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Editor’s Note: Dollars for Docs

The stories ProPublica is publishing today on the drug industry are part of a broader effort to expand the possibilities of collaborative journalism.

The stories ProPublica is publishing today on the pharmaceutical industry are part of a broader effort to expand the possibilities of collaborative journalism.

The data were painstakingly assembled by Dan Nguyen, a ProPublica web developer whose talent for writing computer code is matched only by his persistence. Two ProPublica reporters, Charles Ornstein and Tracy Weber, tracked down the doctors identified as the biggest earners and vetted their backgrounds. Weber and Ornstein uncovered hundreds who had been disciplined by state boards or lacked credentials as specialists, calling into question the pharmaceutical companies’ assertions that they hire only the best and the brightest.

The raw numbers on payments, which represent only a small fraction of the industry’s total outlay, are staggering enough: More than $257 million to some 17,700 doctors and other practitioners.

But the full impact of this investigative project arises from the combined efforts of ProPublica and five separate organizations – NPR, the PBS Nightly Business Report, the Chicago Tribune, The Boston Globe and Consumer Reports. Each used the database to develop stories tailored to its local or national audience.

Now we are inviting every medical patient in the country to join this investigation. The database on our website includes every payment by seven drug companies that have publicly reported since 2009. We invite readers to type their doctor’s name into our search engine and find out whether he or she has received money from pharma.

This may put your next prescription in a different light. We ask readers to share their personal experiences with us as well. Let us know if you feel you were pushed to try a newly available drug or one that exists in a comparable form as a lower-priced generic. We are also interested in hearing about doctors who disclose the payments they receive, and those who do not.

By 2013, all drug companies will be required to publicly disclose payments to doctors. But we saw no reason for readers to wait three years for information that is already beginning to become available to anyone who could penetrate and scrape data from pharma’s labyrinthine websites.

In the not-so-recent past, such an investigation would have been undertaken by a single news organization racing to beat competitors to a “scoop.’’

We think we can achieve our primary mission at ProPublica – journalism that spurs change – by working in concert with other talented journalists and with the tens of thousands of people who will view, hear and read stories by this partnership.

Why just single out pharmaceutical companies?  Conflicts of interests exists in medical device companies, more so, than anything else where physicians directly profit and perform self-referral services.

Carolyn Thomas

Oct. 19, 2010, 6:02 p.m.

Congratulations on this outstanding Big Pharma series, a notable example of your goal: “journalism that spurs change”.

When I first learned about the fraudulent yet widespread practice of medical ghostwriting last year, I was gobsmacked.

As a heart attack survivor who must now take a fistful of drugs every morning, I realized that I have no clue which of my meds were prescribed for me based on flawed research or tainted medical journal articles or the influence of docs on the take from Big Pharma - and worse, neither do my doctors.

The more I learn, the more I fear that this is merely the tiny tip of a very nasty iceberg.  More on this at “Partners In Slime: Why You Should Be Alarmed About Medical Ghostwriting” on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED -  http://www.ethicalnag.org/2009/09/05/partners-in-slime/

marie a. wacht

Oct. 19, 2010, 8:12 p.m.

i expect the same is true for physicians, and perhaps other health professionals,  employed by insurance companies.

Like anything, there are often examples of bad choices and of individuals who abuse the system.  There is nothing inherently wrong with physicians giving educational talks about drugs, devices or treatment.  Should we expect physicians to take time to prepare and give talks without being paid for their time?  What other industry expects people to work for free?  Clearly, these educational talks also serve a commercial interest; so what?  The problem is in the few bad apples that were chosen.  Even then, that does not mean they necessarily did anything wrong.  There are also conflicts that may compromise the public interest when clients in the construction, oil, or ANY industry are “entertained” in the course of doing business, resulting in higher costs that are passed on to the consumer.  There is no difference.

A. John Brown

Oct. 20, 2010, 2:12 p.m.

Im in the same boat as bc meyer.  Speaking about funding, how about investigatig at the funding of propublica, NPR and public media in general.  I say this not in spite of this article but in reference to source.  While article doesnt provide any new insight to an already watered down subject, it does have value in its database of physcians, pharma companies and their respective interactions. 

In paraphrasing Noam Chomsky (it is intentional to reference such an outspoken intellectual) public media is most sensitive to its funding and thus most bias of its reporting. Dr. Chomsky is held as a champion of the people in intellectual arena (also qualified as a leftist/liberal) and even he is most wary of public media and hence by extension reasonable to conclude NPR’s and Propublica’s biasness.  Afterall, the people donating to public media want to read about such topics as expressed by contributions. 

I am interested in seeing how the percentages break out for specialty (in terms of dollars spent), statistical analysis of correlations between medications prescribed and formulary position and lastly total generic utilization vs. branded utilization and outcomes data.

I’m a doctor and I’ve received honorariums by drug companies.  I have done nothing unethical and I stand by my actions.  I have, actually, turned down opportunities to teach about drugs; nevertheless, I need the specialists that drug companies pay to help keep me up-to-date.  I feel compelled to play devil’s advocate.

1.  As an extremely busy doctor with the pressures placed by managed care and the Federal Government (it’s no wonder why there is a shortage of good providers now) the time I have to spend away from my patients, paperwork, and family is very limited.  I desperately need to have the specialists available to teach me about the dozens of new drugs that are launched yearly.

2.  The specialists who are sponsored by drug companies also keep me informed and up-to date with the rapidly changing knowledge-base in healthcare—not just their drugs.  There is nothing wrong with companies paying specialists who teach me about their drugs but also are critical for CONTINUING MEDICAL EDUCATION.  Do you want your primary care doctor to close her ears to new information?

3.  If I’m spending VALUABLE TIME away from my practice teaching others, then I deserve modest reimbursement to help maintain my practice while I’m absent.  If I’m not at my office caring for patients, I still have to pay my staff.  Honorariums from drug companies are crucial to bridge this gap.  Those who disagree with this:  keep complaining when access to your PCP or specialist is even more limited!

4.  Our society is largely based on capitalism.  Individuals are entitled to be paid for services.  Companies who TAKE RISK are entitled to obtain rewards for these risks.  Many who complain about Pharma’s policies don’t complain when this industry helps to fuel their 401(k)s.

5.  Yes, there are unfortunately some bad doctors doing this.  Pharma needs to be more selective in screening their teachers.  Nevertheless, that will cost more money and likely drive honorariums up—it’s worth the price.  By the way, journalists aren’t exactly batting 1000 in ethics and best hiring/firing practice.

6.  EVERY industry including government pays thought leaders to help educate.  What about all of those ridiculously paid LOBYISTS!  Who do you think pays for them?  What about all of the lavish gifts and entertaining that goes on with the construction industry (I.e. public roads and works) and the banking industry?  Why is it healthcare that is the only industry picked on here?

As someone who works in the pharmaceutical industry, I find this topic very touchy. I understand that to people outside the industry or the healthcare profession, the fact that pharmaceutical companies pay physicians can look very fishy. However, companies are not paying physicians to write certain medications. We are paying physicians to speak about their experience with medications, disease states, devices, etc. Pharmaceutical reps no longer give doctors pens, Rx pads, paperweights, or any other office supplies, and they definitely don’t do trips or extravagant gifts. They do still pay for breakfasts and/or lunches, but I assure you most of these meals are not coming from fancy restaurants. The doctors are getting a simple sandwich or salad while they sit down and spend time (which is pretty valuable to these doctors) with reps to be educated on their medications or devices.
I do not doubt for one second that there are plenty of “bad apples” out there taking advantage of the system, behaving poorly and practicing with shady intentions, but I do think it is unfortunate that the general population is under the impression that “Big Pharma” is deciding what medications they get from their physician. In my experience, most doctors will give a new medication a try if they think it will help the patient, but they will not continue to use it if it doesn’t work or causes more harm than good. Most physicians I’ve encountered that are getting paid to speak about products are doing so because they have seen positive results and believe in them. To “Big Guy”‘s point- what industry would expect people to work for free? If a doctor takes a day away from his practice to do peer education, isn’t he losing money by not being at work? We expect him to do this out of the kindness of his heart? That seems a little silly, doesn’t it?

This is ridiculous. Contrary to what too many people believe, doctors do not get rich treating patients. If they accept Medicaid, they’re usually paid less than it costs them to care for those patients. Medicare is nearly as bad. The costs of practicing medicine—staffing, malpractice insurance, etc.—are staggering. Teaching other doctors about medications is a GOOD thing. The more our doctors know, the better prepared they are to treat us. Would you rather than teaching come from the pharma companies? Other people are compensated for the time they spend working. Why not doctors?

This is a witch hunt.

As a physician who has been troubled by this unseemly association between Pharma and doctors I will challenge any doctor who is a pharma spokes person to show that a talk of theirs or their career in this murky world of drug spokesmanship has caused a drug to be taken off the market or prescribing to go down.  I will guess not.
This is reverse logic but it will prove what the good doctors (and their enablers) on this list claim i.e., that they serve a patient friendly purpose.  Or they have to then agree that every drug they have pushed is a marvel of modern medicine.  This we know is untrue.  In real life wonder drugs a few and far between, need very little promotion, and speak for themselves.  On the other hand these doctors speak for “me-too” drugs looking for market share which often raise the stocks of Pharma for a few weeks or months and are then found to be no better than extant material.
As for the guy screaming ‘witch hunt’ (teri robert) I am sure some of us appreciate your support but this is not the way to do it.

tem como colocar bollars   no meu jogo

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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