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News Reports Cite Drop in Physician Speaking Fees

Regional newspapers that analyzed ProPublica's Dollars for Docs data say drug company payments to physician speakers have declined in their states, suggesting that new restrictions and publicity are making an impact.

Amid increasing scrutiny, drug company payments to doctors for promotional speaking have dropped in several states, according to stories by several newspapers using our newly updated Dollars for Docs database.

The Boston Globe reported that payments by several drug companies fell in Massachusetts, “suggesting that new restrictions designed to distance doctors from industry are leading some to abandon the lucrative speaking circuit.”

Eli Lilly and Co., for example, spent $866,919 on Massachusetts health providers who spoke about its drugs last year, a 46 percent drop from 2009, the Globe reported. Payments from GlaxoSmithKline fell at least 29 percent to $884,850, but that underestimates the true decline because Glaxo did not publicly report payments in the first quarter of 2009.

"The data also show that many Harvard-affiliated doctors have dropped out of company speakers' bureaus, a sideline that has allowed many physicians to earn tens of thousands of dollars," the Globe reported.

Harvard-affiliated teaching hospitals barred promotional drug company speeches as of January 2010, and Harvard Medical School followed suit in July.

In our story yesterday, we noted how some drugmakers apparently have used fewer physician speakers and consultants since they began posting their data publicly. Cephalon, a relatively small Pennsylvania company that specializes in drugs for pain, cancer and the central nervous system, paid physicians nearly $9.3 million in 2009 for speaking and consulting. That figure dropped to $5 million last year.

AstraZeneca cut its spending on speakers from roughly $22.8 million in the first half of 2010 to about $9.2 million in the second half.

The St. Louis Post-Dispatch also notes decreases in payments to doctors in the St. Louis area.

Dr. James P. Crane, executive vice chancellor for clinical affairs and CEO of the faculty practice plan at Washington University, told the paper that the "amount of [drug company] activity is down" in general at the university.

The university revised its guidelines in January, requiring that faculty members have "final editorial discretion" over speeches they give for companies and materials presented. Companies had to write that stipulation into their contracts, Crane told the Post-Dispatch.

"We are now requiring our physicians to provide copies of industry contracts to make sure the language is included," he said. "We also sent the policy to 100 pharmaceutical companies letting them know we were making the change and asking them to respect it."

Four companies—Pfizer, Bristol-Myers Squibb, AstraZeneca and Sanofi-aventis—would not accept the policy change, Crane said, and faculty members were told to stop working with them.

The Denver Post reported that an ethics board at the University of Colorado School of Medicine “has rejected more than one-third of proposed contracts between doctors and drug companies since it took authority to approve the deals on June 1.”

The latest payment records show that University of Colorado faculty who “previously made the most from the drug companies” registered no payments in the latest quarters, the Post reported. The medical school dean said one doctor who earned more than $130,000 in 2009 and 2010 has decided on his own to stop taking the money.

Officials at National Jewish Health, a Denver hospital affiliated with the medical school, told the Post that they plan to post online all of their physicians' ties with drug companies.

Ron Berge, the hospital's chief operating officer, predicted that some National Jewish doctors would give up speaking because of the increased scrutiny. For those who continue, he told the Post, "I expect to see significant diminution" of payments.

ProPublica reported in May that the University of Colorado and Stanford were among several schools that took action to enforce or overhaul conflict-of-interest rules after Dollars for Docs data were first published last year.

Other newspapers highlighted local physicians who earned significant sums speaking or consulting for drugmakers.

The Orlando Sentinel spoke to Dr. Damon Tanton, an endocrinologist at Florida Hospital Celebration Health who earned $67,509 from Lilly. "I only speak for products I believe in," he told the paper. "I've turned down offers from companies asking me to speak on products I don't support."

The Plain Dealer in Cleveland spoke to Dr. Mark Mehle, an ear, nose and throat doctor who earned $234,900 in speaking fees. "The reason I'm high on the list is because I'm in demand," Mehle told the paper. "I'm a speaker people can bring in and actually get people to show up for it."

Mehle acknowledged that GlaxoSmithKline prepared the slides he used in some of his presentations, but he said that his ties to the company haven’t influenced how he treats his patients.

"You run into the appearance of conflict. No doubt about that," Mehle said. "But in all fairness, the vast majority of medications I write are generics. Ten to one generics over branded products. So I can tell you it doesn't affect what I prescribe."

Oregon Health & Science University's chief integrity officer, Gary Chiodo, told the Oregonian in Portland that scrutiny of the relationships between doctors and companies is healthy.

"There have been several studies now that even small gifts from industry to doctors influences their decision making," he said. "Even the smallest of gifts ... can influence prescribing practices. And certainly, when you get into the larger amounts, when someone is getting huge consulting fees for doing little work, the influence is great. All of that, of course, drives up the cost of health care."

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