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Patients Deserve to Know What Drug Companies Pay Their Doctor

ProPublica’s newly updated Dollars for Docs database offers a glimpse of what patients can expect in 2013, when all drug and medical-device companies must report to the federal government what they pay doctors to help market their products.

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(Joe Raedle/Getty Images)

Editor's Note: This op-ed is co-published with the Los Angeles Times.

Your doctor gives you an expensive new drug to control your cholesterol, or recommends a certain brand of artificial hip, or says you need a stent to open a clogged artery.

He's the expert. But how do you know his expertise is untainted? The makers of the drug, the replacement hip or the stent may have paid your doctor to deliver promotional talks extolling the virtues of the product. Or they could be paying him, or her, to consult on marketing plans.

It doesn't necessarily follow, of course, that this kind of moonlighting influences the treatment you receive. And many doctors don't accept these kinds of payments. But if yours does, wouldn't you like to know that?

As it stands, doctors don't have to tell you if they're working with the makers of the products they're prescribing you. They don't have to tell you whether they own stock in those companies or do research on their behalf.

There's no place for you -- the patient -- to find out whether your doctor is prescribing more drugs or medical devices made by companies with whom he has a relationship.

Understanding such ties can be important. Many brand-name drugs are wildly expensive, and some carry an array of dangerous side effects. Sometimes similar drugs, either those made by competitors or generics, are cheaper or have fewer risks.

Patients largely trust their doctors to do what's right for them. But a recent string of scandals has raised questions about whether patients need to know more. Pharmaceutical and medical device makers have paid billions of dollars to settle accusations of kickbacks to doctors and improper marketing of their products.

Many physicians say the close ties between drug and device firms and doctors lead to new and more effective medications, life-saving innovations and a better-educated profession. Although this is certainly true, the relationships also can cause physicians to -- consciously or not -- downplay side effects and poor research outcomes, studies show.

Earlier this summer, for example, the Spine Journal devoted an entire issue to repudiating the research of several spine experts that supported the widespread use of a Medtronic bone growth product used in spinal fusions. The articles charged that the researchers, who had substantial financial ties to Medtronic, overstated the benefits of the product, Infuse, and ignored its risks.

Only recently have some tools become available to help patients learn about their doctors' financial ties before they are in the exam room.

Several companies, pressured by Congress or required by legal settlements, have started to reveal the names of the doctors they've paid to deliver promotional talks or serve as consultants.

By 2013, every drug and device company operating in the United States will have to do the same, under the health-care reform law passed last year. They'll also have to say if they've paid doctors for consulting, research, even a dinner.

We've looked at the data from 12 companies, which make up 40 percent of U.S. drug sales, and found some surprises among pharma's favored speakers and consultants.

Many of the doctors who received the most money hadn't published much in the way of research, and many didn't have associations with academic medical centers. Some had no credentials beyond a medical license. And some had been sanctioned for misconduct by their home state medical boards.

Among the top-paid speakers from that sampling was Santa Monica pain physician Gerald Sacks. Since 2009, he has earned at least $522,113 giving promotional talks and consulting for four companies, according to the data.

Sacks, an anesthesiologist, isn't a leader in prominent pain medicine societies, and several top pain physicians told us they hadn't heard of him. He doesn't work in an academic medical center such as UCLA or USC. He hasn't published much research. We tried to talk to him about what he was paid for, but he didn't return numerous messages.

Sacks' slides from a 2008 educational talk and 2009 presentation before the U.S. Food and Drug Administration describe him as the director of pain management at St. John's Health Center in Santa Monica. A hospital spokesman said Sacks has never held that title and that his pain clinic is not part of the hospital. He does have the ability to admit and treat patients at St. John's.

Drug firms have a pretty fair idea of whether their investment in doctors like Sacks pays off. They pay millions to researchers who buy data from pharmacies and track the prescribing habits of doctors. Pfizer, which gave Sacks at least $318,250 for speaking in 2009 and 2010, according to its data, could find out if and how often he gave patients Lyrica and Celebrex, two of the company's pain medications. Firms can also track whether and how often the people who attended such talks prescribed the drugs that were discussed.

But not everyone who would like to examine the data is allowed to. The middlemen who collect this information refused to sell the data to us.

That leaves it up to patients. ProPublica has created a database, Dollars for Docs, which allows you to check whether your doctor is being paid by any of the 12 companies currently disclosing this information.

Because all companies won't reveal their payments until 2013, you might also want to ask your doctor directly about them. It's worth inquiring whether cheaper versions are available, perhaps older or generic drugs. Does the drug have more side effects than competitors' drugs? In some situations, it might be worth asking whether non-drug solutions should be tried first.

Of course, checking the rolls of paid promotional speakers is just one consideration when picking or assessing your doctor. You can also look at your state's medical board website to see if a doctor has been disciplined or criminally convicted. You can talk to other patients about the thoroughness of the doctor's exams and openness to questions.

If you have a smartphone, you can access our database from anywhere -- even while sitting in your doctor's waiting room.

I asked my doc about this, said they only get into trouble if they don’t report it at place of employment. I often have reactions to Astrazeneca meds which he gives samples to me from his office or has his office nurse “order” more samples, most likely stored at the pharmacy downstairs at Univ of Colorado, Aurora, Rx, they are crooks.
I always notify the FDA and the Rx company about the drug reactions which occur within 1-2 days of use. One dropped my lung function to 53%.

I’ve seen many come and go and know many of them from my military days.. so I know some of the inside scoop. I had one try to sell me Zatidor eye drops at $65.00. not covered by insurance, but then she had to admit it was otc, at WM, $12.00. Now the generic is avail, Eye Itch. See, they are a bunch of crooks. I check the state licensing board as MD’s have to list their investments, like stereotactic MRI’s and such. $$$ for docs. More like a lottery for patients?

Barry Schmittou

Sep. 8, 2011, 3:02 p.m.

ProPublica’s stories are so important there are Pharmaceutical law firms associates posting comments but they only mention being affiliated with a Heath Care Coaltion !!

If John Kamp comments please be aware he has an email at Wiley Rein law firm that represents Pharmaceutical companies. Here’s a quote from their website :

“For more than two decades Wiley Rein attorneys have represented health plans, health care providers, pharmaceutical companies and other health-related entities in connection with federal and state health care programs, as well as with the application of federal law to commercial health businesses.”

I believe his connection to Pharmaceutical companies should be disclosed since Mr. Kamp wrote this in his comment on another ProPublica article:

”Reporters wishing to provide more context and meaning to these stories should contact doctors with experience”

Kamp’s comment can be seen at http://www.propublica.org/article/piercing-the-veil-more-drug-companies-reveal-payments-to-doctors

You will notice in the comments on that article I asked Mr. Kamp for help. I emailed the request to him too.

I believe if his Health Care Coalition has a conscience and follows their mission statement, they should immediately help stop the destruction of lives that is seen at http://www.treasonevidence.blogspot.com

I also believe any kind of unethical practices by doctors is very connected to how they might favor the Phramaceutical industry, especially since Obama and Bush both allowed doctors’ paid by MetLife and other insurers to ignore brain lesions, Multiple Sclerosis, cardiac conditions of many patients, and a foot a new mother broke in five places as evidenced in the quotes from numerous U.S. Judges seen at http://www.deadlyorganizedcrimes.blogspot.com

I cater for the DRUG dealers….oops I meant Drug Companies. For eleven years, I have been the fly on the wall. What the docs and reps have done, is nothing short of PROSTITUTION.

hi Barry
You and your problem with Met life. sounds in your e-mail reply more personal. what did your lawyer say as you attempted a law suit?..Any lawyer will take on if he thinks he can win…Big, big bucks for he/she?

Medicines outdate themselves rapidly. companies detail doctors to get the product spread.
This country is far more careful than most other countries; Sometimes beyond belief but limits can only be placed to a certain extent… some trust has to be placed on the manufactures..
Doctors, for the most part,want the best and newest for patients with health problems..almost all are honest and have learned over time to trust certain companies..but things do go wrong, and New drugs and companies spring up worldwide daily.

Guess I ask, do you want a medicine administered that has existed but it’s failure level is extremely high or something new, that a doctor, wants to try to save someones life perhaps..but only knows of the reps promise and the brocures and goverment results?

Or perhaps you have a home brew, and uncle so and so has this brew that can kill a snake and is a cure all…Really?

Barry Schmittou

Sep. 8, 2011, 3:55 p.m.

Bill, I do agree that Doctors should know about medicines but they are being given billions in gifts by the Pharma companies.

The last line of your comment above about me having a home brew is absurd as you have been in the past. Recently when I wrote God please help us all you implied that I wanted God to destroy people with “fire and brimstone”

I will post my comment above again because I do not want your absurdities to distract from the following facts :

ProPublica’s stories are so important there are Pharmaceutical law firms associates posting comments but they only mention being affiliated with a Heath Care Coaltion !!

If John Kamp comments please be aware he has an email at Wiley Rein law firm that represents Pharmaceutical companies. Here’s a quote from their website :

“For more than two decades Wiley Rein attorneys have represented health plans, health care providers, pharmaceutical companies and other health-related entities in connection with federal and state health care programs, as well as with the application of federal law to commercial health businesses.”

I believe his connection to Pharmaceutical companies should be disclosed since Mr. Kamp wrote this in his comment on another ProPublica article:

”Reporters wishing to provide more context and meaning to these stories should contact doctors with experience”

Kamp’s comment can be seen at http://www.propublica.org/article/piercing-the-veil-more-drug-companies-reveal-payments-to-doctors

You will notice in the comments on that article I asked Mr. Kamp for help. I emailed the request to him too.

I believe if his Health Care Coalition has a conscience and follows their mission statement, they should immediately help stop the destruction of lives that is seen at http://www.treasonevidence.blogspot.com

I also believe any kind of unethical practices by doctors is very connected to how they might favor the Phramaceutical industry, especially since Obama and Bush both allowed doctors’ paid by MetLife and other insurers to ignore brain lesions, Multiple Sclerosis, cardiac conditions of many patients, and a foot a new mother broke in five places as evidenced in the quotes from numerous U.S. Judges seen at http://www.deadlyorganizedcrimes.blogspot.com

Pharmaceutical advertising has been proven over the years to WORK, and any rep will tell you that the most effective form of marketing is to doctors.  The cost to society can be significant.

Every doctor should have to disclose EVERYTHING they get from pharma companies and/or trade associations like PhRMA and BIO.

This information needs to be publicly accessible and easy to find.  It should also be prominently displayed in doctors’ offices and waiting areas, and ideally a report audited by an independent body would be sent to all patients on a doctor’s mailing list not less than once per year.

Reportable activities would include: ANY fees paid to the doctor (or close associates such partners in practice, or family members) for any reason by pharma companies or trade associations (along with the specific products involved, where applicable), any services, gifts, trips, reimbursements (e.g., for attending lectures or conferences) or non-monetary perks of any kind received, SAMPLES or any products received by the doctor, including the name of the product and number of samples, the number of meetings with pharma company reps, and so on.

Doctors who claim these practices are important to their work should not have any issue whatsoever with the fact that their patients can make themselves aware of their doctor’s interaction with drug companies.  Complete transparency is vital to patients maintaining trust in and respect for their doctors.

ok labs pay some doctors to sell their stuff but what about the ties labs have on the program for medecine schools? There is a brain washing to make sure doctors think the way labs wants them to think starting in colleges/universities

Emma Weiman Stanford

Sep. 9, 2011, 9:03 a.m.

I sit in the waiting rooms and watch these fancily dressed “reps” get in ahead of me. During holiday seasons they are bringing catered meals for the entire office!  Except for the fact that the “samples” they bring which could go to people who can’t afford the meds, I liken the Docs to Johns, the “reps” as prostitutes and the drug companies as Pimps!!!!!!!!!!!

Dr.Stephen Keister

Sep. 9, 2011, 10:52 a.m.

The entire medical care system in the United States has been corrupted by the drug companies. Only in New Zealand and the USA are prescription medications advertised on TV and at what cost? It is well documented that the drug companies spend much more on marketing (TV, magazines, newspapers, physician conferences and seminars ) than on research. Age old generic drugs at low cost are now,with the complicity of the FDA, are marketed as current products….see the article on colchicine on Wikipedia as prices that are 10-20 times more than they were as generics. There is a great waning of medical ethics in the USA as more and more doctors become complicit in our money oriented society. I am glad to have retired 21 years ago when a physician was a friend and adviser to his patients, not merely a health care adviser ordering tests. I once had a partner, a diabetologist,who cared for many diabetic children, who had a calling hour for the mothers evenings 7-8 PM. 

There is little hope for improvement in spite of Physicians For A national Health Program <www.pnhp.org> and the American Nurses Assn. The USA rates 26th worldwide in healthcare, and none of those nations that outrank us,save one, have “socialized medicine “.

Thank you for your comments, Dr. Keister.  Yes, I believe advertising by drug companies should be illegal because so often the public demands medicines that will harm them or at least not help.  I once complained to a representative of Claritin that the monthly prescription I’d been paying $30 for out of pocket became $80 a month almost overnight.  He said, “Look how much people are paying for a single cigarette.”  So we know the Wall Street criteria that’s fueling the almost criminal increase in prescribed drugs is “how much can we get”, instead of “who can we help and and how much do we need to make a reasonable profit.”  It’s insane that so many of us buy into it.  Just say NO to expensive drugs, particularly for older, poorly educated and disabled people who have no idea what their doctors are prescribing for them.  Our government pays full bore for these drugs and it’s highway robbery of the highest order.

Go into any doctor’s office and notice the magazines.

They are different than the news stand mags. Notice that they are packed with drug company adds, so after seeing the ads and being led into your doc’s examining room you ask your doctor for a prescription.

If you want a free subscription to any general type popular mag, get a subscription card from a mag at the news stand fill it out and put your name with MD after it, i.e. John Q Smith, MD and you’ll be getting the “special edition” until you move. You also be getting the free special edition of People, Time, US News and World Report, Better Homes and Gardens, etc, etc.

Bad part is you may be getting house calls from a pharma rep. trying to give you samples. Just keep responding whenever you hear some say, “Doctor”

Your Mailbox will be full of reading material daily with some nice Pharma ads to help you sleep better.

This little scam of free mags is just the tip of the iceberg.

The real money is in medical devices. If you’re an MD with orthopod boards, just keep going to these chartered classes that give some sort of phony certs, get the certs add them after your name on your business card and give them to the manufacturer’s rep at the next cert class and you’ll be making more money selling things than practicing medicine.

This is America

The drug company would be better off providing grants or loans to the community.  Better yet sponsor an educational event for community HCPs.  The requiement would tax exempt and ethical disclosurer.  When a person goes to the mother=in=laws for Thanksgiving or invited to dinner out or ball game does this get reported to IRS.  To be fair their should be a set amount excempt any overage should have a liability to report either State Medical Board and or IRS.

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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