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Dollars for Docs: Who’s On Pharma’s Top-Paid List?

A review of the highest-earning physicians in ProPublica’s Dollars for Docs database offers insight into why some medical professionals are drawn to the lucrative sideline of public speaking to promote favored drugs.

Pictured, from left to right, top: Amir Sharafkhaneh, Samuel Dagogo-Jack, Stephen Landy. Bottom: Farhad Zangeneh, David Rizzieri, Eliot Brinton.

They are among pharma's most successful speakers, featured at dinner after dinner promoting companies' favored pills to their peers. Each has earned at least $200,000 since 2009 from this moonlighting.

A review of the highest-earning physicians in ProPublica's Dollars for Docs database offers insight into why some medical professionals are drawn to this lucrative sideline—and into the diverse qualifications that drug companies are willing to accept to boost sales.

The list includes a big-name cancer specialist with a thick resume of peer-reviewed research, but also doctors whose qualifications as experts remain a mystery.

Self-promoters who boast of their persuasive skills are mixed in with physicians who refuse to discuss the nature of their promotional work.

Dollars for Docs is part of an ongoing investigation into the influence of drug company payments on patient care. Our list of 43 doctors earning more than $200,000 is based on reports from seven companies that have publicly disclosed such payments to date—GlaxoSmithKline, AstraZeneca, Eli Lilly and Co., Pfizer, Cephalon, Merck & Co. and Johnson & Johnson. ProPublica plans to continue updating the payments data as additional companies reveal them.

So, what kind of doctors are pharma's handpicked stars?

  • Fewer than half are formal educators affiliated with academic medical centers or prominent leaders in their medical societies. The rest are a mix of physicians with limited credentials or about whom little could be gleaned despite searches of research publications, academic websites and professional society leadership lists.
  • Five of the 43 are from Tennessee—more than any other state, even though it's the 17th-largest by population. New Jersey, Texas, California, New York and Michigan each had three.
  • Eleven of the 43 have board certification in the small field of endocrinology, a hotly competitive area because of the multibillion dollar market for diabetes drugs. Eight physicians, the next-largest subgroup, hold no advanced certification, despite speaking on specialized diseases and treatments.
  • Only three of the top earners are women—all endocrinologists, one each from Louisiana, Tennessee and New Jersey.
  • More than half worked for two or three companies. One Tennessee diabetes physician worked for five. Seven earned money solely from Glaxo.

The ranks of the top earners—and their pay—are almost certainly much greater, as more than 70 drug firms haven't publicly reported all their speakers and consultants. Because these data are from only a handful of companies, it's unclear how closely they resemble the industry's physician sales force overall.

In the medical world, there's much debate about whether physicians should be paid to promote the products of drug firms at all. Critics of such talks say companies are using doctors as celebrity spokespeople, exploiting their prestige to deliver what is essentially a drug sales rep's pitch.

Drug companies "spend the money because it puts a veneer of respectability upon the marketing," said Dr. Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. "It's using luminaries to market drugs, and they fully understand what they're doing."

One of Nissen's colleagues at the clinic, endocrinologist Adi Mehta, earned at least $202,600 from three companies. Mehta said in a statement that he feels "passionately" that such speaking educates his peers, the same rationale drug companies use to defend their reliance on practitioners. The prestigious clinic does not prohibit participation in pharma speakers' bureaus.

ProPublica sought out many of the best-compensated speakers to learn more about their backgrounds, motivations and opinions on the influence of the money on their practices.

Ten physicians gave lengthy interviews or responded to written questions. Fourteen declined to comment or did not respond to calls and e-mails. Three others agreed to talk but were unable to schedule interviews.

The top speaker, Las Vegas endocrinologist Firhaad Ismail, did not respond to repeated calls. He earned more than $303,500 from three companies since 2009.

The second-highest paid, Dr. Stephen Landy, directs a Memphis headache clinic. Much of his research is performed with employees of Glaxo, his biggest funder, but Landy also invented a headband to treat migraines using heat and cold. The band, on sale for $29.99, is "ideal for people who wish to avoid medication[s] and their possible side effects," according to asseenontvguys.com.

Landy, who earned at least $302,100 since 2009, lectures about migraine remedies and muscle relaxants for three companies. The talks are not simply promotional, he said, but "scientifically beneficial" for everyone involved.

"At the end of the day, I'm not there to sell their drug," Landy said. "I'm there to educate health care providers about their drug."

Landy conceded that pharma-physician relationships have become somewhat tainted in the public's eyes, but he said they should not automatically be viewed as negative.

"I think most physicians, whether they accept money or not, will do exactly what's best for the patients," he said.

Landy, like many of his peers in the top group, considers himself to be an excellent communicator, chosen as much for his speaking ability as his knowledge.

Psychiatrist Jon W. Draud, also from Tennessee, declared in a conference bio this year that he has "delivered over 3,500 professional lectures to medical personnel."

Draud earned at least $200,000 since 2009 from AstraZeneca, Cephalon, Lilly and Pfizer. At a 2009 conference, he disclosed that he speaks or consults not only for those companies, but also for Forest Laboratories, Sanofi-Aventis, Takeda Pharmaceuticals and Wyeth Pharmaceuticals (Pfizer acquired Wyeth in October 2009).

Draud requested questions by e-mail, but he did not respond to them.

St. Louis pain doctor Anthony Guarino includes an endorsement from a Cephalon drug sales representative in an online brochure advertising his services: "I would definitely recommend him as a medical speaker!"

Physicians in the group come from a variety of backgrounds and specialties. Many have thriving clinical practices and squeeze in talks before and after work. Some make hundreds of presentations a year.

Endocrinologist Robert Busch, for example, made at least $234,000 from four drug companies since 2009. Busch, a member of a group practice in Albany, N.Y., said he brings the hands-on experience "some of these big gurus" at top universities lack: "I see patients day in-day out, like my audience."

With his kids grown and a wife who doesn't mind, Busch said he is able to spend a few nights a week holding half-hour teleconferences or having a driver take him to speaking engagements up to two hours away. He usually sleeps on the way home, he said. Last year, Busch gave 198 talks of some kind for Lilly alone.

Busch said he doesn't like reading from the slides provided by the companies, a recent requirement by the firms to ensure speakers do not discuss unapproved uses for drugs. But he says he is still able to give a thoughtful presentation: "You're not just a paid monkey reading slides."

The extra cash he earns, Busch said, helps him support his parents and pay for college for his kids.

Dr. David Rizzieri, an oncologist and cancer researcher at Duke University Medical Center in North Carolina, specializes in bone-marrow and stem-cell transplantation. He earned at least $240,000 from two companies.

In written responses to questions, Rizzieri said his peers request him to learn about the diseases he treats and the drugs he uses. He said he speaks at early-morning breakfast meetings or late dinners to avoid missing work. When he travels, he said, he packs multiple events into the same trip.

Another academic, Eliot Brinton, an associate professor at the University of Utah School of Medicine, made at least $203,900 from three companies and says he makes money from at least three others. Brinton said he has followed the debate generated by Dollars for Docs and has worried that his own presentations are medically sound.

"There is always the potential that somehow I'm getting in under the radar and then springing this very subtle and very pernicious sales message," he said. "I'm listening to myself every time I speak, and I have to ask myself the question: ‘Is what I'm saying truthful?'"

So far, Brinton said, he believes it is.

Alabama physician Mark Sweeny is not an academic, nor has he produced peer-reviewed research. He is on the staff of Decatur General Hospital's internal medicine clinic, but his board certification in internal medicine has expired.

He is, however, married to a Glaxo regional sales manager and since 2009 has earned at least $203,000 from Glaxo and another $52,170 from AstraZeneca.

Told about Sweeny's earnings, Dr. Larry Sullivan, Decatur's vice president of medical affairs expressed surprise at the amount, "Damn!"

Sullivan said Sweeny was "probably not" a leader in his field but "he's a good physician. He does a very good job." Sweeny doesn't need permission to speak on behalf of the industry as long as he fulfills his work responsibilities, Sullivan said.

Neither Sweeny nor his wife, Beth, the regional sales manager for Glaxo, responded to calls. Glaxo spokeswoman Mary Anne Rhyne said in an e-mail she could not comment "except to say that the decision to use Dr. Sweeny as a speaker on behalf of GSK was not made by a relative."

Another top earner, pain physician Gerald Sacks, declined several times through his receptionist to discuss his speaking fees. Since 2009, he has earned at least $249,300 from three companies.

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, Calif. 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.

His private practice is busy, typically treating between 150 and 200 pain-management patients a week, he said while testifying on behalf of Xanodyne Pharmaceuticals before the FDA panel in 2009.

Some among the top-paid doctors declined to discuss their pharma relationships, citing packed schedules.

"Because of the busy clinical practice, family illness and staffing change and travel, I am quite overwhelmed right now," wrote Virginia endocrinologist Farhad Zangeneh who earned at least $229,200 from four companies.

Dr. Amir Sharafkhaneh, an associate professor and pulmonologist at the Baylor College of Medicine in Houston, said in an August e-mail that he supports the public disclosure of industry payments.

"However, I am uncomfortable doing interviews because English is not my first language," said Sharafkhaneh, who earned more than $222,700 from three companies. "Presenting technical information in my field is easy but discussing complex and nuanced social topics is difficult for me. Sometimes I have problems expressing my views clearly."

When ProPublica offered to hire a translator for Sharafkhaneh, Baylor spokeswoman Lori Williams responded in an e-mail Friday. She said the doctor would not be available for an interview but that the college had begun a review of his compliance with disclosure policies.

Among the physicians who spoke to ProPublica, most praised the pharmaceutical companies for choosing them to bring information about the latest advances to overworked doctors.

Dr. Samuel Dagogo-Jack, chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center, made at least $257,000 from three companies.

He said that he receives such kudos for his talks that he has heard it said that "companies would be at a competitive disadvantage" if they didn't use him.

This article is implying that all physicians who speak for pharmaceutical commpanies are somehow bought by these companies. I have worked for multiple companies and arranged many talks on companies behalf. I don’t know of single instance when I or anyone within the company has asked the speaker to give advertisement on the companies behalf. Speakers are free to express their opinions. I have used these speakers to rain the family physicians and internist, who diagnose and treat many complex diseases but are not fully equiped to do so. I am sure there will be instances of over use / abuse. However this article implies this is rampant and widely done. I disagree.

This article only scratches the surface of what goes on in the medical industry. These drug peddlers are the lower eschelon guys pushing meds. Where you should look is into Sen. Charles Grassley’s investigation onto “Medical Devices”. The folks you speak of are only helping pharmas clip pennies by comparisson. The real money is being clipped by the device manufactuers and the hospitals that let the doctors pushing the big buck stuff. This is a scandal as big as Wall Street that nobody wants to open up.

Raj’s comments are interesting when weighed against your informative article. Wonder who Dr. Raj works for??

I have to agree with truebee, Raj.  Medicine in this country has taken a dark turn for the worse where most medical treatments allowed are expensive and ineffective.  Less invasive and less toxic treatments that cure or are more effective are suppressed for treatments that will maximize the profits of big Pharma and the medical manufacturers as they think of new ways to poison the population; think 300M gadolinium based contrasting agents (GBCAs) injected into an unsuspecting population of the young, old and those in their reproductive years.  And add to that all the pharmaceuticals that are being pulled off the market due to deaths and the maiming of many and you begin to wonder who it is that controls the FDA.

Thank you, ProPublica for daring to confront the pharmaceutical companies and for providing consumers with this information and for your other stories highlighting questionable medical practices.

I respectfully suggest that it’s very important not to denigrate Raj – for many reasons, including that it misunderstands the fundamental nature of this transaction.  One of the most essential elements of this whole enterprise is that the large majority of those involved (the doctors, and even most of their ground-level handlers at the company) actually believe (and must believe) they are doing noble work.  For most of them (although certainly not all), it would be impossible to do a “good” job (from the standpoint of the company) unless they felt that way – for the doctors, that means they have to believe they are unbiased, and free to say anything they wish.  (Drug reps become far less successful salespeople if and when they ever stop believing that by selling their company’s drugs they’re … helping cure disease!)

That doesn’t mean we should share this delusion; of course no company is going to pay someone to do anything but improve its bottom line.  But for the most part the companies, knowing the importance of self-delusion on the part of “their” doctors, can’t simply instruct speakers on what they can or cannot say; they must rely, instead, on a number of powerful social controls.  First is the subtle semi-conscious notion that it’s ungracious to say something unpleasant about someone who’s paying you; there is also, of course, the mostly unconscious understanding that this well-paying gig will surely dry up if one bites the hand …  Far more important than any of that, however, is the entirely unconscious bias that occurs when you are in a relationship with a “friend” – this is why drug reps are taught that they need to get their clients to think of them as close friends ... while they should always remember that they’re nothing of the kind.  (If the rep cared about his/ her client, as an actual friend, it would interfere with his ability to get her to do what he wanted.)  It’s also why drug reps are chosen for their (physical and personality-wise) attractiveness.

Once you give a speech on behalf of your friend – who treats you so nicely, and is so laudatory about your knowledge and expertise (what a great speech!) – and who pays you pretty darn well, to boot – it will take something awfully dramatic before you are capable of thinking poorly of her.  It’s hardly a surprise that you’re also incapable of finding fault (or at least anything more than minimal fault) with whatever you know your friend is hoping you might say – which has the added disadvantage that it would also require you to think poorly of yourself!

This is ultimately all about the inevitable incompatibility between health-care as an activity designed to benefit the public health, and as an activity whose goal is to maximize profit.  (PhRMA, not surprisingly, always frames these two conflicting goals as symbiotic, which is absurd – for reasons beyond this discussion.)  Right now, in the US, the huge business of “health-care” is mostly driven by the latter – such that when the two possible aims collide (as they routinely do) profit virtually always wins out.  We need to understand that paying a bunch of “key opinion leaders” obscene amounts of money is bad not because the participants are bad individuals, but because this is a powerful means of influencing prescribers to choose on behalf of corporate profit, rather than on behalf of patients.  As long we attack the wrong bogeymen, we’ll never be successful in changing this.

Thank you for revealing a possible problem relating to the ties between Drs.& Drug companies. Although many Doc’s will beat their breasts declaring that their only concern is the patient,why do they continue to proscribe their patron’s products even though there are cheaper generics available. I now have added the question"do you receive any compensation other than drug samples fron drug companies” to my list of questions when going to a new doctor.

One of many sources that goes inside this for profit disease treatment industry. This is just scratching the surface,,,,Google pharma industry whisteblowers if you want more.

http://www.moneytalksthemovie.com/

The Doc’s now serving in Congress wonder just how much they have made from the Pharma’s?

Melody Petersen’s book ,“Our Daily Meds” exposes this whole subject in detail. It is an enormous and scandalous problem.

Sadly, there are those who abuse the system.  At a meeting with the AMA nearly 10 years ago discussing this issue, a pharmaceutical industry representative said “It’s one thing for us to stop giving perks to physicians - and we’ll do that gladly.  But you have to stop your physicians from demanding these things.” 

Working globally for a pharma company, I came across many physicians who were in it for the money.  And they weren’t necessarily on the up and up with their institutions.  Is it rampant?  In terms of the percentage of physicians, probably not.  But these kinds of relationships have been bad for the industry and bad for medicine.

“... But you have to stop your physicians from demanding these things.”

That sniveling remark deserves a rich round of laughter all around. Yes, pharma industry, of course. If a doctor demands perks, you are absolutely compelled to deliver them. And don’t forget to shrug your shoulders and say “What’s a poor struggling corporation to do?”

Sniveling?  Believe it or not there are some people (and some corporations) in pharma who do the right thing.  I was in a position of responsibility where I had to tell global opinion leaders to desist and refrain….

@Tom: Didn’t say there weren’t people in the industry who try to do the right thing. Maybe there actually are. But my point was that dissembling with a “we wouldn’t do it if doctors didn’t demand it” is not going to win pharma any points. It comes across as sniveling because it’s childish “make them stop first” nonsense. If pharmaceutical companies simply did not provide these “perks” (a very generous euphemism, by the way) it would do doctors no good to “demand” them.

The spigot is not on the doctor end of the firehose.

A. G. Alias, MD

Nov. 2, 2010, 2:09 p.m.

I want to express my deepest appreciation of ProPublica, for bringing out these shameful things on physicians, some of them are to an extent prostituting for Big Pharma. True, they also provide some valuable instructions to their colleagues, regarding recent developments in the field. But they often blindly promote expensive brand name drugs, the cost of which is of little concern to them or to the audience, from the way they introduce them. This high powered sales events are more like a festival to the participating physicians, who may get a free meal and some goodies like pens, or even other more expensive gadgets, with the result that most physicians are looking forward to such events. Now such free gifts are being curtailed. The net result is often a minus for patient care, because they don’t give out information about dangerous side effects.
For example, I just came across an information, “Traci Johnson, a healthy 19-year-old with no mental problems, hanged herself during Lilly trials of Cymbalta in the drugmaker’s own clinic in 2004.” Not many psychiatrists are aware of this. I haven’t been, until two days ago. This was on a website <www.ssristories.com/show.php?item=4572> dated, Oct 10, 2010, under the title:
“Are We Giving Our Soldiers Drugs That May Make Them Kill Themselves?” The author writes, “More soldiers than ever are on drugs that have been linked to suicide and violent behavior.” I was searching for antidepressant-induced violence, both to self and others, on the “parent” website <www.ssristories.com/index.php>, which gives over 3,500 individual cases of antidepressant-induced violence, both suicides and homicides, and related violent events, when the recipients were on one or another antidepressant, usually, Prozac-like “SSRIs.” In the website, http://www.ssristories.com/show.php?item=4572>, the author also writes, “In September [2010] alone, there were 18 civilian suicides, 11 murders, two murder suicides and other violence linked to people who were using or had used antidepressants, according to published reports.” There may have been confounding factors, but at least one or two violent incidents could have been prevented with more judicious use of antidepressants. It is Big Pharma’s enormous power and influence that suppresses the downside of such uniquely beneficial drugs, that causes this much havoc. And in this, the physicians who are on Big Pharma payroll, sometimes turn into “useful idiots.” That is why, the ‘net result’ of such CME activities is often a minus, for patient care. Furthermore, it is a substantial drain on the national resources, from the high cost of brand name drugs.
 
In fact, in 1989, within three years after the introduction of Prozac as a breakthrough antidepressant, an “SSRI,” Joseph Wesbecker, who was on Prozac for four weeks, shot dead eight people and injured 12 others before killing himself at his place of work in Kentucky, This case was tried and settled in 1994. As part of that settlement, pharmaceutical company documents about antidepressant-induced violence,  both to self and others, were released into the public domain (PLoS Medicine, September 2006.). Wesbecker case, however, did not dampen the rapidly increasing antidepressant use, which almost doubled between 1996 and 2005, to an estimated 27 million individuals over age 6, in the USA. Whereas, the 1976 “Tarissoff case,” when a foreign student told his therapist of his intention of murdering a female student, because he was infatuated with her, but she did not reciprocate. The therapist duly informed the campus police about this young man’s intention. Still a case was made against the institution, for failing to prevent the murder. That case became a landmark case, especially for mental health professionals, whereas, despite being a horrific massacre, the Wesbecker case did not; very few mental health professionals are aware of this case. That’s the power of Big Pharma.

What’s any physician who raking in the bucks going to say? “Sure, I take the money and I advance the corporation’s agenda,” or “Of course I’m not compromised!How dare you! The very idea! I’m a PHYSICIAN, of COURSE I have only my patients’ best interests in mind. Hippocratic oath, Dr. Kildare! The idea that I would, like, promote a drug—that’s ridiculous, I would never, ever, ever do that. The money is not an issue. Not even a teeny-tiny bit. The very idea! How dare you! Hippocratic oath, Dr. Kildare!”

My guess is on the latter. Easy to convince yourself of your noble objectives. Easy as popping a pill.

John Reichenbacher

Nov. 6, 2010, 5:49 p.m.

The ProPublica article has factual errors, which apparently Mr. Ornstein has admitted (in reference c that drug companies hire people with tainted reputations)., among other references. There have been no corrections noted to the site. There are certain elements of this article that constitute libel.  As challenging as it is, hopefully a libel suit will ensue.

ProPublica should do an article on the Medical Board . They would likely be surprised (or maybe not)  to find that there are physicians who sit on them that speak for the drug companies, too.  I’d like them to also describe how a death of a patient and prescribing a drug off label where no one was maimed or killed constitute “Gross negligence” a term Medical Boards’ often use to slap the wrist of physicians.  I am not saying that there aren’t physicians to commit serious infractions, but none of this is put into perspective for the reader.  You would be shocked at how many “respected experts” , both academicians and community physicians are apparently a danger to society because they lacked documentation to support the accusations presented. 

The witch hunt against pharma and doctors is on….A number of the recent accusations and judgments or plea bargains include   “prescribing drugs that are off label”.  A recent situation had an expert for the Board that moonlights for Blue Shield.  You can guess what the outcome of that was.

By the way, the ProPublica journalists are among the highest paid in the industry.  I find that rather amusing.

Frank Kline MD

Nov. 10, 2010, 1:50 p.m.

If drug companies didn’t profit financially from funding research, paying speakers, using drug reps and giving away pens and such they wouldn’t do it.

Most of the drug company sponsored CME that I attend doesn’t push specific drugs but does a flyby for good health habits and then pushes medication.

I myself am a physician who does the occasional talk for a particular medication.  I’m not pulling in hundred’s of thousands of dollars for this.  Less than 5k, actually, so I may not be the best representative of the big bad doctor out to make a buck.  I will say that I agreed to talk about the medication because I feel it works better than the alternatives, which I have tried on my patients.  Like any business, there are many who abuse the system, or are ingenuine in their statements, or who are only in it for the money.  You can always find horror stories.  But at least for me, I believe in the product that I recommend and won’t say anything that is untrue.  Drug talks are a simple way to increase my visibility with my peers as well as earn a few extra dollars recommending a product that I routinely recommend to my patients multiple times a day.

Dt. F.- You grabbed $5k-how much per hour was that? Don’t you understand that it’s not the lecture time that’s involved or your faith that the drug you are pushing is s damn good. it’s the idea that in most people’s head that you, as an alleged independent physician are recommending the drug. If the drug is so good, why did you have to be paid $5k to promote it? If its so good, you should have turned down the $5k. Lets be real here, it was about the money, and its always about the money!

i dont have to be paid to promote it -I’m prescribing it anyway.  Why shouldn’t I get paid for educating my peers about what I have found to be a good medication?  This isn’t a phone call saying “I like it!”, this is an hour long talk on it’s pros and cons, and my clinical experience.  You’re partially right:  the money does influence my desire to talk about the drug, but it has absolutely no bearing on my desire to prescribe the drug.  Every drug is a tool, and a good doctor knows which tools to use at what point.

This really, really gets to the root of the problem. Dr. F - as is apparently the case with many of your colleagues - it baffles me that you don’t seem to see the conflict of interest here. No one would deny you the right to fair compensation for speaking at an event regarding your experience with or assessment of a medication. Being paid to do so by the maker of the drug is the problem, because it reduces you to a tool in the company’s marketing arsenal.

In effect, you are being made the Tidy Bowl Man while believing yourself to be the Authoritative Symposium Guest Speaker. In exchange for the compensation you rather petulantly say is deserved, you sacrifice your credibility and open yourself and your profession as a whole to accusations of bias because - guess what - the APPEARANCE of impropriety is more than sufficient to bring the house down. Worse, it isn’t just about the possibility of you yourself being influenced by this system. You are making a recommendation to your peers on behalf of the company who directly benefits from that endorsement. This is only an education program if I can call a ThighMaster infomercial a home study course. 

If you and your peers truly want to benefit the profession with information exchange about diagnosis and treatment (and it really isn’t about the money), work with them to establish an independent forum for the exchange of this information. Better yet, work to improve information exchange mechanisms within existing professional organizations. Guess what? Other professional organizations who organize such events actually charge attendees to attend and use those funds to pay honoraria to invited speakers.

You said “Every drug is a tool, and a good doctor knows which tools to use at what point.” Pharma has a version of this truism as well. Just replace “drug” with “doctor” and “doctor” with “marketing department.”

Don’t be such a tool.

It’s funny how there is always a group of people who like to be doctor bashers.  Jealous people who haven’t accomplished anything in their lives because they are either too lazy or not smart enough.  To start with, 200k is not that much money.  Many people with much less education and experience under their belt make much more than that for public speaking.  These doctors also spend a lot of time traveling, so the fee doesn’t cover just their speaking time. 

I have attended many of these drug presentations and they cover research in depth.  They discuss the raw numbers as well as the research methods used.  They show comparisons between other meds that are used for similar cases and the comparable outcomes.  All the physicians present join into the conversation in Q&A.  Risk factors are discussed. These presentations are very educational and benefit society as a whole. 

If you continue to bash the drug companies and physicians then we will all lose out on much more than we think.  The benefits of these gatherings are to us and not the physician.  Keep complaining and they will be disallowed.  Don’t you think these groups of physicians have anything better to do with the very little free time that they have (friends & family of their own) than to sit around and discuss medications and their best uses with other physicians?  Of course they do.  But you would rather sit around and call them all unethical and dishonest because you are jealous of their hard work, intelligence, and success.

@Melissa: You said “... you would rather sit around and call them all unethical and dishonest because you are jealous of their hard work, intelligence, and success.”

While you are certainly entitled to hurl baseless accusatrions regarding the motivations of people about whom you know nothing, it would be more helpful if you would stick to addressing the actual issue being raised based on facts in evidence.

A few specific questions:

1. If these events benefit society so significantly, why do these altruistic physicians need pharma marketing revenue to drive them? I pay thousands of dollars a year to attend professional conferences (as do many professionals whose domains are heavily knowledge-oriented). Not a single one of them has any hope of providing a societal benefit, and speaker fees are covered by attendee registration fees. 

2. In your experience, has a speaker at one of these events ever concluded by advocating a competitor’s medication over the one sold by the company footing the bill for the event?

3. Do you have any evidence to support the contention that pharma spends this money to benefit society?

4. Can you find any statement in these articles (or comments here) that imply ALL doctors are “unethical and dishonest?” I happen to have a great deal of respect and appreciation for the profession in general, and for most of the doctors by whom I’ve been treated, But this issue raises serious ethical questions that should be addressed. You say at one point “Keep complaining and they will be disallowed.” I certainly hope so!

By the way, I’ve accomplished quite a bit, consider myself to be quite successful, and might dare to go so far as to consider myself (=gasp=) at least as smart as a doctor. Jealous? Not by a long shot. Disappointed and upset by what I see happening here? Yes, definitely.

One more point: Once again, we see the argument that the compensation is “not that much,” etc, etc. And once again I’ll say the point is completely missed: It’s not about how much water comes out of the hose, Melissa. It’s about where the other end is connected.

I’m not going to answer point by point but obviously physicians deserve to be compensated for their hard work.  Most do have no idea how much they work or how hard.  Hospital visits pay nearly nothing.  Physicians do countless work for free everyday because insurance either denies their payments or because the patient will not or cannot pay.  Medical education is extremely expensive.  The toll on their health is a great price to pay as well due to stress related to the profession.  The physician also has many other expenses related to malpractice insurance and they deserve to have a high standard of living due to all the work they have done and continue to do.  They deserve any money they are paid because they have earned it many times over. 

Yes I have heard speakers say that a different treatment other than the pill they are currently representing might be a better course of action when responding to a Q&A session for specific cases.  If the specifics don’t call for the medication or any medication or if the risk factors are too great they have mentioned alternative courses of action. 

I still feel that the majority of people that complain about these payments are simply ignorant of the facts and are jealous.  Maybe you are not but of course it will not apply to each and every individual.

It is very hard to find a physician who has offered nothing to better society or a profession that offers more!  Educate a physician about a medical update and society is given better care.

Melissa- you seem to be another one that needs to have had an ethics course somewhere along the way.

Its extremely odd that you don’t see the conflict of interest here. As I said previously, the pharmas don’t use RN’s for these lectures, wonder why. The RN drug pusher proabaly knows more about real results that Dr. F. does as they speak to many doctors BUT the RN doesn’t carry the weight that asn MD carries, so they recruit MD’s to reinforce the claimed results. Pharmas like every big business is about “bottom line” only. Why would they pay an MD $5,000 or more per hour, if there wasn’t a devised plan to deceive.

Some old adages to consider Melissa; “Nothin’ is for Nothin’ ” - “there is no free lunch” . If some company is giving away free lectures with coffe donuts , pens pencils etc, etc, don’t you think the person giving the lecture did get something or do you think there are doctors floating around willing to give free advice. Gee Wiz, I sure haven’t met any lately. Come to think of it, I know a lot of MD’s,RN’s, DO’s and they didn’t spend 8 years getting that education to get a $10 per hour job. As a matter of fact most I know went to school specifically not to be poor.

@ truebee.  You seem to be one of those self righteous types that needs an ethics course. 

They use physicians because they are the ones who know how to use the drug and they can discuss the drugs use with other physicians.  They want the drug used in the proper way.  The RN has not had a medical education.

Society owes a lot to physicians and all the free work they do for us.  It goes well beyond what I have listed.

And Truebee.  I’m going to a fundraiser tonight that is organized by physicians.  They raise money to pay for the things that medicare does not pay for.  They do this for people who have difficulties paying.  Physicians are very charitable.  We shouldn’t expect them to do free work when we think they should.  Like everyone, they should get to pick when and where they chose to be charitable.  You sound like one of those jealous ones.  Besides that, you certainly sound like you didn’t even take the time to read my entire post.  Figures.

Melissa:

Thanks for your response. It is interesting to note how much you know about the medical profession. This may well be your reasoning as displayed in response to Dan’s very extensive comments.

Its seems clear that you are in bed with this method of deceit and pay to MD’s for pure deceit or stretches. Hopefully your mask isn’t so good that the people you perform for at these paid lectures aren’t fooled by your alleged neutrality.

Your ability to ignore a basis and fundemental conflict of interest is amazing but once again, money talks.

Make certain to lobby your congressman/woman and your senator to push to eliminate medical malpractice law suits and product liability law suits as that will eliminate your need to check for any conmflict of interest. then it will be every person for themself just as the vested interests have wanted for the past 50 years.

Dear Close Minded.  I would not want an RN to teach a room of physicians medical treatment plans that would then be used on me or one of my loved ones.  An RN can not offer the medical insight or knowledge to promote an effective exchange of medical information.

LOl people I perform for at these paid lectures?? I don’t perform for anyone.  I’m just a person with a lot of common sense.

Sad that you think physicians are going to use a drug against the patients best interest just because they went to an educational dinner where the speaker was a physician.  Give some credit. But at least they got the information from someone qualified to give it when they were at the dinner.

” In exchange for the compensation you rather petulantly say is deserved, you sacrifice your credibility and open yourself and your profession as a whole to accusations of bias because - guess what - the APPEARANCE of impropriety is more than sufficient to bring the house down.”

my credibility is quite fine, thank you.  you seem quite ignorant of what goes on at a talk, which is understandable, as you are not a physician.  You seem to think I spend and hour saying rah rah rah this is the best drug ever!!!!!  when in fact the talks are as Melissa describes - a review of relevant medical studies, indications, strong points, weaknesses.  Only after I’ve given a very regulated, scientifically backed and vetted presentation am I allowed to comment on my personal uses and preferences.  Think of it as a relevant review of the scientific literature as it pertains to the use of this drug.  After this review, I can comment on other aspects of the medication which may not be proven, but are my observations.  Strangely enough, I have never said “and this is the best drug evar!!!!!!” 

You trust your physician when you go to his office with a problem, but you seem to have an issue trusting him when discussing medications and review scientific literature while being paid for it.  Perhaps you can give the doctor some credit and believe that most, not all, but the vast majority of doctors who do these talks are just supplementing their income endorsing medications we already endorse daily by our prescribing preferences, and that the fairly minimal compensation that most doctors get for these talks is not going to sway our use of these medications if we have objections to them.

  I prescribe what I think is best for my patients, period.  I also get paid, minimally, to share my opinion with other doctors.  As I said before, this article may identify some who abuse the process, but one or two or ten bad apples does not mean all doctors are money grubbing whores ready to promote whatever poison comes our way for a few thousand bucks.

WOW! must have touched a nerve. Dr. F and Melissa take note: changing the subject doesn’t remove a clear conflict of interest. In the end it is what it is. Happy earnings.

no nerve touched.  I’m trying to educate someone such as yourself who clearly has his opinion made up.  I am neither upset nor threatened by your objections.  I just thought the forum would like the opinion of someone with firsthand knowledge of what the article is addressing.

and thank you for the wish.  I shall enjoy my earnings.

Thank goodness for the lawyers who represent these poor people that have been deliberately harmed by greedy physicians and pharmaceutical companies.  While pharmaceutical, device and biotech companies are only in it for money as are physicians-where would we be without altrustic legal representation.  Why should the lawyers get anything less half the settlement plus expenses?  Now lets talk about money earned per hour.
Shame on doctors and pharma companies for striving to be lucrative!  Let’s solve that by regulating and limiting how much money they can make.  Then surely these industry’s will only attract people in for the “right reason”.  I, personally, would trust my life and the lives of those dear to me to someone who spends more time worrying about how he is going to make his mortgage payment than someone who actually {gasp} received a payment from a pharmaceutical company to deliver a lecture about a drug and disease state.

Steven Reidbord MD

Nov. 12, 2010, 9:34 p.m.

I am a physician myself, use my real name on forums like this, and have long been concerned about pharmaceutical promotion distorting medical decision-making.  As stated above by several posters, the conflicts of interest are glaringly obvious.  ProPublica has created an eye-opening database from public sources — and it’s just a taste of what’s to come (assuming the new health care reform law isn’t torn down), since public disclosure of industry payments to doctors will be required by all drug companies starting in 2013.

I’m a psychiatrist, a field that has been tainted by an inordinate amount of promotional money, and consequent scandals and lawsuits.  The best explanation I’ve ever read of the subtle psychology involved in pharma promotion was stated by Jerome above (http://www.propublica.org/article/profiles-of-the-top-earners-in-dollar-for-docs/#10087).  I tip my hat to his spot-on analysis.

@Lisa: It’s pretty difficult to manufacture innocence by pointing to well-established guilt elsewhere.

@Dr F: Setting up a strawman, calling it me, and knocking it down is also a poor strategy for a debate. As you have bought into this system, you either can’t, or won’t, see the completely obvious and unambiguous ethical dilemma here.

Why do you think, for example, that the Code of Conduct for United States Judges specifies that they must recuse themselves from cases in which they have a financial interest? I’m sure many of them would consider themselves immune to such bias, but time and time again we see that this is not the case.

I was hoping that most physicians, by virtue of the impact of the decisions they make and the importance of trust in the doctor-patient relationship, would endorse this investigation as an important step towards shutting down this dirty little secret. The actual reaction has been quite shocking to me in its defensiveness and, frankly, self-serving “why shouldn’t I” tone.

truebee.  Just because you cannot connect the dots doesn’t mean anyone changed the subject.  So you believe you have touched a nerve just because we responded? That is crazy.

Lisa- if you think you’d rather have a physician who is worried about paying the mortgage payment then you don’t realize that you will just end up not having a physician at all.  They won’t be there for us when we need them if people & the gov’t keep dumping on them. 

Its so much easier to pick on the doctors than everyone else so they are often the target.

Once again Dr. F and Melissa- what it is, is what it is, a clear conflict of interest. Obviously your medical educations never touched on basic ethics. when someone or some company is willing to pay you to “hawk” something because of your professional standing in a community, and that same someone doesn’t have that standing and will profit from your attachment, its WRONG. Wake up and smell the coffee!  You might change some minds with your licenses but you won’t change the priciple of the matter. Perhaps you should try religion, all religions stand on the same ethical grounds and it might be less expensive that taking Ethics 101 at a community college.

Once again Dr. F and Melissa- what it is, is what it is!! A clear conflict of interest. Obviously your medical educations never touched on basic ethics. When someone or some company is willing to pay you as an MD to “hawk” something because of your professional standing in a community, and that same someone doesn’t have that standing and will profit from your attachment, its WRONG. Wake up and smell the coffee!  You might change some minds with your licenses but you won’t change the principle of the matter. Perhaps you should try religion, All major religions stand on the same ethical grounds and it might be less expensive than taking Ethics 101 at a community college.

sounds like me and melissa touched a nerve…..........I’m perfectly capable of seeing your point truebee, I just disagree.  I understand your concerns, and can see your point.  But, as stated before, you really don’t know what you’re talking about, as you are neither a medical professional and have never attended a talk.  so…..........

and dan davis, — again, I’m not upset nor defensive, just thought people might like some firsthand knowledge about what the original article is talking about.  I really don’t care what you think :)

Steven Reidbord MD

Nov. 13, 2010, 11:42 a.m.

It’s a pity these discussions nearly always devolve into name-calling.  I’m a physician myself, and I use my real name online; I think it holds people more accountable.  You can also google me if you like, and will see that I have longstanding concerns about pharma money and its effect on medical decision-making.  The conflict of interest is glaring.

Even though it can’t be shown to create bias every time, the potential for it to do so is huge, and this potential is exactly why industry spends billions on marketing its products this way.

Professional codes of ethics in medicine, law, business, etc, all strive to minimize conflicts of interest because they recognize professionals are humans first and can be swayed.  The hubris of the medical profession makes us prime targets, since we feel we are above (or too smart for) the efforts of marketers.  Of course we’re not.  All industries, not just pharma, strive to sell their products.  It is up to the medical profession to police itself — or society to impose external restrictions if it cannot.

As a psychiatrist I am most interested in the subtle psychological factors that play into medicine’s blind spot about industry marketing:  Label it “education”  and it gets a pass.  The 4th comment at the top of this page by jerome captures this very intelligently and concisely, and I hope you all (re-)read it.  Calling each other names will never lead to a solution, but recognizing how good intentions can lead to adverse outcomes can.

“Even though it can’t be shown to create bias every time, the potential for it to do so is huge”

sigh.  there is a potential for abuse everywhere.  how about drug companies giving me bags of cash for prescribing their medications?  that would certainly be a lot easier than this whole charade of pretending to like a medication and talking to other doctors about it.  leave it to a psychiatrist to worry about the “subtle psychological factors that play into medicine’s blind spot about industry marketing”.

the point is, there is potential for abuse in every system.  I can’t speak for dr reidbord, but I prescribe medications because i believe they work well for my patients.  i also talk about this, and get paid for doing so.  do i prescribe competators’ medications?  of course.  they work well.  or insurance prefers the cheaper brand.  you want to talk about ethics in medicine?  talk about that - anonymous insurance companies forcing me to use inferior generic medications, or meds that are 20 years old and less effective.

would i talk for a company whose medication i felt was substandard or not effective?  no.  would i prescribe a medication i felt was substandard?  well, often i am forced to by insurance companies, or by patients who want the cheaper alternative generic.

i find it very telling that a dr with longstanding concerns about this topic is unable to bring up any more convincing evidence than “even though it can’t be shown to create bias every time….”

just as in any business or industry, there are many potential avenues for fraudulent practice in medicine.  this is not particularly profitable (for most physicians in a full time practice) or easy for deception (everything discussed at a drug talk is scientifically vetted and verifiable.)  any physician trying to pull one over would find his credibility quite diminished, either by verification of the literature or by personal experience with patient treatment.

and i don’t see any name calling degeneration here.  just an exchange of ideas, and an attempt at education.

thank you Dr. Reidbord. Dr. F and Melissa (also a PX on the grab for dollars) For awile I thought none of you guys was going to realize the short comings of the few that wrote in. Dr. F. complains about insurance companies (the people who burned the books on ethics- oh! along with bansters and politicians) When you take money to promote something or in fact when you are offered money to promote something, its time to think, why do they want me? why am I so special? they can’t be out of people,  can they be? Why are they paying me $3,999 per hour, can I be wirth that much money? The questions answer themselves or at least they should answer themselves, if they don’t, it time to move on or be counted with the insurance companies, goldman sachs, and the pharmas.

@Dr. Reidbord: Thank you for sharing those comments. It was very encouraging to see your concern for this troubling situation. And thank you for using your real name.

@Dr. F: Let’s say, for the moment, that you are a plaintif in a class action case against large corporation Microblatz Inc. The evidence against the corporation is strong, and the general pre-trial expectation is that the judgment will be in your favor.

On the first day of the trial, the judge makes the following statement: “By law I am required to report to you any financial interest I might have related to this case, so I am stating for the record that I own 1000 shares of Microblatz stock.”

Then he turns to you and says, “But please do not be concerned in the least. I intend to make a fair and unbiased judgment in this case. Rest assured that I am above such petty bias and am not affected in the least by this investment.”

Do you believe the judge? What is your level of confidence that the judgment will be in your favor?

This is why “appearance of impropriety” is a term with specific legal meaning, and why it is specifically included in judicial code of conduct documents as grounds for recusal.

@Melissa: Are you a pharma sales rep? Someone in pharma marketing?

This is so interesting.  As a whole (always exceptions) physicians are the most ethical and responsible group you will find anywhere.  I do not know any MD’s that ever hurt there patients by writing a medication they thought was inferior.  Most pharma talks are done by MD’s who use and believe the science supports the product they are commenting on.  Done correctly the company then finds the person that already likes their product to speak.  If the two goals of education and business coincide then so be it. 

When you go buy tires for your car, does the store discuss that the sales rep took them out the night before?  Does your electrician tell you why he /she picked that wire?  We don’t always require disclosure from brokers that make more by choosing one financial product over another. 

To go one more step, think about surgeons.  Generally they make more money in the OR than anywhere else.  Every surgical recommendation could be hallenged by - “Which choice makes you more money?”.  At some point we trust this group of people to have the patients best interest at heart.  We trust them to make critical decisions and use critical thinking when evaluating and making clinical decisions.

We are worried more about physicians than lawyers?  They worry about facing the judge again next time?  They get paid by the hour?  They take class action suits that makes no one but them money?  They can drive up medical costs via law suits that are looking for the medical lottery and that’s all ok? 

Yet the “A"students who will never make the kind of money equivalent to CEO’s or the number of years spent in a library studying, and whom wake up each day with the goal of caring for others, are the ones we scrutinize.

Bizarro world.

@Dr G: As my Mom used to say when I would point to the transgressions of a friend as being far worse than mine, “We’re not talking about Johnny, we’re talking about you.”

Of course those abuses exist in the legal profession, and they have a huge impact on health care. But that’s not what we’re talking about. Your suggestion (and that of several others here) that addressing this problem somehow means that other abuses aren’t important is just misdirection and doesn’t really contribute to the discussion. Clearly, though, it rolls off the tongue quite easily and so must be a common rationalization within the profession.

You said “We trust [doctors] to make critical decisions and use critical thinking when evaluating and making clinical decisions.” Yes, we want to be able to have that level of trust. That’s exactly why this is so important, and why it is so similar to the judicial ethics example I used earlier.

I am already bombarded daily with TV ads that tell me I should ask my doctor about [insert drug name here], but which end by rattling off frightening lists of potential side effects. Clearly pharma does not have my best interest at heart. If I then find that my doctor is being paid by the same company to promote its medications among his/her peers (or even that s/he attends such events under any sort of notion s/he is receiving information that can be considered objective), what do you think that does to any foundation for establishing trust?

It was probably true that my parents’ generation trusted doctors automatically. Mine never even asked questions, as well as I can remember. They just sat quietly for the examination, then gratefully accepted the prescription(s) handed to them. The world is different now, and trust is a much more fragile thing that has to be earned and then carefully maintained.

In case it’s not clear, participating in or defending these “education programs” doesn’t go in the plus column of that trust ledger.

I don’t want to play anymore. Its a waste of time.  Dan has said it all once again and none of the people responding are listening. The old adage, “You can lead a horse to water but you can’t make him drink” has never been made clearer. Conflict of Interest, isn’t a primary concern of these PX’s or PX apologists. Money talks, Nobody walks.

Keep up the good work Propublica!

Steven Reidbord MD

Nov. 14, 2010, 4:49 p.m.

@Dr. F
“i find it very telling that a dr with longstanding concerns about this topic is unable to bring up any more convincing evidence…”

There are hundreds of papers on this topic.  For a start, see:

http://www.drugpromo.info/
http://www.ncbi.nlm.nih.gov/pubmed/10647801
http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html


@Dr. G
I agree that physicians as a whole are well-meaning, ethical, and highly responsible.  As commenter jerome noted, sponsored speakers honestly feel they are performing a valuable and even noble service.  And I’ll go further:  They ARE.  Unfortunately, there are also unintended negative consequences, many of which have been documented in the medical literature (see above).

Why we hold MDs to a higher ethical standard than tire salesmen or electricians should be obvious.  Our fiduciary relationship with patients makes them much more vulnerable to any conflicts of interest we might have.  I have a blog (who doesn’t?) that includes posts about this ethical issue, and why we physicians need to hold ourselves to a higher standard with respect to potential conflicts of interest:

http://blog.stevenreidbordmd.com/?p=13
http://blog.stevenreidbordmd.com/?p=34
http://blog.stevenreidbordmd.com/?p=33

I just received a check for 10 k from Pfizer.  When will it show up here?

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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