ProPublica recently published a major update to our Dollars for Docs news application – a database tracking money physicians have received from some of the pharmaceutical industry’s largest companies to promote their products.
Currently, the database lists $761.3 million in payments from 12 companies, which account for about 40 percent of U.S. sales. But in 2013, all drug and medical device companies will have to disclose what they are paying doctors for promotional talks, consulting, research, meals and more. Until then, ProPublica’s Dollars for Docs team – Charles Ornstein, Tracy Weber and Dan Nguyen – hope their project will shed some light on the industry’s ties to physicians. They join the podcast this week to explain the technical complexity of this project, why pharmaceutical companies enlist physicians to promote their products to begin with, and why patients have a right to know this information.
Read the full transcript below and subscribe to all of ProPublica’s podcasts on iTunes.
Mike: Hi, I'm Mike Webb and welcome to the ProPublica Podcast. Last week we published a major update to our award‑winning Dollars For Docs database. The project shows how much pharmaceutical companies pay doctors to help them promote their drugs.
The update adds payment from four more companies for a total of 12 pharmas that control 40 percent of US drug sales. The old database had about 30,000 records and now with the update it contains more than a half million.
To talk about it and our new findings, we have Tracy Weber, Charles Ornstein, and Dan Nguyen joining us here in the storage closet studio. Since they've all been on before we'll skip the bios and we'll go straight to the questions. Welcome to the podcast, gang.
Mike: OK Dan, so you had the tough job of collecting the new data, including the four additional companies. How much money are we talking about this time around?
Dan: Total in the database that we have now is more than $760 million. With just an extra year of data overall but it's a little deceptive in a way because, as you said, we have more companies this time around. And not only that, more companies are disclosing more things as a result of their legal settlements.
Mike: What do you mean more things, more specific about the payments?
Dan: Right, progressively, some of the agreements, they give them some lead time in order to collect all their payment data. So maybe the first year they're only reporting speaking payments over a certain amount. Then the next year they're going to reporting speaking engagements, meal payments, anything under $25 for example. So it's not just a greater range of time that our database covers, but a greater scope of different kinds of things that are being disclosed.
Mike: And it's probably hard to keep it organized so that's it's apples to apples, oranges to oranges.
Dan: Yeah, I think that's what's the most frustrating thing for all of us working on this is that right now there's no ‑ again, each agreement asks for different things and the companies generally kind of meet at least the minimum of that and sometimes just the minimum. Yes, it's not apples to apples and sometimes things change even in the mid‑year. For example, we had one of the companies, Allergan, doesn't disclose exact amounts as do the other companies. They disclose a range from one to a thousand. So that total of $760 million doesn't include them because we can't say for sure how much all those payments from one to a thousand actually amount to. So we've got to account for all these things while trying to do our analysis and it's. . .
Mike: It's difficult.
Dan: It's difficult to make the apples‑to‑apples comparison. But each company is doing their own thing and they don't have to think of the big picture obviously. They're just meeting the terms of their agreement.
Mike: Right. Charlie, help us understand why the pharmaceutical companies would even make these payments. Why is it in their interest?
Charlie: Well, companies rely on doctors and other healthcare professionals to educate their peers about new medicines or new uses for medicines. They also rely on doctors to perform research and to consult with them about not just research but also marketing strategies. So they're very reliant on the medical community for peer education and to help promote their products. Because when it comes down to it, a doctor would prefer to hear from another doctor about a drug than they would to hear from a sales representative. And so it's easier to get a doctor to come to a dinner meeting when another doctor is speaking, especially a doctor that they may have heard of, than it is to get them to come and hear a sales representative.
Mike: And you did a story about some of the dinners that the doctors received.
Charlie: Right. So the pharmaceutical industry has a voluntary code of conduct that says that companies should only provide modest, occasional meals for physicians. But when it comes down to it, some companies were providing more than occasional meals to physicians and their definition of modest was, in one case, under $135. So one physician we found who had done no services for the company Pfizer, had received more than $3,000 in meals from the company last year, which we calculated to be at least 22 meals at the $135 limit.
Mike: Right. Tracy, you co‑wrote an op‑ed in the Los Angeles times with Charlie and you mentioned a Santa Monica physician named Gerald Sacks who’s received more than a half million dollars since 2009. Tell us about it.
Tracy: Well, why we noted Dr. Sacks in there is one of the points we're making in the op‑ed is that this is some information that would be valuable for patients to know. One of the points of this transparency is letting patients go and see whether or not their physicians are speaking on behalf of a medication and whether that's a medication that they're being prescribed. Because in many cases, name brand drugs are both more expensive because they're newer, they have less of a track record, and there's older drugs that are safer, less risky, and less pricey or even generics. And in some cases the better option might be non‑drug therapy.
So Dr. Gerald Sacks is one of the highest paid doctors in our database. He speaks or consults on behalf of four companies. He's a pain doctor in Santa Monica. But when Charlie and I went to research Dr. Sacks we could find out almost nothing about him. He isn't well‑known by his peers. He doesn't have any major research. He isn't affiliated with a prominent medical center.
So for patients, here we have a physician that's one of the highest paid physicians and it's difficult to research him. So this allows patients to go in and see who he works for and whether or not they might be prescribed a medication. And it's a question to bring up with Dr. Sacks. But for any patients it allows them to ask questions about what their treatment is.
Mike: Do patients have a right to know this information?
Tracy: Patients do have a right to know and that's one of the points of having this become more transparent and having a new law that's going to force all companies to tell this information. It's not everything for a patient. A patient also should, maybe, check the medical boards in their state to look for criminal behavior or any sanctions for anything their physician had done, check with other patients. But if your doctor doesn't want to talk to you about whether or not he speaks or consults on behalf of a drug company, that's something worth noting.
Mike: Right. Dan, is it clear what doctors are paid the most for? Is it research? Is it promotional talks? Why are they getting these good sums of money?
Dan: By far the biggest category is speaking. It amounts to more than $400 million over the two years or so that we've collected data and the next category is research which is $240 million. Not everything is apples to apples, not every company discloses research so for all we know that could be a much greater expense, but only two or three companies actually disclose their research payments so far. But among all the other categories, between speaking, meals, consulting, anything else, speaking by far takes up the greater share. We have $400 million being split between 44,000 different payments. So that comes roughly to about $9,500.
Again, one of the things in our database is that we can't say specifically how many doctors that represents because as a doctor works for a different company he may be referred to as Joe Smith or Joseph Smith. So this is just the straight, plain numbers.
Mike: Right, the records aren't uniform.
Mike: When they talk are the doctors speaking from knowledge, from research that they've done themselves or is this information that's been provided to them by the pharmaceutical companies?
Tracy: I was going to bring that up, because one thing we haven't noted is why it's interesting to know if your doctor speaks. Most people go, "Well, what's the problem with that? They're knowledgeable about this medication and they're delivering the talks." But the pharmaceutical companies require the physicians to use slide presentations prepared by them. So they're not able to just talk at random about the drug and their experiences with the drug. They have to use the materials provided by the company.
Mike: They have to.
Tracy: They have to. This is called "promotional speaking." It's not called promotional speaking for nothing. A thing to note about the research is that one of the reasons looking at research is a little more difficult is a lot of times the research money doesn't go directly to the doctor, it goes to pay staff, it goes to pay for equipment, it goes to pay for all manner of stuff associated with the research; some of the money might not be going to the physician at all.
Mike: Charlie, overall did you find that these payments are on the increase or on the decline?
Charlie: It's really too early to say. But some preliminary indications suggest that payments may be going down. Among companies that have reported payments for speaking over more than one year it appears that for Cephalon, for instance, which is a small pharmaceutical company based in Pennsylvania, their payments dropped by more than half.
Mike: Do you have any idea why?
Charlie: They said it was just a change in their overall strategy as opposed to any particular thing relating to the disclosure of this information. We found with other companies as well that it was a smaller figure. Eli Lilly it was about 10 percent that the drop had. With GlaxoSmithKline was about 15 percent. So there were small decreases. It's early to say. It could be that it's year‑to‑year market fluctuation. It could be that once you have to disclose this information that it's having an effect on how often they use speakers. I think we'll know a lot more in a couple years as we see some patterns and trends develop.
Mike: In the future how will patients be able to find out this information? Are we going to keep updating the database or will there be another way?
Charlie: The good news is that we're really entering an era of much greater transparency in this arena, and so additional companies can be expected to report this year, next year, then in 2013, the federal healthcare reform law requires that every pharmaceutical and medical device company report this information publicly on a federal website. To Dan's point it will be released in a standardized way where the definitions are the same for every category. So people really will be able to get a full perspective of the whole country, all physicians, all companies. Right now we're talking about 12 companies, 12 companies that represent about 40 percent of US drug sales. But there's more than 200 companies out there. So you don't know what you don't know and I think in the future we'll know a lot more and that'll be really good news for patients.
Mike: All right. Well thank you all very much for joining us. It's a really great job and it's one of our most popular features.
That was Dan Nguyen, Charles Ornstein, and Tracy Weber. Thanks for the great work and for joining us today. If you would like to look up your doctor, go to projects.propublica.org/docdollars. You can see all of their reporting and all of the payments from that page. And that brings us to the Officials Say the Darndest Things Tumbler quote of the week. Here we go, "To assume that we're naturally for these things because we've been for them does not mean we will be for them if they cause debt, if they [have] tax increases, and if they take money away from the free enterprise sector, which creates jobs." Who said it? Representative Pete Sessions, a Texas Republican, on why President Obama shouldn't assume that the GOP will support a jobs plan full of provisions that Republicans have supported in the past.
All right. That wraps it up for this show. Thanks to Minhee Cho for producing it and for you to listening. For ProPublica, I'm Mike Webb.
Transcription by CastingWords