Posted On: September 18, 2011 by Patrick A. Malone

Dollars for Docs: Learn How the Big Bucks Flow from Drug Manufacturers

In 2013, by law all drug and medical-device companies will be required to report to the federal government how much they spent promoting their products. It’s a long-overdue effort to shine a cleansing light into the murky closets of Big Pharma.

The figures will reflect not only expenses for advertising but fees for doctors who are paid to speak about their wares in what are often described as "educational" seminars.

Until 2009, such pharmaceutical company payments were not disclosed. But the enormous sums came to light under pressure from lawmakers or as a condition for settling federal whistle-blower lawsuits. Some companies have reported the first full year’s payments, and thanks to the stark comparisons of how much they paid, some appear to be tightening their purse strings.

As described in a series of articles by the investigative service Pro Publica, this world of conflicting interests is wide and deep and soon to be accessible to any patient who wants to check up on the professionals who treat them.

In its recent gob-smacking dish, Pro Publica reports that eight pharmaceutical companies, including the nation's three largest, doled out more than $220 million last year to promotional speakers for their products. Industry leader Pfizer, with drug sales of $26.2 billion last year, spent $34.4 million on speakers, ranking third among the eight companies. Eli Lilly and Co. spent the most on speakers, $61.5 million, and had about half the sales of Pfizer.

The data about payments to health professionals in 2010 published by Pro Publica also includes information about expenditures for travel, meals and other perks that encourage people to think nice things about the companies that make their lives so comfortable.

Some companies have reduced their doctor-payment budgets since disclosure has become common. Cephalon paid physicians nearly $9.3 million in 2009 for speaking and consulting, and $5 million last year. AstraZeneca cut speaker spending from about $22.8 million in the first half of 2010 to about $9.2 million in the second half.

And, no surprise, some physicians have reduced their shill-for-pills work in the bright light of public disclosure. One pulmonologist was paid at least $88,000 for promotional talks on behalf of GlaxoSmithKline in 2009, but last year she declined the work out of concern that patients would think her advice was tainted.

And that’s the bottom line for patients: Can you trust the advice or treatment of someone who is paid by companies whose products are vying for a role in your care?

Like the hematologist who was paid $49,250 from Cephalon in 2009, and $177,800 (plus $35,500 for travel) in 2010? Is it any wonder that he didn’t return calls from Pro Publica’s reporters?

One pain specialist who spoke and consulted for four companies has earned $522,113 since 2009. In a companion commentary published in the Los Angeles Times, the Pro Publica reporters noted that this anesthesiologist’s slides identified him as the director of pain management at a well-known urban hospital. But that hospital’s spokesman said the physician has never held that title and that his pain clinic is not part of the hospital, even though he does have admitting and treating privileges.

He didn’t return calls either.

Maybe the poster girl for questionable behavior courtesy Big Pharma is Dr. Christiana Goh Bardon, who, as Pro Publica reports, “runs a hedge fund in Boston that bets on the rise and fall of health-care companies. She was paid nearly $308,000 to ‘provide input on our BioTherapeutics business development plan,’ Pfizer spokeswoman Kristen Neese wrote in an email.

“Bardon, who started her hedge fund after her Pfizer contract ended, was required to sign a confidentiality agreement and not allowed to invest in Pfizer or any of the biotech companies that Pfizer was looking at acquiring or partnering with for projects, Neese said.

“Bardon said in a voice-mail message that she does not currently practice as a physician and her work was based on her business acumen.”

From a patient safety point of view, business and medicine do not make a happy marriage. It’s in patients’ best interest to know who and what are influencing their doctors’ decisions. Until 2013 when all companies post their payments for your review, ask your doctor if he or she is being paid by pharmaceutical or device manufacturers. If you’re prescribed a drug, ask if there’s a generic or older version available, and if it has more side effects than a competitor’s drugs.

You can also review your state’s medical licensing board website for disciplinary or criminal issues your physician might have had.

To see if your physician has been on the Big Pharma payroll, search the Pro Publica database called Dollars for Docs at http://projects.propublica.org/docdollars/.


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