with the board, Breeding admits unethical and unprofessional conduct. Reviewing 23 patient records, a consultant found Breeding often that gave addictive pain killers without clear justification. He also voluntarily relinquished his Florida license.

New York’s medical board put Dr. Tulio Ortega on two years’ probation in 2008 after he pleaded no contest to falsifying records to show he had treated four patients when he had not. Louisiana’s medical board, acting on the New York discipline, also put him on probation this year.

Yet during 2009 and 2010, Hastik made $168,658 from Lilly, Glaxo and AstraZeneca. Ortega was paid $110,928 from Lilly and AstraZeneca. Breeding took in $37,497 from four of the firms. Hastik declined to comment, and Breeding and Ortega did not respond to messages.

Their disciplinary records raise questions about the companies’ vigilance.

“Did they not do background checks on these people? Why did they pick them?” said Lisa Bero, a pharmacy professor at University of California, San Francisco who has extensively studied conflicts of interest in medicine and research.

Disciplinary actions, Bero said, reflect on a physician’s credibility and willingness to cross ethical boundaries.

"If they did things in their background that are questionable, what about the information they’re giving me now?” she said.

ProPublica found sanctions ranging from relatively minor misdeeds such as failing to complete medical education courses to the negligent treatment of multiple patients. Some happened long ago; some are ongoing. The sanctioned doctors were paid anywhere from $100 to more than $140,000.

Several doctors were disciplined for misconduct involving drugs made by the companies that paid them to speak. In 2009, Michigan regulators accused one rheumatologist of forging a colleague’s name to get prescriptions for Viagra and Cialis. Last year, the doctor was paid $17,721 as a speaker for Pfizer, Viagra’s maker.

A California doctor who was paid $950 this year to speak for AstraZeneca was placed on five years’ probation by regulators in 2009 after having a breakdown, threatening suicide and spending time in a psychiatric hospital after police used a Taser on him. He said he’d been self-treating with samples of AstraZeneca’s anti-psychotic drug Seroquel, medical board records show.

Other paid speakers had been disciplined by their employers or warned by the federal government. At least 15 doctors lost staff privileges at various hospitals, including one New Jersey doctor who had been suspended twice for patient care lapses and inappropriate behavior. Other doctors received FDA warning letters for research misconduct such as failing to get informed consent from patients.

Pharma companies say they rely primarily on a federal database listing those whose behavior in some way disqualifies them from participating in Medicare. This database, however, is notoriously incomplete.

The industry’s primary trade group says its voluntary code of conduct is silent about what, if any, behavior should disqualify physician speakers.

“We look at it from the affirmative — things that would qualify physicians,” said Diane Bieri, general counsel and executive vice president of the Pharmaceutical Research and Manufacturers of America.

Some physicians with disciplinary records say their past misdeeds do not reflect on their ability to educate their peers.

Family medicine physician Jeffrey Unger was put on probation by California’s medical board in 1999 after he misdiagnosed a woman’s breast cancer for 2½ years. She received treatment too late to save her life. In 2000, the Nevada medical board revoked Unger’s license for not disclosing California’s action.

As a result, Unger said, he decided to slow down and start listening to his patients. Since then, he said, he has written more than 130 peer-reviewed articles and book chapters on diabetes, mental illness and pain management.

“I think I’ve more than accomplished what I’ve needed to make this all right,” he said. During 2009 and the first quarter of 2010, Lilly paid Unger $87,830. He said he also is a paid speaker for Novo Nordisk and Roche, two companies that have not disclosed payments.

The drug firms, Unger said, “apparently looked beyond the record.”

Companies make their own experts

Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.

At an FDA hearing, he borrowed David Letterman’s shtick to deliver a “Top Five” list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug’s risks had been overblown.

“I still feel very convinced in the drug,” Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.

Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.

Roseman’s public profile comes from his work as one of Glaxo’s highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.

Pharma companies often say their physician salesmen are chosen for their expertise. Glaxo, for example, said it selects “highly qualified experts in their field, well-respected by their peers and, in the case of speakers, good presenters.”

ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to.

“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.

“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”

To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians’ specialties.

In numerous cases, little information turned up.

Las Vegas endocrinologist Firhaad Ismail, for example, is the top earner in the database, making $303,558, yet only his schooling and mostly 20-year-old research articles could be found. An online brochure for a presentation he gave earlier this month listed him as chief of endocrinology at a local hospital, but an official there said he hasn’t held that title since 2008.

And several leading pain experts said they’d never heard of Santa Monica pain doctor Gerald Sacks, who was paid $249,822 since 2009.

Neither physician returned multiple calls and letters.

A recently unsealed whistleblower lawsuit against Novartis, the nation’s sixth-largest drug maker by sales, alleges that many speakers were chosen “on their prescription potential rather than their true credentials.”

Speakers were used and paid as long as they kept their prescription levels up, even though “several speakers had difficulty with English,” according to the amended complaint filed this year in federal court in Philadelphia.

Some physicians were paid for speaking to one another, the lawsuit alleged. Several family practice doctors in Peoria, Ill., “had two programs every week at the same restaurant with the same group of physicians as the audience attendees.”

In September, Novartis agreed to pay the government $422.5 million to resolve civil and criminal allegations in this case and others. The company has said it fixed its practices and now complies with government rules.

Roseman, who has been a pharma speaker for about a decade, acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Asked about Roseman’s credentials, a Glaxo spokeswoman said he is an “appropriate” speaker.

Getting paid to speak “doesn’t mean that your views have necessarily been tainted,” he said.

Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard have begun banning their staffs from accepting pharma money for speaking, he said. “It irritates me that the debate over bias comes down to a litmus test of money,” Roseman said. “The amount of knowledge that I have is in some regards to be valued.”

ProPublica Director of Research Lisa Schwartz and researcher Nicholas Kusnetz contributed to this report.

Healthcare professionals learn about new medicines and gain additional knowledge on existing treatments from a variety of sources. Discussions with peers, CME, peer-reviewed journals and interactions with America’s biopharmaceutical research company representatives all provide critical insights that ultimately benefit patient care.

Doctors and other healthcare professionals with real-world clinical experience in specific therapeutic areas are uniquely qualified to educate and inform their peers about the medicines they prescribe. Interactions between healthcare professionals benefit patient care through the exchange of the latest regulated information about the benefits, risks and appropriate uses of medicines. America’s biopharmaceutical research companies sponsor speaker programs to facilitate these important information exchanges.

Although you acknowledge that these exchanges “fill an educational gap,” unfortunately your article gives short shrift to the informational value of these exchanges, and you overlook the federal requirements and solid voluntary guidelines in place that govern these forums.

To help ensure that the scientific information presented is accurate and up to date, companies sponsoring speakers bureaus comply with both federal requirements and stringent self-imposed standards.

For example, the Food and Drug Administration holds companies accountable for the presentations of their speakers; materials presented at these forums must be consistent with product labeling approved by the FDA.

In addition, the PhRMA Code on Interactions with Healthcare Professionals, which was strengthened in 2008, contains detailed provisions specific to the conduct and training of speakers. Under the PhRMA Code, company decisions regarding the selection of healthcare professionals are based on defined criteria such as medical expertise, reputation, knowledge and experiences in a particular therapeutic area, and communication skills.

Consistent with the PhRMA Code, companies also may look to other qualifications including, but not limited to, specific experience with the medicine, faculty or medical society affiliations, leadership positions, authorship in the relevant therapeutic area, speaking experience, and participation in clinical trials. In addition, companies have policies, procedures, and training in place to foster compliance with provisions governing speaker programs, including conducting periodic reviews to ensure speakers still meet the requisite qualifications.

Speakers bureaus, together with other sources of information including direct interaction between biopharmaceutical companies and healthcare professionals, help improve patient care in various ways, such as disseminating information that will help address treatment gaps. While your article suggests that such information exchanges are sometimes viewed as leading to overuse of medicines, data from many peer-reviewed studies have shown that medicines used to treat many chronic conditions are far more likely to be underused than overused. Physician leaders like Francine Kaufman, M.D., former President of the American Diabetes Association (ADA), have credited pharmaceutical companies, along with patient advocacy organizations, with helping narrow the gap between the standard of care and actual practice.

Your piece also implies that company-sponsored speakers bureaus and interactions between company representative and healthcare professionals have an undue influence on prescribing decisions. To the contrary, research has shown that many factors impact prescribing decisions, including a physician’s clinical knowledge and experience, a patient’s unique situation, peer-reviewed journals, continuing medical education, clinical practice guidelines and insurance coverage and formularies.

Recent prescribing trends reflect these influences, particularly insurer strategies such as tiered co-pays and prior authorization. Today, 75 percent of all prescriptions are filled by generic drugs, up from 47 percent in 2000.

New, innovative medicines play a key role in patient care, enabling patients to live longer, healthier, more productive lives.  America’s biopharmaceutical research companies are committed to providing healthcare professionals with accurate, up-to-date information about new treatments and the benefits and risks of medicines.

Diane Bieri
General Counsel and Executive Vice President
Pharmaceutical Research and Manufacturers of America (PhRMA)

That was a pretty long response considering how little there was of relevance to the actual article. Does big Pharma hire sketchy, underqualified docs or doesn’t it? And if it doesn’t, how do you explain all the evidence presented in this article?

The point is that pharma is hand picking speakers who will promote their message. There is no reason why physician education has to be provided by the pharmaceutical industry. If journalists got continuing education paid for by corporations, we would all be outraged.

James E. Barone, MD

Oct. 19, 2010, 9:30 a.m.

Ms. Bieri’s comments remind me of the movie/book “Thank You for Smoking.” Consider the source. There are numerous papers proving that drug company-sponsored programs influence prescribing practices. These so-called “experts” are giving canned talks written by the companies. The truth is, even the researchers who give these talks are shills.

If I were picking a drug to prove how worthy this article is, I would use the fluoroquinolones as an example. There are two decades of documented damages done by this group of drugs but doctors still write clinical reports stating “seems to be tolerated well” or when confronted with a patient who suffers life altering crippling reactions state “it is within the standard of care” even when given against the black box warning. Your trusty lobbiest is at work. When did it become acceptable to not know about the drug you are prescribing?

PS - Some Journalists are paid for by corporations…...and the media as a whole. That is why Americans now live in a Third World country.

I suspect that the “257.8 million in payouts since 2009” figure way underestimates how much money is flowing. The article would be better if it laid out all of the categories of activities in which doctors receive some benefit from pharma, all of the pharma companies, and then what fraction of (i) and (ii) the comprehensive database actually covers.

Great effort, though. Must have been a ton of work.

thomas foley

Oct. 19, 2010, 10 a.m.

doug-
you are obviously not in the medical or pharma industry-
pharm industry supports programs for docs that would not be possible otherwise because of financial reasons—cost to put on educational programs-
its ironic that congress has made the industry change when congressmen now can receive money and not report who is funding their campaigns—ask carl rove about this-
do you trust your doc—just ask them any question-
an honest doc is just that—if a doc is dishonest or underqualified-he/she will be weeded out-
great response diane bieri- most people who will make comments on this sounding board will be grossly underqualified to make statements

Doug Bremner MD

Oct. 19, 2010, 10:09 a.m.

@thomas

OK, now I put my degree behind my name, so the goof’s on you. Doctors can pay for their lectures. There are CME courses not pharma funded and they can attend meetings of their societies. I also do not support lack of disclosure of contributions to politicians.

my bad dr bremner-
i just find it offensive that we have all these articles that basically state that doctors are too stupid or too influenced by a free pen or steak dinner to make good decisions on their pts behalf-
tfmd

Ronald P Jordan

Oct. 19, 2010, 10:31 a.m.

I’ve long had views on the pharmaceutical and health care industries about their value and serious problems.  It is a complex world and to save the reader time, I’d say it’s about doing the right thing.  If you care about your fellow inhabitants of this world, do unto others as the saying goes and just do the right thing whenever you can.  That goes for journalists as well as Pharma company executives, doctors, pharmacists or consumers of medical care.  We are all in this world trying to make it better for those who will follow us, we have problems, but let’s not let each other go over the edge.

It is clear to me that far too much rhetoric about big bad Pharma exists.  Are there bad doctors out there? Sure!  Do big companies sometimes step over the line? You bet they do! Do individual sales people do the wrong things sometimes too? Absolutely they do, even if they are highly trained and respected professionals. Those things do not mean however that the bad happens always or even more often than the good. It’s also hard for a journalist to get precise balance in their writing although I believe most try.  Do most people long to earn enough to be happy and enjoy life also? Yes, and do journalists struggling to find a way to survive in a rapidly changing information age sometimes need to focus on something sensational and negative just to get a web hit…or NPR interview? SURE THEY DO!  So what should we all think of the drug industry and doctors who work for them?
First off, as always, buyer, or consumer, beware. There are all kinds of obstacles and problems in life.  Getting and consuming the best health care, medicines or NEWS for that matter is all up to you. You need to look out for your own health, well being, opinions and wallet the best you can. It’s unlikely that government, academia, the health care “system,” politicians or journalists will be able to protect you from every pitfall.  Seek out medical professionals that you trust for their caring attitude, their availability to you and the knowledge you don’t have time to generate on your own.  Select and use medical treatments that you feel you can trust and monitor them continuously on your own and with the help of your doctors, nurses and pharmacists to be sure they are delivering you value.
Doctors do need to learn about new drug products from somewhere.  My take is that government has gone too far here. The FDA, National Institutes for Health or the Center for Medicaid and Medicare Systems, the AMA or your insurer for that matter, don’t know what is best for you, or for everyone for that matter, all the time.  As best I can tell, they are trying to do the best they can in life and work, which unfortunately for us humans, is woefully too little, too much of the time.

Without re-investment of some Pharma profits into education, academia, dissemination of knowledge, continuing education, we will never get sufficient information to most of those who need it anywhere near in time.  The pendulum of preventing Pharma promotion of its research products has swung too far.  Should they just punch out the pills and put them on the street and say “you figure it out.”

We need to help caring professionals who as the Pharma response and article point out, use multiple sources to make decisions about the care they provide, figure out what may be best for each patient, one at a time.  Their direct and their patient’s experience should drive what is used. Not a PBM or government. The PBM story is another the article missed, totally.  Health care in not only local, it is individual and while “evidence” based medicine is surely useful and helps, waiting for all the evidence, all the time, if no one is trying new options is a never ending black hole. 

Incremental improvements in medicine need incremental experimentation.  We need to use our technology and instantaneous worldwide communication networks to get the best real time information on what is happening in medical care to everyone who might need it. If problems develop with a drug, bad luck, pull it off the market. We need better systems of surveillance and vigilance, not less promotion.  Why not pay for adverse event reporting?

One question to close. Would you be happy to live the rest of your life only with the medicine that exists now and information we know today being used in your care?  I think not, I’m happy to have a great industry searching daily to improve my life and working tirelessly to solve problems while making the profits they need to succeed. Value begets rewards they deserve their success and I hope this country does not drive them out so we are third world for your children some day. I’ll keeping looking out for my own interests also, while always do the best I can to do the right thing.

Ronald P. Jordan, R.Ph., FAPhA
Dean, The University of Rhode Island, College of Pharmacy

About five years ago when I found out about the drug company payments to doctors, there were only 5 states that required reporting of how much doctors receive in kickbacks from drug companies and 17 other states had tried to get disclosure and the drug and doctor lobbies defeated the bill. Minnesota has been requiring reporting since 1997.

http://www.phcybrd.state.mn.us/main_pay.htm

One of the health care reforms proposed in 2014 is to make the drug companies disclose every doctor or medical professional kickbacks. What good is that? When Minnesota has had the reporting requirement for 13 years. The real reform would be to make it Illegal to kickback to doctors not just reporting the kickbacks.

Ever wonder, if a doctor prescribes a drug, if it is for you or for the kickback. Making the kickback illegal will remove any doubt.

The drug companies also spend an average of $6800 a year, wining and dining every doctor and staff by the 66,000 drug salesman.

Dr. Bremmer, how many CE courses have you paid for out of your pocket during your career?  And if you are counting the physician societies mentioned, scratch those off—- they would not exist without commercial funding and support- which by the way is mostly hadndled in an independent hands off manner—no influence allowed.

Doug Bremner MD

Oct. 19, 2010, 11:21 a.m.

My, my. We have some real essay writers here.

@Ronald I don’t think “buyer beware” and academia has no role in guiding healthcare are not acceptable answers. As a professor in a medical school, I very much think the public expects and should DEMAND that academic medical centers should play a leading role in this issue. The fact is that many of these talks were once given by academic doctors and they have jumped ship in time to get off of these databases, which go back 18 months only, but which were forewarned several years ago.

@Doug You spelled my name wrong, but a simple google search will show you that I am a researcher, writer, and lecturer, which means I can get CME at the (non industry funded) conferences where I am speaking.

I am glad to see these articles explode the myth that doctors have to use the pre-packaged slide sets because they are “approved by the FDA” (in fact the send them after the fact). I always thought that was rot, and was dropped from the speaker’s lists for insisting on having final say on the slides (thinking that otherwise it was just advertising). That was 10 years ago, and I am frankly ashamed to see fellow physicians participating in what are now openly called “promotional” talks.

Most of the ills and benfits of the pharmaceutical industry can be ascribed to simple economic motivations.
The idea that a free pen alters a physician’s prescribing practices seems rediculous and no doctor believes that it affects them. Yet, there are still thousands of drug pens all over many hospital and doctor’s ofices. Why would for-profit pharmaceutical companies spend literally millions of dollars for decades on advertising that doesn’t work? Of course it works.
Similarly, the talks that doctors give are designed, in part, to educate, but also to increase sales of the sponsoring product. I have given one drug sponsored speech in my life. It was paid for by one drug company and attended by a representative of their chief competitor. I gave a fair and balanced talk regarding the benefits of both agents as well as others of the same class. I never heard back from the two representatives and have never been asked to speak for either company again. Could be because I didn’t use any of the supplied slides that represented the drug companies views. I am OK with never giving another talk.
I agree that CME through medical porfessional societies are less influenced and a reasonable compromise as it allows the pharmaceutical industry to promote education and research without such a biased and aggressive and, frankly embarassing system as now exists. I do agree, however, that even our professional societies are in large measure heavily influenced by industry. Most of the directors and governing board are heavily subsidized by industry. You just never see a really good clinician on the boards.
At the end of the day, the real question about american medicine is: Is it about profits, research, teaching and patient care (the last three replicates the University of Iowa’s logo), or is it about patient care, teaching, research and profits (the first three should be the university of Iowa’s logo). Its not about the concepts, its about the emphasis. I’d work for less than I make now, but not a lot less. Doctors are the last profession in the US. When they become de facto whores for big money industries, they will join lawyers as the butt of bad jokes, rather practitioners of a high art.

MH,MdPhd - very thoughtful and professional comment. I know there are many like you out there so don’t think all are tarred by the same brush.

tfmd - you find it offensive to read true statements of corruption? I would think you would find it worrisome and maybe something worthy of taking some interest or action on. But you are offended?

RPJMD - what a looongg comment to say so little except you are happy and will continue to look out for your interests. ‘value begets rewards they deserve their success…..hope this country does not drive them out so we are third world for our children’ .....hm, do you know more “patients” die from ADR’s from drugs prescribed by happy doctors and approved by the FDA than from any illegal drug use combined?  Most are suffered worst by our elderly and our children - our most vulnerable citizens.  These are facts. That is why we are already Third World in health care. I find it offensive that our medical professionals have so little interest in the facts of their chosen career endeavor. After all - it is sometimes life or death and education should be the tool against the illness. If you expect patients to always beware, and to not expect educated diagnosis why do they need you? So many are treated without being consulted or given a choice. I find your long letter egregious. Not all doctors are created the same and I am very grateful for that.

AstraZeneca provided the following perspective on speakers programs in an interview with our compliance officer on our corporate blog this morning:

http://www.azhealthconnections.com/azhealthconnections/2010/10/astrazeneca-and-doctor-speakers-programs.html#tp

- Tony Jewell, AstraZeneca corporate communications

@ Bremner…a little scary…if that is how a professor in a medical school reads…“academia has no role in guiding healthcare” ...vs. “It’s unlikely that government, academia, the health care “system,” politicians or journalists will be able to protect you from every pitfall.” You can see why I hate to rely totally on any one person alone in an information burdened world. I have no problem with acadmeic medicne, in fact, I think pharma should support it more!

@boo badly…similarly scary…yes patient die from ADR’s, some from over use, some under use, some from mis prescribing, some from errors in dispensing, lots of reasons.  Plenty of resons for people to be careful themselves with their medicines. Doctors alone cannot save us all.  It takes a team of caring professionals and the armament the industry provides.

@MHMD…the last profession…a bit much. I hope they are also practicing the best science they can gather and that they are doing that with their pateints and other health professionals collaboratively. No single person can know it all.

Has anybody questioned other industries like medical technology, medical supplies, i.e. Medtronic?

More than 100,000 patients die every year in the US because of mistakes made in their medication.  These errors include wrong meds, wrong doses, and wrong patient I.D., but most of the deaths could be prevented through education.  It is appalling to me, as a patient, that PR from Big Pharma passes for education.  Even with an informed medical advocate to help the patient, most patients are still at the mercy of their doctors.  Several doctors have prescribed meds for me that would have caused anaphylaxis, even AFTER I told them about my life-threatening allergies, because they had been “educated” at Big Pharma “seminars” that had misinformed them.  We have a serious problem in the US when the intelligent, informed patient is a better care provider than the doctor.

RPJ - why don’t you just say $@*) happens and be done? All situations are different, consider a patient goes for treatment of a common infection, walks in having not had to take medication for almost 10 years, in wonderful health basically and after 7 days they have experienced several acute bodily failures, became crippled and can no longer walk. At no time was the patient advised what drugs were being used nor why they are failing.. And they are stone walled for weeks by every healthcare entity involved regarding those new excruciating pains they are having. When you have to demand your medical records from a hospital stay to find facts that are known - there is a problem that should be addressed by said profession. When said drug has been approved by the FDA which bases said approval on clinical reports written by medical professionals - there is a need to correct it. If said doctor does not read nor know better than to give a drug against medical guild info provided for it, they really can’t stand behind the statement of “standard of care”.

I hate to tell you but doctors lost the pedestal long ago. Most patients wish and demand to be informed. Not all are given such info nor are they treated with respect.

I only state this because you seem to feel it is a witch hunt and not based on facts. But also - you seem to want to blame the victims. Surely you could not be that uncaring?  None of this is based on single incidents nor any one drug.

It is good to read suggestions for fixing real problems that are life threatening.

Betsy Jacobson

Oct. 19, 2010, 2:24 p.m.

ProPublica has provided an important forum for the exchange and dissemination of important information on the role of The Pharmaceutical Industry on our lives and on our doctors’ decisions. 

Much more information exists on Big Pharma’s behavior for which ProPublic had no room to include in today’s reporting. Of the several exluded behaviors are:
PAY FOR DELAY which affects the availability of drugs from which doctors may choose.
GHOSTWRITING which pays MD’s and non MD’s for the use of their names on the publishing of researech projects in which they played no part, but for which bundles of money contribute not only to the marketing of the drug but to the doctors’ decisions about using it.
THE WITHHOLDING OF PROTOCOL FAILURES IN STUDIES in order to make the whole study look good so that doctors will prescribe the drugs. This incomplete info appears in some of the most prestigious medical journals on earth.

And the list goes on.  Let’s not gild the pharmaceutical (you should excuse the expression) lily, please.

I would be interested to see an overall breakdown.  I can’t determine if this is significant or not.  Yes, you uncovered a number of suspect characters promoting pharmaceuticals, but do they make up a significant number?  I only scanned the article to see if it was listed, and found a 17,700 figure. is this the total of Pharmaceutical reps?  If so, a “few hundred” does not seem significant to me.  That could be only 2%, right?  Is my math off?  I’ll bet you could find 2% negativity in just about any data set.

Yes, there are doctors who are scumbags/crooks and even if they get caught, they still might have some redeeming ability to identify which drugs are good or bad (though it’s hard to trust a scumbag/cook)

I always tell my doctors that I avoid medicine as much as possible. I had some horrible reactions to them in the past and frankly I don’t trust big pharma.

georgina sanchez

Oct. 19, 2010, 3:44 p.m.

Are any of the Doctors based in Puerto Rico ???? I find your article right on target, about what has been suspected by many….thank you for bringing it out of the dark….

Georgina, you can see our list of doctors who were paid in PR here:

http://projects.propublica.org/docdollars/states/puerto-rico

Sharon McEachern

Oct. 19, 2010, 5:02 p.m.

It is troubling that many doctors do not repeort on colleagues whom they know are bad physicians. Oh, they admit it! Ethic Soup reported on how one in three American physicians don’t think they’re responsible for reporting colleagues who aren’t fit to practice. Based on responses from almost 2,000 physicians throughout the U.S., about 36 percent said it was not their professional obligation to report any collegues who were significantly impaired, due to substance abuse or mental illness, or just plain imcompetent:

http://www.ethicsoup.com/2010/07/doctors-code-of-silence-many-keep-mum-on-colleagues-incompetence.html

Carolyn Thomas

Oct. 19, 2010, 5:33 p.m.

Although this article focuses on ‘bad docs making good money’ from Big Pharma, even the best of doctors can be pervasively influenced by industry.

Surprisingly, and despite docs’ insistence that they are not influenced at all by receiving Big Pharma gifts or perks or honoraria, a review published in the Journal of the American Medical Association suggests that even the smallest of gifts does indeed influence the choices physicians make.

Big Pharma spends this money on docs for only one reason: it works.

Dr. Ashley Wazana at McGill University in Montréal reviewed 29 studies on doctors’ prescribing behaviour in the U.S., Canada, Holland, New Zealand, and Australia.

In his review, Dr. Wazana noted these examples:

- free samples, honoraria, and research grants led doctors to be significantly more likely to prescribe that drug
-  freebies also led doctors to request the drug for formularies
-  accepting a free trip to a drug company-sponsored conference led doctors to increase prescriptions of that company’s drugs by 80-190%.
-  doctors who “occasionally” attended pharma-sponsored meals were 2-3 times more likely than other doctors to request that the sponsor’s drug be added to a hospital formulary
-  doctors who “often” ate these meals were 14 times more likely to do so
-  two out of five doctors attended company-sponsored meals, and a similar proportion accepted funding for travel or lodging to attend drug company-backed conferences

More on this in “Pens, Pizza, Parties: How Big Pharma Freebies Impact Your Doctor” from THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED at
http://ethicalnag.org/2009/12/08/pens-pizza-parties/

Gunther Steinberg

Oct. 19, 2010, 7:32 p.m.

The FDA examines, comments and passes or rejects claims relating to medications. Hucksters who are paid to spread the word about a medication are influenced only by the requirement and text provided by their employers.
  If their own opinions about the value of a drug is at variance with the company line, they need to quit. It is questionable though that they have the research experience to make their own judgment. In any case, they are “employed by the pharmaceutical companies, who provide their information, true or not or tilted, and the money is very good.
  A first class research physician might give a talk if he had done a project and made a significant finding on the value of a drug for certain conditions. If he does it on multiple occasions, rather than to present one paper, he becomes a hack for the company.
Money talks and influences decision for almost all people, doctors included. Many surgeons do procedures that are not really necessary, but yield very high fees - five figures for an hour’s work. They justify it to themselves as being good for the patient.

In the end, doctors like large incomes and the marginal ones, the one that have been warned by the FDA, or fired from hospitals, feel it is a nice way to make a living since they once got the degree, even if they no longer deserve the title of MD or PhD.
Integrity is a disposable matter, when times get tough.

steve merrill

Oct. 19, 2010, 7:52 p.m.

What shysters and glorified windbags!! I had a superannuated MD prescribe Topamax and thank god the pharmacist caught it when I read the warnings..AND they are handing out Neurontin (gabapentin) like candy for pain even though it’s illegal, eats one’s liver, and makes them drool and have no thoughts or ideas..What scares me is that people are driving around on these meds and it’s as dangerous as drinking, or worse, as there’s no obvious “symptoms”. And the new “syndrome” is fibromyalgia and there’s plenty of suckers falling for it..Anyone remember Zomax? FenFen? Redux? How many more zombies and walking wounded will there be? As corporations are “people” and have rights to “free ($) speech” then why cannot they be jailed? As Baron Thurlow said they have “no soul to save nor body to incarcerate”..Just say NO, thank you..SM

BUSINESS IN GENERAL HAS BEEN A BAD CITIZEN..AND PHARMA IN PARTICULAR…THE BUSINESS ETHIC CAN BE STATED IN THE REVERSE OF THE BOY SCOUT OATH..ON MY HONOR I WILL DO MY BEST TO HELP MYSELF AND CHEAT THE REST…MONEY REALLY DOES MAKE PEOPLE LOSE THEIR INTEGRITY AND THEIR MINDS…HONOR IS NOT EVEN A CONSIDERATION..

Mary Sue McAslan

Oct. 19, 2010, 9:38 p.m.

As a pharmacist, I stopped going to drug company dinners (and other presentations) a long time ago. I choose my CE by the qualifications and integrity of the speaker (not by the name of the fancy restaurant). “Presentations” sponsored by drug companies are nothing more than promotional opportunities for new and expensive drugs and the doctors who present the “information” are talking from a script and showing drug company slides. My recommendation - don’t go to these presentations. Read the study, have an intelligent discussion with your colleagues and then make up your mind for yourself.

Joel Gelman, M.D.

Oct. 19, 2010, 10:46 p.m.

In my specialty, Urology, many Academic Urologists are paid consultants who receive a substantial income from industry, and in return, give educational talks.  This relationship does offer legitimate benefits to the medical community and can benefit patient care.  Any sponsorship is always disclosed and this is considered a legitimate practice.  However, it does create the appearance of a conflict of interest and can introduce bias which is not best for patient care.  Therefore I personally do not accept any money from industry.  There is an organization that encourages this independence

http://www.ethicaldoctor.org

I recently updated my own website and make it a point to clarify that I do not have any financial relationship with drug companies or product manufacturers

http://www.centerforreconstructiveurology.org/erectiledysfunction/ourapproach.htm

I state this because although disclosure is required for research publications and presentations at professional meetings, it appears that on the internet, this disclosure is often lacking.  I personally think the lack of disclosure of relationships on the internet is a bigger deal than doctors being paid to promote products to other doctors.  I say this because the doctor audience knows when the speaker is being paid, but the internet website visitor may not know all of the financial relationships involved.

So the presentations the doctors were getting paid for were for actual CME credit? I can’t find where that was reported.

I think if pharma hired these guys/gals, they should have looked into them better. But to suggest that these pharma companies were doing anything different than promoting their drugs and how to use them, is misinformation. THEY aren’t claiming that. [see AZ’s response linked to in these comments]
The WRITERS OF THIS ARTICLE are claiming that in the beginning of this article. They are suggesting that your health is in jeopardy over drug promotion to doctors (which they confuse with CME). And we should be mad that pharma chose to spend THEIR money on some not-so-reputable people.

I hope the company doctor-reps were able to stick to the company provided slides that had to have been approved by medical and legal teams to ensure compliance with the FDA. At least then, I can be somewhat assured that if my doctor attended one of these dinners, he or she would be getting the information from the drug label and be reminded how to accurately prescribe the medication.

Got a problem with doctors?Try a lawyer instead.$5000 per hour consultation is common in Australia for a barrister/senior counsel-even a ‘one off’ where they dont go on to represent a client ie, do some thing for one..Think of it like this-if big Pharma pays the doctor to prescribe their brand-which will doubtless work ok-the doctor is happy and can afford his/her analysis without taking his/her hostility or sexual impulses out on the patient..Keeps the wheels turning well- a ‘social lubricant of a sort-until the tower they are building is finished and they can plunge from it- just like the ‘devil divers of Pentacost’-tho’. metaphorically speaking of course.

Steve Merrill-I, too, was prescribed Topamax for pain management!  The quack doctor had me work up to 8 pills in 1 evening dose. Talk about a drooling zombie!  I doubled over in pain 1/2 hour after taking, sat for 10 minutes at the stop sign at the end of the street because I could not remembe when I looked left what I had seen when I looked right.  Now they want to put children on this horrific med and use it for weight loss?  I weaned myself off this med taking 1 less pill per day for 2 days until I was off.  No follow-up calls from the doc on how I was doing or why I hadn’t come back..nothing!!  Then I read that it was a good thing I’d weaned myself off because I would have had seizures..for a med to manage pain? 

I trust big pHARMa as far as I can throw.  I think they’ve influenced doctors to use their drugs for reasons other than the FDA approved.  And I have NO faith in the FDA.  They’re in big pHARMa’s pockets.  Drugs that should be banned are still being prescribed.

Betsy Jacobson

Oct. 20, 2010, 8:09 a.m.

Just a bit of a correction, Steve M.  Fibromyalgia is NOT a new syndrome.  But whar’s totally accurate about what you said is that patients (“suckers”) are believing doctors who are paid handsomely by pharmas such as Lyrica’s Pfizer, when Lyrica is the most expensive version of gabapentin, pregabalin, and another version of Neurontin. TV commercials, those expensive little devils, are also quite influential.

Betsy Jacobson

Oct. 20, 2010, 8:13 a.m.

Mary Sue, thank you for what you wrote.  It is the ONLY appropriate method of learning about a drug.

Betsy Jacobson

Oct. 20, 2010, 8:15 a.m.

Mary Sue, thank you for what you wrote.  Yours is the ONLY appropriate method of learning about a drug.

Betsy Jacobson

Oct. 20, 2010, 9:02 a.m.

Pam, isn’t it extra-ordinary that we can’t even trust the FDA which has, on its committees that approve drugs, people who work for the pharmaceuticals who have manufactured those drugs?

Aggrey E. Quintyn

Oct. 20, 2010, 9:58 a.m.

Do you know your doctor?

Betsy Jacobson

Oct. 20, 2010, 10:27 a.m.

To continue - - several of their answers are downright stupid.  These are folks who made it through medical school, graduated, and became our physicians.  Their total lack of awareness of the human condition is appalling.  I’m still shocked at their attitudes and behaviors after hearing from over 25,000 patients in search of doctors.

Betsy Jacobson

Oct. 20, 2010, 11:12 a.m.

The first 1/2 of the above message was deleted, & I must remember what I said. Here goes:

Do you know your doctor? Important question. I even recommend that patients meet a doctor, just for a few minutes, before becoming a patient (and offer to pay for that time), and one very well known specialist in my field told me that he thought this was “insidious entrapment.” Charming.

Bravo, Joel Gelman, for not accepting industry money.  Not easy to do, but totally appropriate. You clearly are a person of integrity.

Also, while disclosure is mandated, I believe it doesn’t always happen,

BTW, Big Pharma doesn’t always get what they pay for.  I’ve been to Grand Rounds at a hospital where Fibromyalgia was being presented, and I saw doctors walk in, sign their CME forms, and leave, not listening at all to the lecture.  C. 2/3 of all CME’s are pharma funded.

Saunders Jones

Oct. 20, 2010, 11:37 a.m.

I have always suspected that the “high cost of medicine” can be traced to the fees and perks that physicians receive.  At the end of the medical chain is a greedy (or feeling entitled) doc with his hands out, asking for “more, more?”.

Steve Hartwell

Oct. 20, 2010, 11:41 a.m.

What also scares me is how nobody here has said anything about Richard Smith, former Chief Editor of the British Medical Journal, http://en.wikipedia.org/wiki/Richard_Smith_(editor)  who, along with staff, and editors and staff of 12 other medical journals, tried several times in 2000 and 2001 to tell the world that the majority of studies and articles in their journals were paid for by pharmaceutical companies, who hired alleged reputable doctors and scientists to put their names on the studies and articles to make their bad products sound trustworthy. All those journals people got fired for trying. Smith wrote a book about it in 2006. How many of you have even heard of him, the others, and their warnings ? None apparantly. That’s something worth also being very scared about.

Betsy Jacobson

Oct. 20, 2010, 12:04 p.m.

I seem to be very chatty on this subject, but I spend most of my life involved with it.

Doctors definitely feel entitled and their superiority to the patient is clear.  It manifests itself in lack of respect, lack of attention and caring, etc., etc., etc.  You understand immediately their disrepect when they introduce themselves as “Dr. _____” and use your first name in the same sentence. 

Then try to have a sharing relationship with them, get to know them, etc.  It just doesn’t work.  Most are not people people. So the concept of the hand out is poignant.

They will be happy to tell you now that with the insurance problems, etc., they make much less money than they used to.  Why do they keep on talking about money?  They’re certainly entitled to earn it, but the patient’s welfare really ought to be # 1 on their agendas.

The meanest doctos I’ve ever met was at a conference, and his name is way up on the list of cash gifts from Big Pharma.  Interesting, no?

Betsy Jacobson

Oct. 20, 2010, 12:11 p.m.

To allay your angst a bit, Steve,  a lot is now being written about this subject.  Read books and papers by Marcia Angell, MD, formerly with the New England Journal of Medicine, Melody Petersen, formerly with the NY Times, John Abramson, MD a very discouraged MD, and many others.  Try these folks first.

A. John Brown

Oct. 20, 2010, 2:08 p.m.

Excluding the datebase of physicians and companies and monies received and paid out, there is little value in your “investigation”.  These practices have been in place for many years.  I find most interesting the extent to which accusations are presented to imply, implicitly or explictly, that this is specific to healthcare. 

Healthcare is a vast and complicated issue and to be reduced to pharma/physcian behavior is mypoic.  I understand that the focus of “investigation” was precisely just that to which I respond again nothing new here.

The comment about industry funded education/sponsorship is most upsetting given the fact that a most celebrated leftist/liberal Noam Chomsky has spoken at length as to the more delicate situation public radio and by extension NPR and ProPublica find themselves in.  If public funded media does not strictly adhere to certain topics and biases there funding disappears almost instantly.  So I say explictly I am an avid listener and supporter of public radio and I am appalled as to the rightousness that is being presented here.

In closing, there are dishonorable actions and people in every industry and company just as there are dishonorable patients that lie about their medical situation in order to continue receiving so form of state or federal financial assistance.  Here is a suggested article propublica “investigate”. The cost to tax payers for the cheating “patients”.

Carolyn Thomas

Oct. 20, 2010, 3:19 p.m.

To: A John Brown

“...I find most interesting the extent to which accusations are presented to imply, implicitly or explictly, that this is specific to healthcare…”

Nobody is saying that corporate “stealth marketing” (which is what we call this in PR) is unique to the health care field.  But since this is the topic we’re discussing, health care does seem an appropriate focus.

And this topic is far more IMPORTANT to me as a heart attack survivor who must now take a fistful of cardiac meds every morning than, say, national public radio.

Jeanne Lenzer, writing in ‘Reporting On Health” - a resource for investigative medical journalists - explains:

“Stealth marketing is frequently used by the health care industry whenever it puts its marketing messages into the mouths of seemingly independent third parties. In this way, the third party – usually an academic researcher, a medical school teacher, a professional association, or a patient group – lends credibility to the marketing message while disguising its hidden origin as the paid mouthpiece of commerce, not science.”

Thus I have no clue which of my cardiac meds were prescribed for me based on flawed industry-funded research, tainted medical-ghostwritten journal articles, or CME “education” provided by docs on the take from Big Pharma. 

Stealth marketing is part of every industry - but it’s just more deadly when it comes to our health.

More at:  “Stealth Marketing: How Big Pharma Tries To Shape Medical News” -  http://www.ethicalnag.org/2010/08/20/stealth-marketing/

PS -  thanks to Mary Sue for your concise wisdom here as a pharmacist!

Betsy Jacobson

Oct. 20, 2010, 5:25 p.m.

Stealth marketing is new to me, yet, of course, we see it all the time in PR efforts in general industry.

Health care is not exclusive to ANY marketing deviation, and no-one here has said it is.  This IS, however, a health blog, A. John Brown, so that’s the industry upon which we focus.  That you have denigrated the focus of anyone’s investigation in a very corrupt industry which affects the health care of every citizen of the U.S.A. is unfortunate.  I think we must all investigate and know well the practises that so totally affect our lives.  There is no “righteousness” in corruption and the denial of every citizen of decent health care because of a devotion to the bottom line.  Many of us are well studied in this field and would be happy to provide court reports and solid examples of this awful behavior.

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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