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In Minnesota, Drug Company Reports of Payments to Doctors Arrive Riddled With Mistakes

A new federal plan will require drug and medical device companies to report all payments to U.S. physicians in 2013. The danger? As Minnesota discovered, some information submitted may not be accurate.

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A version of this story ran Monday in the Minneapolis Star-Tribune. This story is not subject to our Creative Commons license and cannot be republished until Tuesday, Dec. 14, 2010.

Long before the rest of the country cared, Minnesota took aim at the pharmaceutical industry.

In 1993 it passed a novel law: If drug companies paid any of the state’s health providers to push their pills, the money had to be publicly reported.

Two decades later, the federal government is poised to follow suit, promising a new era of openness.

But a ProPublica analysis of drug company disclosures in Minnesota provides a cautionary lesson for the new federal plan, which will require drug and medical device companies to report all payments to U.S. physicians in 2013: The information submitted may not be accurate.

To vet Minnesota’s reports, ProPublica compared them to its Dollars for Docs database, a compilation of speaking fees and consulting payments to physicians and other health providers nationwide by seven drug companies since 2009.

Cases like that of St. Paul pain specialist Todd Hess turned up.

Minnesota’s website shows that Hess received $364,828 last year from four companies—far more money than any of the state’s other physicians.

But those fees understated what at least one of the companies reported on its own website (and on Dollars for Docs). Eli Lilly and Co. told Minnesota it had paid Hess $67,353 in 2009 to give speeches in favor of its pain pill Cymbalta. The company reported Hess made $74,050 during the same period.

The Minnesota official charged with overseeing the drug company data said he hadn’t known about the discrepancy—and wouldn’t unless someone flagged him. The law requiring the disclosures provided no resources to audit their accuracy, said Cody Wiberg, executive director of the state’s pharmacy board, which collects the information.

Contradictory Reports From Drug Firms

Experts who study physician-industry relationships say the accuracy of this information is important. Based on the disclosures, patients or employers may wrongly believe a physician has greater—or lesser—ties to a drug company.

ProPublica found multiple examples in which drug firms reported either inaccurate or inappropriate payment information to Minnesota.

Pfizer, for example, told the state it paid Dr. Randy Schapiro $1,770 last year. But on the firm’s website, it reported spending $43,827 on him in the second half of 2009 alone.

And Wyeth, now a Pfizer subsidiary, reported payments to individual doctors that actually went to their institutions for clinical research. That error landed transplant surgeon Arthur Matas at the top of the payments heap in Minnesota, earning $500,000 in 2009. The money really went to the University of Minnesota, according to Matas.

Minnesota records show Matas personally received just $6,190 in 2009 for consulting for Bristol-Myers Squibb and speaking to the Mexican National Transplant Congress on behalf of Genzyme.

Representatives of Wyeth, Pfizer and Lilly said they were unaware that their reports contradicted one another until contacted by ProPublica.

Wyeth submitted a revised report to Minnesota removing Matas and more than a dozen other physicians from the records because the payments did not go to them personally.

Pfizer has submitted a revised report listing Schapiro’s pay last year as $96,889—more than 50 times what it initially said. A Pfizer spokeswoman said her company found internal problems that led to the inaccurate report.

A Lilly spokesman said his company also would amend its Minnesota report. Some of the discrepancies ProPublica found, like Hess’, are the result of problems with the company’s system for tracking payments, spokesman Scott MacGregor said in an e-mail.

Hess and Schapiro, like other Minnesota physicians interviewed, said they were unaware of the discrepancies—and hadn’t looked at the latest disclosures. They said the media makes a bigger deal about potential conflicts of interest than patients do.

“If it’s cleaned up, then I don’t personally have any problems with people seeing the numbers," said Schapiro, a specialist in multiple sclerosis who is now retired and living in Colorado but who still does speaking and consulting.

Schapiro said the doctors paid by pharmaceutical companies are “leaders in their fields,” and patients should want to see their physician among them. “If their doctor is not on the list,” he said, “maybe they should look for a different doctor.”

Hess, the St. Paul pain physician, said his patients aren’t concerned about his speaking fees. The media is lumping together educational speaking with the excesses of the past, he said, when drug companies showered physicians with gifts and free trips.

“This is a mountain-molehill thing,” he said. “I know the problems of the past. I know what pharma has done to change those. People just can’t get over the past.”

A Pitched Battle To Pass Law

Minnesota’s experiment began in the early 1990s as an answer to complaints to the state attorney general’s consumer division.

Patients were calling, concerned their doctors were steering them to higher-cost medications they couldn’t afford. Physicians were reporting the pressure they were getting from the pharmaceutical companies and “the bonanza” of trips, fancy dinners and other inducements, recalled Matt Entenza, then an assistant attorney general.

Entenza’s office suggested solutions to Minnesota legislators. It was a pitched battle from the start, he said. Entenza said he and a colleague faced a small army of lobbyists for the drug companies, physicians and business organizations. A provision requiring the disclosures was deleted from a health care bill in a Senate committee after it passed the House.

In an “11thhour maneuver on the floor,” then-state Sen. Bill Luther succeeded in getting it added back to the bill as an amendment, said Entenza, now a senior fellow at Minnesota 2020, a public policy think tank in St. Paul.

Luther, who later served in Congress for eight years, said the bill was

“very controversial, and I had to use my political position” to get it passed.

Years later, Luther learned that the drug company reports had been simply filed away. Only after researchers and others pressed to see them were they put on the website of the state’s pharmacy board in 2006.

Wiberg, the board’s executive director, said his agency was an unusual choice as the home of the disclosures. The pharmacy board oversees drugs, pharmacies and pharmacists, not money or physicians, he said.

Today, the state posts reports covering about 900 physicians, nurse practitioners, physician assistants and veterinarians and includes payments from companies of every size. It does not put them in a searchable database but requires users to click through the individual reports of 80 companies to find their doctors.

ProPublica has combined Minnesota’s 2009 reports into one database

National Law More Expansive

Several other states have followed Minnesota’s lead and required companies to report such payments, but not all make the information public.

Vermont passed a similar law in 2001, but until this year allowed companies to keep the names of speakers and consultants confidential as “trade secrets.” Massachusetts recently published its first list of payments to doctors there.

The federal law, known as the Physician Payments Sunshine Act, is more expansive than Minnesota’s effort in some respects. The act covers both drug companies and medical device manufacturers, while Minnesota's law is limited to pharmaceuticals. It also calls for a searchable database, which will make looking up a doctor easier.

But as in Minnesota, the federal law does not require auditing. It does allow for various fines if a company reports incorrectly or not at all. Inadvertent failures to report can result in penalties of $10,000 for each instance up to $150,000 a year. Intentional failure to report can lead to fines of up to $100,000 and a maximum of $1 million annually.

Unlike in Minnesota, the federal legislation was embraced by some pharmaceutical companies worried about disparate state laws that would have set up different requirements.

Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has studied Minnesota’s disclosure law, said he was surprised to learn of the discrepancies. He said the companies are quickly learning that there’s an intense interest on how much they pay physicians.

"You just hope that going forward they do a better job and take it as seriously as possible,” he said.

See our database containing the Minnesota 2009 drug company payments reports. Read our ongoing investigation, Dollars for Docs.

Inform our investigations: Do you have information or expertise relevant to this story? Help us and journalists around the country by sharing your stories and experiences.

As I have said in prior posts, it all about “conflict of interest” Isn’t it strange how the drug companies under report monies paid to the Doctors. Obviously the pharmas know absolutely what they are doing and are hiding it. What more can be said? Maybe, “George Bush or Ronald Reagan said it was ok do do that because it was good for business? Once you let avericious “bean counters” into the inventive or creative industries, shenanigans start to happen. Go back 20 years and look at “Roger and Me”. Roger Smith took this country’s largest company and largest employer and killed it. It just took 20 years for GM to lay down.

Unless there are “value added” industries put into place, this counrty is on its path to 3rd world status. People old enough and intelligent enough to read this shouldn’t worry because they’ll all be dead by the time it happens. If it took 20 years for GM to tank, it should be 70or 80 years until we are living in mud huts, but it is coming.

Since 1980 there have been no significan “value added” industries to come forth. The S&L bubble, stole billion of GDP, the Dot.Com stole multiple billions, the Mortgage fiasco stole trillions or more and destroyed to rule of civil law. This last travesty, when over will have sucked 40% or the US’s wealth, and so far no one is mad. 

The fincial services industries are not value added and suck 10% to 15% of our GDP every years, no one is mad!

The list goes on and on.

I am not a Union sympathizer by any means but the day the music died was that Friday in August 1981 that Ronald Reagan fired the Aircraft Controllers, that set in motion the begining of the end. In case someone things I a Union hack, another date that will live in history is the August monday that Albert Shanker took the NYC school teacher on a strike that lasted 8 months.

Hold onto you your seats folks!

My sister is a registered nurse with 40+ years experience, including leadership of nursing teams in specialized areas such as burn centers and emergency rooms.
About a year ago she was scheduled for hip replacement surgery that was cancelled at the last minute because of the materials problems recently found resulting from metal-on-metal wear in the replacement kits sold by a major supplier.
She now believes she was unnecessarily pushed into the surgery option by a specialist surgeon anxious to plump up his own resume and the fees of his practice. He was a national spokesman and consultant for the company making the replacement joint.
And that’s what they do for members of the community—sort of gives a new meaning to “professional courtesy.”
She still has the natural joint and has good mobility (including sledding on upstate Pennsylvania hills this past weekend) with occasional doses of naproxem sodium (Aleve).

Bruce: I guess your family has caught on. Who made the knee they were going to use? J&J subsiiary, Medtronics, really doesn’t matter, its all the same deal. Its a conspiracy to take down either the government through medicare/medicaid or your sister’s insurance company, or even worse, your sister’s bank account.

All your family can do is thank the Lord you were not vicyimized and try to explain this scam to your friends and acquainences.

50 years ago Medical doctors were held by the populous as the most respected people in our society. Big business picked up on that issue and knew from reading their Bibles that everyone can be bought and that it was only the amount of the buyout that was important.

And here we are today.

It always about the money and when they deny it, then its really about the money.

Great article to add to information from the book,  Bad Science or Ray Monihan (medical news reporter)‘s talk at recent Cochrane Review Colloquium:
http://www.cochrane.org/multimedia/multimedia-cochrane-colloquia-and-meetings/colloquium-colorado-2010/opening-session-ray-m

Last week, I took my son to one of the emergency physicians clinics as he needed a shot for school that couldn’t wait.  As I sat in the waiting room, I glanced over at one of the two big screen teevees they had on opposite glass.  I literally jumped of my feet and screamed out loud when I saw an add in full screen from some doctors outfit (seriously doubt or at least I wholeheartedly hope it wasn’t from the AJM) endorsing - of all things - Espartame. 

That is past a conflict of interest.  That is right down reckless from any pseudo so-called doctors group to endorse a substance as toxic and harmful as Espartame.  They may as well start doing ads for crack now.

Susan Gronemeyer

Dec. 26, 2010, 4:16 p.m.

This article refers to the non-disclosure of physicians and pharmaceutical companies in the promotion of “their” drugs.

However, in 1980, Eli Lilly performed their phase 1 clinical trials on BSA cloned insulin.  Please note the this trial didn’t include Type 1 diabetics (the ones that must inject insulin to survive) and tested their cloned drug on Type 2 diabetics and non-diabetics.  During their Phase 2 clinical trials in England in 1982, there was a 30% adverse reaction to the drug, since the trials were performed on all diabetics.  But Eli Lilly went back to the doctors who performed the Phase 1 clinical trials and since they had not studied any Type 1 diabetics, the percentage was lowered to 2-3%.

The whole motive to Eli Lilly creating this drug was to make a profit.  BSA cloned insulin has already been shown to not be a superior drug to animal-derived insulin, but the pharmaceutical corporation has the power to get a life-saving drug replaced by a defected one which is not covered by the laws that protected animal-derived insulin from having it’s price jacked up.  Having been a Type 1 diabetic for 44 years, I have discussed this problem with multiple doctors, but because their instruction is in pushing drugs, they’re not interested in providing a good drug for their patients.  The last doctor I had was afraid that her career would be compromised if she listened to her patient and lessened the time period for me to purchase my next vial of insulin.

By the way, the manufacturer didn’t even know that their newly cloned insulin substitute expired in 28 days.  If this product is so “superior to animal-derived insulin”, then why does it expire in “28 days” when the animal derived insulin .lasts until it is used up if it is refrigerated.  Oh that’s right, the corporation is liable for their “errors” as long as they’re making money.  Disgusting, absolutely disgusting.

Susan: read my earlier comment and then go to your library and take out “Roger and Me”, Michael Moore’s 20 year old docudrama. When bean counters are allowed a seat at the table and into idea oriented businesses, its just a matter of time. They just concentrate on bottom line and hire lawyers to determine exactly what they can get away with, without getting locked up. If they see a window slightly open, they then pay legislatures to open it all the way, either immediately, or a little at a time. History is before your eyes.

Had any reporter checked hom much pharmaceutical companies spend on goverment officials?
The put out millions of dollars to political convention parties for representative and senators to lure them into their side.
Please go an plublish that as well

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.

Drug Company Numbers Conflict

In disclosures to the state of Minnesota and on its own website, Eli Lilly & Co. reported paying the same doctor different amounts during 2009. Some examples:

Pfizer also reported different amounts to the state and on its website. In some cases the amounts reported on the company’s site for the 3rd and 4th quarters of 2009 exceeded what was reported to Minnesota for the entire year. Pfizer has since revised its Minnesota report.

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