Last week, ProPublica reporters Charles Ornstein and Tracy Weber hosted a conference call detailing how media organizations can use our Dollars for Docs database in their own reporting.
Ornstein and Weber outlined how to check a doctor's credential and discipline record. As we reported, hundreds of doctors who have been accused of professional misconduct, were disciplined by state boards, or lacked credentials as researchers or specialists are being paid by drug companies to speak on behalf of medications. Our database lists more than 17,000 doctors.
Newspapers across the country localized the story. The Plain Dealer in Cleveland published an extensive article disclosing doctors who received money and explaining the importance of having an open discussion with their physicians. The Times-Picayune listed Louisiana doctors and a link for readers to search for physicians.
You may continue to e-mail Charles.email@example.com for additional questions or comments. They are also available for interviews.
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Charlie Ornstein: Thanks. That was Mike Webb. And this is Charlie Ornstein, and I really appreciate you guys joining us today. I thought before we open it to questions, we could explain a little bit about why we undertook this and then show you some of the most important pages that we think are on the site. So why did we do this? This started because we started noticing the pharmaceutical companies posting disclosures on their websites of the amounts of money they were paying for speakers and in some cases consultants.
And it was difficult to analyze. In some cases, it was difficult to see who was even the highest paid or how many doctors were from specific areas. And you would have to do some downloading of the data and putting it into your own spreadsheets, and that was only for one company, let alone looking across the industry.
So we thought it would be helpful to aggregate this information and look for trends and see who people were, and actually start spurring conversations. And not just conversations between reporters and pharmaceutical companies or reporters and doctors, but also between patients and their doctors, to have patients be able to ask questions about if their doctors received money and whether that was influencing their care. And to have the conversations that whether you are in the industry or not, it is something that folks believe are important conversations for patients to have with their doctors.
I wanted to also say one more thing before I walked you through the website. Lots of people are on this call. We have kept it open to anybody who wanted to be on it, and so there are representatives from media organizations, from government agencies and from the pharmaceutical industry as well. So if there are questions that you have that are I guess specific that you want to ask us or more confidential, you can feel free to reach out to Tracy or me after the call, and we are happy to help you out.
Go to the database, and select the first link on the page, which is the "Docs Database." It's projects.propublica.org/docdollars. The first thing I wanted to point out was the caveats about the data. And if you see the "read more about the data" link and click that, where it is the second link in the email, it is some of the information about how we put together the database.
This is a database of $257.8 million, which is about 17, 700 providers and about 30, 000 payments. It encompasses seven pharmaceutical companies, 4.5 of which were required to make these disclosures as a result of settlements with the Justice Department. And I say "a half" because one of the subsidiaries of Johnson & Johnson agreed to make these as a condition of a settlement with the Justice Department, but the others were not required to but they all disclose.
They amounted for about 36% of the US prescription drug sales in 2009, and while that's a substantial share, there is still more than 70 drug companies that operate in the U.S. that have not reported and won't be required to report until 2013 when the Physician Payments Sunshine Act takes effect, which is part of the Healthcare Reform Bill that passed in March.
But even among the companies that reported, there are differences in the reports. Some companies have disclosed for six quarters, so a year and a half; and others have disclosed for only two quarters which is six months. And so the amount of money will be larger once everybody is starting to report consistently and over the same time periods.
But even if that happens, you also have different things that are being disclosed by different companies. For instance, some companies include payments for speaking, while others also include payments for consulting and travel and meals. And so, it is really important that you look at each company and what it is they are disclosing, so that you understand that it's head to head.
Also, it is important to note that we have just taken exactly what the pharmaceutical companies have put on their websites and put it on our website. We haven't changed names or addresses, and the companies haven't put specific addresses but have rather just used cities and states. And so doctors have the same name and we found this many a time. And so before you start adding payments together, it is important to do the research to make sure that you are talking about the same physician as opposed to other doctors.
Finally, it was important to note that there are a number of companies that have not yet disclosed and so you should take that into account as well. I wanted to also have you turn to, if you don't mind, the companies' page, which is if you look at "about the companies" in the middle of our database page and see the details of their disclosures, you will see which companies are disclosing as a result of settlements and how long they have been disclosing, the amount of money they are disclosing, and what they are disclosing for.
The companies that are highlighted in pink are disclosing as a result of settlements. And when you click through to each company, you can find out information about that company's top drugs, you can also find out information about any lawsuits that have been settled, as well as to read the settlement press releases and the corporate integrity agreements, you can see the payments by that company across each state and the top payments made by that company.
One thing to note about payments is that each payment by year is listed as a separate payment. So a doctor may receive more than one payment from the same company if it is over more than one year.
The next page I was hoping you would look at is our states page, which is linked from the bottom left of our main database page, but it is also in the links that we sent. It says "more state data." And when you click that, you can see for every state, the average quarterly spending per company from the highest to lowest and the total amount that went to the state. You can also click on an individual state and that will have all of the payments made to doctors or other health providers in that state.
We've tried to make it easy, although we don't have a city search, we allow you to sort it by the city in that state search. And so if you do Alaska and you do it alphabetically, you will be able to see all of the Anchorages that come up first, and that will help you look for doctors in your city. The reason we didn't put a city search on here is that sometimes companies spell city names differently. For instance, St. Louis sometimes is spelled St. Louis and sometimes it is spelled out as Saint Louis, and we didn't want to have folks miss some of those payments by filtering on a city if there were other variations for that city, just so you know.
And then finally, I wanted to show you the page that deals with the top earners. What we try to do as we aggregated the data is be able to look at any health provider that made more than $100, 000 over the course of the last 18 months, in some cases it was a shorter period than that. And for each of these providers, we ensured that the payments were going to a unique person. We look to see whether they had board certification in their medical specialties, which Tracy will talk about in a second. We look to see whether they had any disciplinary actions and we aggregated their payments in one place so you could see that. On that page as well, you can sort by state or you can sort by name or you can sort by amount. So, we tried to make this as sortable as possible and as easy to use as possible. And I will turn it over to Tracy.
Tracy: So once you have now looked through all of this stuff and you want to check on some of the doctors in your area, I wanted to tell you a little bit about that, because we have gotten a lot of emails from folks that were plugging in doctors and had a lot of questions about that. First thing is, you can plug in a lot of doctors who won't be there, because this is only seven companies and there is probably eighty drug companies making payments. So someone who is not in here doesn't mean that they don't get payments from pharmaceutical companies.
Secondly, the payments in here are limited. As Charlie said, some companies have only disclosed six months out of the last eighteen months, and some companies have many fewer payments in there. So a doctor who is getting money from just one company, that could be just six months of payments.
Also, many doctors we found on our list, particularly in looking at the doctors that made over $100,000 in this database also speak on behalf of a lot of other companies. So, when you go and do research on them, we found for instance there were more than dozen doctors in that group that made over $100,000 that also disclosed speaking on behalf of at least nine or ten other companies. One physician spoke with twenty other companies. So you need to do a lot of research to sort of get a good picture of who the physicians are and don't assume that the total that comes up here is the total amount of money that the doctor makes.
And secondly, so to take a look at some of these doctors, we did a lot of things to sort of find out who they were, what their qualifications were, were they specialists in the field on which they were speaking. And so, I was going to suggest a few ways that you might go about doing that.
You can plug the doctor's name into PubMed, and that will pull up or should pull up all of the peer reviewed research that that physician has done. Now the problem with that is that usually goes by the first initial and last name and if the doctor has a common last name, it can sometimes be tough to ensure you can find all of the research, but you can also take a look at specialties and sort some of that out.
Secondly, you can look at the American Board of Medical Specialties website. And you can plug the doctor's name in there and see whether or not that doctor is board certified in his specialty. Again as Charlie pointed out earlier, many, many doctors have the same name, so you really have to do a lot of checking back and forth, back and forth to ensure that the doctor you are looking up is indeed the same doctor that's in the database.
Sometimes in some of these cases, the drug companies provide different middle initials for some of the same doctors and we have had to sort that out. You can also look at the AMA website, the American Medical Association, which also lists board specialties.
We looked at state medical boards where the doctors were the addresses where the doctors were located. You can usually plug the doctor's name in, but some states immediately pull up any disciplinary records against the doctor. Other states require you to mail in and get those records.
Some states list malpractice against the doctor and allow you to see what that is, other states do not include that information. Some states will include if the doctors have been dismissed from a hospital for misconduct of any kind, other states don't. But it is not difficult to do that, and you can see whether or not your doctor has been disciplined. But sometimes looking at a state board website will also tell you whether the doctor has been disciplined in another state where he has a license.
We also took a look at the FDA website to see whether or not they have been issued a warning letter based on research misconduct or perhaps speaking misconduct. And you can find those letters on the FDA website.
You can also search for where a doctor is speaking for continuing medical education. And on both, the research and the continuing medical education, they usually have to disclose everyone else that they have a conflict with either speaking or consulting or advising or research or even sometimes whether or not they own stock in a pharmaceutical company. And that's always a good way to see whether or not what other companies, what other maybe even medications the doctors are speaking on behalf of.
And I also suggest talking to the doctors. We have had actually great luck and learned a lot from talking to the physicians in the top group in the database. Ask what drugs they are speaking on behalf of. You know Judy Graham in the Chicago Tribune ran a great chart of the doctors in her area and what companies they worked for and what drugs they were speaking about. It was really interesting.
And you can also ask how much they are making from those companies. Now Charlie and I found that most doctors had no idea how much money they were making. And they basically said that, you know, it's in their tax return.
And a lot of the doctors we spoke to would speak for one company one year and maybe another company another year and they would work a lot when a new drug came out and then maybe taper off for them. So they could have conflicts one year and the next year not be working for that company and it is unclear whether it is still considered a conflict.
I also would suggest for local reporters to look at the court house for malpractice. I mean if it is in the county where the doctor lives, you can search for any sort of lawsuits against the doctor, and those often provide a lot of information.
The most difficult thing we found was making sure we had the right doctor. And I can't stress that enough, and we were looking at some of the disciplinary records. There were seven doctors with the same name in Manhattan alone, and it is very difficult and in some cases we could not be sure it was the doctors, so they were not included. You need to really take a close and careful look when you are matching up folks.
Mike: OK. While we are waiting, we are going to take one of the email questions that came in. And that was: does our database include payments for continuing medical education?
Charlie: So I will try to take that. Continuing medical education is different from speaking that is included in the payments database, and in fact would not be included in our database according to the companies that we asked. Continuing medical education is where doctors can get credits for going and hearing folks speak. And there is an accreditation group for continuing medical education that looks at the independence of these talks and makes sure that conflicts are fully looked at and that the information presented is accurate and complete.
There are some folks who believe that there is too much of a role for industry in terms of giving unrestricted grants for continuing medical education, but that's not something that's part of our database or has been part of our first story.
Mike: OK. We are waiting for questions, just as Jeremy said, hit star if you have a question to ask. Why don't you talk a little bit about how this got started? I know it is not exactly pertinent to what everyone wants to know, but what was the impetus for you guys beginning this project?
Tracy: Well, you know the drug companies; there has always been a talk about the relationship between pharmaceutical companies and physicians and other health care workers. And when they began posting these, it was very difficult to see trends or even who the people were. You know we were very curious to see who were the people that were among the favorite speakers, and who were the ones that the pharmaceutical companies relied on most and were there trends in the payments. So we decided to put them all together, and Dan figured out a way to download and combine these things and make them sortable and searchable and it was a very tremendous undertaking.
Mike: I don't want to scare anyone away, but how long did it take?
Charlie: It took several months certainly. I got a question by email Mike that I thought I'd throw out there.
Charlie: And that had to do with: what did I mean earlier when I was talking about payments to doctors by year? So here is what I mean, is that the list of payments, every payment is listed separately. And so, you may see, especially the top payments list by company, a doctor listed there, but you should see if there is a second payment to that same doctor.
So if Eli Lilly reported a payment in 2009 and that's at the top of the Eli Lilly payments list, there could be a payment lower on which is for the first quarter of 2010, and you need to add those together. So you shouldn't just look at the list and if you see one payment, assume that's the only payment because this is information that included both 2009 and 2010.
Mike: Go ahead and put the next question through from Eric Whitney. And he asks: what kind of feedback are we getting from the readers?
Tracy: We have been getting great feedback from the readers; many, many, many hits on the database because people have been curious to find out. I think people are just generally curious to see if their doctor is among this group. I think there has been a little confusion about, but this is just seven drug companies. And then people are saying, well I know my doctor gets money from Amgen and it's not in there. And they haven't looked at the caveats to say this is just seven of the companies so far. But we have had a lot of it has created a very interesting conversation about the issue and what to do once you know your doctor is on there and it doesn't matter whether or not the doctor makes one thousand or one hundred thousand and at what level.
But most folks said, they see it as a red flag that they can have a discussion with their doctor. It may mean that they are happy and they have got a great explanation from their doctor or it could mean that they need to ask more questions.
Charlie: We got another question about: Tracy had mentioned earlier that you should look to see if the your doctor is speaking for CME or if they have disclosed that they have stock in a company and how do you do that?
One of the easiest ways to do that is to type in the doctor's name and to add CME or disclosure or speaker in a Google search and you turn up quite a bit that way. You can also, as Tracy mentioned, search in PubMed and at the end of research articles the disclosures are included in that, but we found quite a bit by doing just basic Google searches.
Tracy: I have to add a caveat to my CME thing. I did speak with one very prominent researcher who believes that he only has to disclose his conflicts that have to do with the medications or conditions that he is lecturing on or doing research on. So I was asking him why he had different disclosures in the same year, and his university backs him up on that. So it may not be at an entirety, but it is a good place to start when you call him up to talk.
Mike: OK. Let the next question through, it is from Robin Adams.
Robin: Yes. Hi, I'm with the Ledger in Lakeland. My question was about how you determined what payments to leave out in doing your total. This involves Dr. Gameel Hodge, who is on your list, all of his payments were from GSK, the $77,950 that he is shown as the payee. Now the question, there is also a breakdown of $25,500 going to Gryphon Consultants, which is a private company. I know you had said in your notes that if money went to a medical group, a group of doctors, you wouldn't include it. I wondered how you handled some of these private company type situations, which incidentally the hospital that employed him knew nothing about?
Charlie: So I would definitely ask additional questions based on your last comment, but how did we decide to include companies where the payee as it's known is different from the person's name.
What we excluded were payments for instance from Eli Lilly in which the payment encompassed the work of more than one doctor. So Eli Lilly sometimes made a payment to a group for the work of two doctors or three doctors, in this case with Dr. Hodge, the payment even though was to a different payee and it may have been a company that he created, it was only for his work and that's why he would be included.
Robin: OK. Excellent. Thank you.
Charlie: 21:28 I have a couple of questions on email. One is: why was there such a variance in the amounts spent by company and can this data be believed?
That's a very good question. And I think part of this is that it's still shaking out. I mean clearly companies spend different amounts on this, but when you have companies that have reported over six quarters and companies that have reported over only two quarters, it is difficult to draw any major conclusions about it.
What I mean by that is Merck and Pfizer and AstraZeneca and Johnson &Johnson have each only reported for two quarters, where Cephalon (2009 and 2010) has reported for six and GSK (2009 and 2010) and Lilly (2009 and 2010) have each reported for five. I think we need to see more data, and then I think we can look at the trends.
Also, it is important to take into consideration that some of these companies like for instance Merck and AstraZeneca have not yet reported payments for consulting. They are only reporting payments for speaking. Some are also not including travel and meals in there. So if we are comparing apples to apples, that is one thing. But right now, we don't know if the two quarters Merck disclosed payments for, the third and fourth quarter of 2009, if that matched their average spending in the first two quarters or if they did most of their spending in the first two quarters.
So I think we will learn a lot more within the next half year or so, and once we have the full year 2010 for these companies, then we can start looking at them again and answering your question.
Tracy: But I also think that you need to take into consideration that companies spend more when they have new conditions coming, or new drugs coming out, or when they are making a new marketing push. And so according to some of the doctors I spoke to, work a whole bunch for a period of time and they maybe don't work for two quarters. So there is unevenness in the payments based on the cycle of marketing.
Mike: OK. I have a question from Stacy Singer from the Palm Beach Post. And she is wondering if anyone has explored whether there is a relationship between over prescribing drugs and payments for lecturing on those drugs? She says it is implied in the story, but wants to know if there is explicit evidence.
Tracy: This database is supposed to be transparent, but what it leaves out is the closing the loop of, OK so you have a doctor who is getting money from a drug company, you know how much money that is, but you simply don't know what drugs he prescribes and how much of it he prescribes. And so it is very difficult to draw conclusions on how his speaking fees might influence his personal prescribing. But there has been a raft of recent lawsuits against some of the biggest pharmaceutical companies and a lot of those have settled within the last three years. I mean in the last three years alone, the pharmaceutical companies have paid out seven billion in settlements on these cases and some have pleaded guilty to crimes.
The details in those suits show that sort of detailed some of the answers, some of those questions at least for certain periods and at least for certain drugs. These suits are off-label marketing of drugs; those would be marketing for uses that are not approved by the FDA. And they detail how speaking payments and consulting payments were often just rewards for prescribing.
They gave one example in one of the suits about a group of doctors in Illinois who they met two nights a week at the same restaurant speaking to the same group of doctors, and they were paid for speaking. Some speakers were paid to speak to one person. One company paid doctors to go through speaker training with no intention of ever having them speak.
Allergan had their top injectors according to prosecutors go out to Newport Beach for an advisory board meeting at an ocean front hotel. And so there are some indications in these lawsuits that in some cases there is a connection.
Charlie: Just to add one thing to what Tracy said, all total these companies have paid nearly seven billion to settle these cases and a number of them have pleaded guilty to criminal counts, but for the most part they deny misconduct in their press releases that go along with the settlements.
Mike: OK. Charlie, why don't we go to another email question.
Charlie: Sure. One question is from Laura Newman. I am interested to know whether you are able to correlate payments to drug prescribing patterns, e.g. specific blockbuster drugs? And no, that's not possible, prescribing data is not a public record and it is kept really closely by the industry, not shared with reporters or the public.
So something like that at least so far has not been done. And I think if reporters or others can get to that question, that's an important question and one that can help guide a lot of conversations.
Mike: OK. It sounds like Getahn Ward from The Tennessean.
Getahn Ward: In terms of specialties, was there any correlation where we saw the highest payments in?
Charlie: Well, I think you can actually go to our list of top earners and sort it by specialty and take a look at the specialties. If not, we included the medical specialties for those who made more than $100,000. And I think you see certain specialties showing up in a regularly endocrinologist, psychiatrists, pain physicians, cardiologists. It is worth taking a look down the list and seeing the numbers that jump out to you.
Tracy: I have a caveat to that too though. Because this is the seven companies, these companies might be the ones that are making the drugs for those specialties. And that as we add companies, other specialties might appear much more frequently based on what drugs those companies make.
Charlie: So there is another related question that came from Kelsey Heinz from the American College of Cardiology about searching by specialty. The companies have not in their reports included for the most part the specialties that these doctors are in. And so when it came time for us to put this together as Tracy indicated, we were relying on looking these doctors up individually in the American Board of Medical Specialties, in the AMA database.
It is time consuming and so for all doctors, we certainly were not able to do that, but for the doctors that are there, if you are not able to search by specialty, we can talk to our folks about making that a search.
Mike: Do you have another e-mail question, Charlie?
Charlie: Yes, OK. Here is a question from Jeff Hansel who says: when I ask about this type of conflict, a physician will say that she or he speaks about a topic rather than about a drug. Such doctors say that it is not a conflict to accept money for time to provide education about a condition such as high pressure, for example, what are your thoughts?
That's a good question Jeff. And one of the things we have heard quite a bit actually recently is that for the most part, physicians now are having to use slides provided to them by the drug companies for their presentations, and have very little ability to go off message, to change slides up or to alter the scripts that the companies provide.
Doctors themselves have been telling us that when they are speaking for a single drug company, it is quite likely that even if it's just a couple of slides that they mention about the drug, it will be about the company's drug, not necessarily trying to promote their competitor's drugs. So I don't know if that totally gets to your question, but increasingly because of these lawsuits that have been settled, there is a lot more oversight and control over the slides that can be presented, and it's the companies that are deciding the content of those slides.
Mike: Charlie is going to do another email question.
Charlie: This is a question from our former intern Joe in Dallas. Hi Joe. What's the best way to localize the story if I am not necessarily a data savvy reporter? Fortunately for you Joe, you are a data savvy reporter. So you can localize in any way you want, but for others who are not data savvy, what we tried to do with the database was make it as intuitive and user friendly as possible.
You can look at it by state and then within a state, you can look for a city within that state. You can talk to doctors and ask them about what it is that they present, why it is that they participate with the companies, whether they provide this information to their patients and how they factor that in, how they think that their patients benefit from speaking on behalf of the companies.
And whether or not their institutions place any limits on them, I think you heard from one of the questioner's earlier that when she started asking questions about a doctor, Dr. Hodge that the doctor's institution didn't know about that. So certainly checking to see whether or not institutions know about the speaking roles of their faculty is one question that you could pursue.
Tracy: I'd also say that it would be helpful if you are localizing to ask other doctors in the area about that doctor, if it's a doctor that makes a lot of money as a speaker. One thing we found is that all of the pharmaceutical companies say that these are top experts, the most respected guys in their field, respected by their peers, publish a lot of research, members of associations. And in several cases, we found that we could find almost nothing on some of the top-paid speakers, but also that their colleagues around the country had no idea who they were, even sometimes in their own towns had no real sense of their qualifications. So it is interesting to talk to physicians in the area, and just so you know, sometimes the wives don't even know that they are making speaker money.
Mike: That sounds like trouble to me, but I am going to move on to the next question from the Charlotte Observer. And her question is-how do you aggregate payments for individual doctors in this study?
Charlie: Karen, we did this for the doctors who made more than $100, 000, but this goes back to what Tracy was saying at the beginning about you are having to check the identities. And that if two names look the same, go to your state medical board for instance and see are there two doctors by that name in your state. If there are no doctors by that name in your state, it could be a registered nurse, it could be a pharmacist, it could be a dietitian.
Look to see if the city that's in the state medical board database matches the city that you have in your database, and even call the doctor as we did on more than one occasion to ask whether or not it was indeed that doctor. Typically, if the doctor was the only doctor with that name in the medical board website and they often do provide middle initials, they provide the name of the clinic that they work at. It becomes easy to add those together and say that you are dealing with a definitive match, but it does require a little bit of work.
Tracy: Also, we had two separate cases of father son doctors, and the "Jr." and "Sr." are not always included and those are something you got to find out on yourself and be very careful.
Mike: We have a question from Paul from the Green Bay Press Gazette. Paul, are you there?
Paul: I'm there or here.
Mike: Go ahead.
Paul: I'd like you to be able to talk a little bit more about some of these services these doctors are doing for this money. I don't know specifically when you are talk about honoraria; I don't know what that means. I don't know what health care education program is. When we have professional advising or expert led forums, are we necessarily talking about a doctor doing some advocacy for the company or he might be talking to members of the company about a condition, talking to researchers about a condition? What is investigator initiated research mean and in what way is that compensated?
Charlie: Yeah, the terms. So these are the company's terms, these are not our terms. And each company on its website and we can try to add this to our website, and we had intended to, has a glossary of the terms that they use and what they mean. And so what an expert led forum essentially is speaking to other doctors. And we can try to add that to our site, but you can also go to the individual company sites and look at their glossary of terms as it relates to the companies. We are happy to send around after this call a list of links to all the call participants with the links to each individual company's transparency sites so you can get the information directly from those sites as well.
Paul: The implication of the website I guess is that we are wondering whether the doctors are getting compensated for advocating a certain drug or prescribing a drug, but I guess what I am wondering about since I don't know anything about doctors giving talks to other doctors on behalf of a drug company, does that automatically mean that they are talking about their drug? I mean is there room in all of this for an innocent application of that money. Look, we like these guys' expertise, we are not really going to be talking about him using our product, but we want him to talk about neurology or something or doesn't that happen?
Charlie: We are not at all meaning to suggest that this is for nefarious purposes or that this is wrong or that this is illegal or anything like that. It's not the case. I think what we are suggesting is that these things that folks should ask their doctors about and journalists should ask doctors in their area about.
So there are sessions where speakers talk about general topics like advances in fibromyalgia. Typically they are put on by companies that have a drug in fibromyalgia that they are trying to promote, and so while this session itself maybe generally about the topic, the idea is to educate doctors about the area so that they are more equipped to diagnose fibromyalgia and perhaps recommend a drug to treat it.
You don't see a company that for instance doesn't have an Alzheimer's drug holding sessions on Alzheimer's disease. The companies have an interest in the topics that they are putting into research and development funds for and they are speaking on that. There have been a number of articles and such which say that if the companies didn't feel that they were getting an adequate return on their investments that they would not be investing in this area.
Paul: Sure, thanks.
Mike: OK. We have Sean Wickman. Hi, go ahead.
Sean: Hi. And I am wondering if there is anything in the AMA Code of Ethics. I was trying to read through that today that addresses this issue of a potential conflict of interest in these payments. Pharma seems to have a code from the perspective of a pharmaceutical companies, but I am looking to see if there is something that sort of addresses that, so you could use that code to match up behavior and the answers to some of the questions of whether they are living up to that code. I don't see anything in the code that actually addresses that issue, did you folks come up...?
Charlie: That's a great question, I don't know the answer to that. And I think it is worthwhile to look at. You are right that Pharma does have a code that deals with interactions with health care professionals. It was drafted. It was edited in 2002 and re-edited in 2008. It got a lot of attention because it eliminated things like pens and sticky notes and beanie babies that were going to doctors as well as trips to resorts or expensive restaurants, but it still included speaking and consulting. One of the things you see is that a number of major academic medical centers are banning such procedures. And when you talk to them, they explain their justification that they are concerned about it, and it could be a local story to ask if they are doing it, but I would encourage you to call the AMA directly and ask for their code and send us an email and let us know what...
Sean: I did that.
Charlie: Let us know what they say, if they respond to your question too.
Sean: Thanks. I am still waiting on the call back. [laughter]
Charlie: We have an email question.
Charlie: Yes, from Daniel Lathrop at the Dallas Morning News. How hard is it to find connections between these doctors and where they have privileges?
Tracy: You know, it totally varies according to the doctor. Some doctors if you are Google searching them, you can pull right on up which hospitals they are at. Usually if they are academic medical centers, sometimes you just have to call the doctor directly and ask them where they have privileges. It is not something that is typically posted anywhere and lots of doctors have privileges at a number of different area hospitals.
Charlie: I found that sometimes the State of Florida, if there is anybody here from Florida, I think Stacy is, that the Florida Medical Board actually has where doctors have privileges, but that is a vast minority of medical boards that get into where doctors have privileges. So consider yourself lucky in Florida. I also found that sometimes they are listed on like the vitals.com profiles or other health profile websites, but I'd be really cautious, I'd never reprint that without verifying it with the hospital or with the doctor.
Mike: OK. I have got another question from Peter Aldhous. Peter has a question about the arrangements for obtaining the data sets. Are there plans to update the data?
Charlie: Yes, Peter. When we launched this we thought it was really important that it not just be a static feature that wouldn't be updated. ProPublica is going to devote considerable resources to keeping this database up to date as new companies come online. Three have already agreed that they are going to start posting data next year, Forest, Novartis and Allergan and the existing companies are going to be updating their data as well. So over coming months we are going to be trying to include those updates as quickly as we possibly can and make them freely available to the public as well. One thing you can do is sign up on our website to get data updates on this application, so you can get an email directly from us as soon as we update the data.
Peter: So, what I was specifically asking was when I said arrangements to obtain the data, was whether you have any plans and we too greatly encourage you to do so, to make the entire data set available for download or provide it offline to reporters who want to use it without the interface of the web search form, and to be able to relate it to other databases as well.
Charlie: We have had some conversations about that. I think one of our big concerns has to do with the fact that this data is changing, oftentimes by the month. And that any data set that we would share with a reporter the next month would be out of date. And we are concerned about having multiple databases, at least that we are providing, floating around the Internet potentially being used on websites and then not updated. And I actually think that does more of a disservice to consumers than keeping it on our site. So I think we made a decision that we are going to keep it on our site, keep it completely searchable and transparent. And if there are ways that you think we can make it more so, we are certainly interested in hearing those.
But for the moment, I think we are concerned about the negative effects of sharing the raw data and the fact that it could potentially have multiple copies of the same data set.
Peter: There is a precedence, if you look to the State of Florida, the State of Florida makes its entire medical board database available for download on a weekly basis.
Charlie: Well, it is something we talk about, and I don't think it is ruled out of consideration for the future, but for the moment I think it is something that we are not planning to do.
Mike: OK. We have a question from Darcy.
Darcy: OK. My question is, I know we were talking about the seven billion dollars in settlement payouts that some of the pharmaceutical companies have made, and I believe that's through Department of Justice cases. Is there in your project a link anywhere to figure out whether a particular doctor has been tied to any of those settlements?
Charlie: That's a great question, Darcy. We, in our sidebar, which we can send you a link to after the call, we have actually embedded within it the links to each of the lawsuits that resulted in the settlement so that you can have an opportunity to look in those yourself. We haven't created a database that mentions individual doctors. And one thing I would say is that, most of these suits do not mention individual doctors; they may refer to Dr. A or Dr. B. A couple of them do mention individual doctors. We saw individual doctors who were mentioned in a case involving AstraZeneca for instance. And that allowed us to follow up when they started disclosing their payments and we found that some of the doctors who were mentioned, were also doctors who were still getting payments.
So, we are happy to send you the link to that sidebar and you can read those documents yourself. We wanted to make them as freely available as possible.
Tracy: I also wanted to say that one thing that in these suits, they are usually filed by a former drug company employee, usually a sales representative who notices behavior like the off label promotion of drugs and files a federal whistle blower suit. And these suits take quite a long time. And once they are joined by the Federal Government, it is all secret until it's settled or adjudicated in some way.
And when these cases are settled, all of the documents involved are returned to the drug companies. So for folks like us who are interested in maybe seeing all of the evidence in these cases, in the exhibits, in the transcripts, and all that kind of stuff, you don't get to see that. And it is not available. While some of the complaints make public some of the names of the physicians involved, many of them just go by one doctor and another doctor. So you are not able to find that information out.
Charlie: I have an email question from Lindy Washburn. Hi, Lindy. What's next for us and is this the beginning, and are we going to be looking at more companies as they come out, medical devices or what else? We made a decision at the start not to include medical devices in our database because it is so different from the pharmaceutical industry. And in the medical device industry, a lot of the payments have to do with royalties, and that's for sort of an inventor share for coming up with the device.
And we thought they were different enough that it would be tough to connect it in our database. I know that there is another database run by PharmaShine, which does charge a fee beyond a couple searches a month that does include the medical device manufacturers, and some of them do post that online. So it may be worth getting in touch with them if you are interested in looking at doctors who receive payments from medical device companies.
Linn: Yes. The question is, is there a way that this database can get into the conflicts of interest that maybe implicit in this study, because many doctors are quite defensive about these contacts that they have and are not willing to admit that they have really developed a corporate ethic that goes beyond anything that has to do with prescribing particular drugs, that it has to do with the relationships they have with corporate executives on an ongoing basis.
Charlie: We want to keep adding to our database and encouraging reporters to ask questions about it, not necessarily in a negative way, but to ask about the conflicts that you refer to in relationships that exist. And we think that asking questions based on the data is a key thing, it is a good thing. People should be doing that and people should be asking questions beyond just: are you prescribing these things, but going to the heart of what you just raised as well.
And we have another online question from John Mack about we mentioned that Pharma companies do not report these data in a consistent or transparent manner. And we also questioned the wisdom of distributing our own database because of having multiple versions which could be confusing. Perhaps this is why some pharma companies release the data in non-transparent ways. Should pharma companies make the raw data available or they continue to be translucent?
By translucent, I think you mean difficult to analyze, download, and look at. The only reason that we are not distributing our database again as a flat file, is that we want to just make sure it is up-to-date. And I think the reason that the pharma companies perhaps are organizing it the way they do is that you can't see who the top speaker is.
In our database, you can see the most payments and organize it by state, by city, by area, by doctor; alphabetically, by amount, you can do a whole lot of calculations. And I would argue that certainly the way that we have put the data up is not translucent at all. I do think that every pharmaceutical company should be putting this up in raw data and that anybody can download. And I think that would solve some of the problems that Peter raised as well.
And one other thing about that is that in 2013, the Physician Payments Sunshine Act will require that every pharmaceutical company report this information to the Federal Government and will be put up on a website that will hopefully be sortable and scalable and that folks can use. And I think that will make our database obsolete and we welcome that in fact.
Mike: All right everyone, well we thank you so much for joining us. And as Charlie said, this is just the beginning of the series that we are going to continue. Thank you, Tracy. Thank you, Charlie and everyone on the call.
Charlie: Thanks, Mike. Thanks everybody for joining us.
Mike: Bye bye.
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Transcription by CastingWords