When pharmaceutical companies first started revealing their financial relationships with physicians, almost all of the listed doctors did actual work for them -- delivering promotional talks, consulting on marketing or new products, conducting research.
But as the firms' reports have become more detailed, hundreds of thousands of doctors are being listed merely for eating lunch or dinner on the company's dime.
ProPublica's initial Dollars for Docs database, released last October, included about 30,000 payment records. Today's update includes more than half a million.
Take Pfizer. Eighty percent of the 200,000 doctors included in its 2010 payments were listed only because they had received one or more meals paid for by the company.
Dr. Semyon Isakovich Emert of West Hollywood, Calif., for instance, received $3,065 worth of meals from Pfizer in 2010 and $1,046 worth in the first half of 2011. He did not perform any services for Pfizer, according to the company's report.
Emert said in a brief telephone interview that he doesn't keep track of how many dinners he attends and doesn't give it a second thought. "Patients don't ask about this."
Under federal law, all drug and medical-device firms will have to publicly report all payments to physicians, including food, beginning in 2013.
A voluntary code of conduct adopted by the Pharmaceutical Researchers and Manufacturers of America says that "it is appropriate for occasional meals to be offered as a business courtesy" to doctors and members of their staffs attending information presentations by sales reps.
In such cases, the guidelines say, the presentations have to "provide scientific or educational value," and the meals should be "modest" by local standards and not part of an entertainment or recreational event. Meals for spouses and take-out meals are not appropriate, the guide says.
For some doctors, the meals don't appear modest. At least 20 doctors, including Emert, received meals worth $2,000 or more from Pfizer between July 2009 and March of this year. None served as a speaker, consultant or researcher.
Pfizer spokeswoman Kristen Neese said these physicians attended "at least one, if not two" programs a month in which experts talked about particular diseases or Pfizer products. The company has a limit of $135 per person on meals at each, she said. If Emert's meals hit that limit, he would have had 22 of them last year.
"We really do believe that these expert-led forums are a very valuable educational opportunity for them to learn about the experience of their peers," Neese said. "We wouldn't limit what they could go to."
Six doctors, most in New York City, received more than $1,000 in meals from Eli Lilly and Co. in the first quarter of this year and performed no services for the company, records show.
Lilly spokesman J. Scott MacGregor said in an email that the spending reflects a mix of in-office business meals and meals at educational events. "While each individual meal was within Lilly meal limits, we have determined we need to improve awareness among our employees around the standard of occasional meals," he said.
For patients, seeing that their physician received company-paid meals probably wouldn't carry much weight, said George Loewenstein, a professor of economics and psychology at Carnegie Mellon University and an advocate for full disclosure of drug-company payments to doctors.
"It's much more likely to have a kind of 'Tell-Tale Heart' effect on the physicians," said Loewenstein, whose research has shown that payments and gifts influence actions. "A doctor is very likely to say it's not worth it to take a $15 meal because it's going to get listed on the website."
Relatively, the meals didn't add up to much money. Pfizer's meals amounted to only $18 million last year, compared to $34 million for promotional speakers and $108 million for research.