On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country.
The information is being made public under a provision of the 2010 Affordable Care Act. The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research.
It's not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That's because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project.
We've aggregated information from the websites of some large drug companies, which publish their payments as a condition of settling federal whistle-blower lawsuits alleging improper marketing or kickbacks. Today, in cooperation with the website Pharmashine, we've added data for 2013, which now covers 17 drug companies accounting for half of United States drug sales that year. (You can look up your doctor using our easy search tool.)
Here are some facts we've learned from the data.
Many, many health professionals have relationships with industry.
Dollars for Docs now includes 3.4 million payments since 2009, totaling more than $4 billion, of which $2.5 billion was for research. For 2013 alone, there were 1.2 million payments valued at nearly $1.4 billion.
It's not possible to calculate the exact number of physicians represented, because drug companies haven't used unique identification numbers that cross company lines. But it's clear that the figure is in the hundreds of thousands.
Excluding research payments, the drugmaker Pfizer appeared to have interactions with the most health care professionals last year — about 142,600. AstraZeneca came in second with about 111,200. Johnson & Johnson and Forest Labs each had nearly 100,000. There are an estimated 800,000 to 900,000 active doctors in the United States.
"Most physicians that are in private practice are touched in some way" by the industry, said George Dunston, co-founder of Obsidian HDS, the creator of Pharmashine.
Surveys conducted in 2004 and again in 2009 showed that more than three-quarters of doctors had at least one type of financial relationship with a drug or medical device company. The figure dropped from about 94 percent in 2004 to 84 percent in 2009, said the lead author, Eric Campbell, a professor of medicine at Harvard Medical School and director of research at the Mongan Institute for Health Policy at Massachusetts General Hospital.
Dr. Campbell, who has been critical of physician-industry ties, says he hasn't conducted a follow-up survey but suspects that the percentage of doctors receiving payments has probably decreased somewhat since then.
"I think they're being much more targeted and specific," he said.
Some doctors have relationships with many companies.
Those who read the fine-print disclosures accompanying medical journal articles know that doctors often have relationships with several companies that compete in a drug category (such as heart drugs or those for schizophrenia). Our data bear that out.
Some highly sought-after key opinion leaders, as they are known in the industry, work for half a dozen or more companies in a given year.
Dr. Marc Cohen, chief of cardiology at Newark Beth Israel Medical Center, received more than $270,000 last year for speaking or consulting for six companies listed in Dollars for Docs. He is a prolific researcher and author.
In an interview, Cohen said he works only with companies whose drugs are backed by large clinical studies. "In general terms, the science behind the product is very strong," he said.
The biggest companies aren't always the ones that spend the most. Some smaller drug companies spend big, too.
Consider Forest Labs, a midsize drug company that was acquired in July by Actavis, a larger company based in Dublin. Forest's $3.8 billion in United States drug sales in 2013 placed it on the edge of the top 20 companies, according to IMS Health, a health information company.
Its sales were far lower than those of Novartis and Pfizer, the top two companies by sales last year. Yet Forest easily outspent these competitors on promotional speaking events last year.
Forest spent $32.3 million on paid talks in 2013, compared with $12.7 million for Novartis and $12.6 million for Pfizer.
An Actavis spokesman declined to comment on the company's strategy, but a Forest spokesman said last year that the company spent more on speakers because it didn't use pricey direct-to-consumer TV marketing. It also had more new drugs than its competitors.
Companies with newer drugs or newly approved uses for their existing drugs often seem to spend more. Companies that don't have many new products or have lost patent protection on their drugs, or are about to lose it, tend to pull back.
"A lot of this has to do with where companies are in their development cycle of new products or emerging products, rather than an industry-specific trend," said John Murphy, assistant general counsel at the Pharmaceutical Research and Manufacturers of America, an industry trade group.
Meals vastly outnumber all other interactions between drug companies and doctors. But they account for a much smaller share of costs.
Food accounted for nearly 50,000 of Amgen's 55,000 payment reports, excluding research, in 2013, or roughly 91 percent. But at a cost of $3.1 million, those meals represented only about 20 percent of its payments. By comparison, the company spent almost double that amount, $6 million, on just 600 physician speakers.
Other companies followed the same pattern; speakers can command $2,000 to $3,000 per engagement, or more.
Given doctors' busy schedules treating patients, mealtimes are often the only time to reach them, said Murphy, PhRMA's lawyer.
Researchers say that whatever the motivation, even small gifts or meals can influence a doctor's perception of a drug and lead to more prescribing of it.
ProPublica is a nonprofit investigative reporting newsroom based in New York.
9(MDE1MTIxMDg0MDE0MDQ3NTY3MzkzMzY1NA001))
Transcript
ROBERT SIEGEL, HOST:
Now, how much money companies that make drugs and medical devices spend than on M.D.'s and other medical professionals. The Affordable Care Act requires those companies to report payments that they make to doctors, and tomorrow the federal government is expected to release a lot of new data. One group that will be scrutinizing the data is ProPublica, the nonprofit investigative newsroom. ProPublica's Dollar for Docs project has been monitoring drug-industry payments for the past four years and joining us to talk about it is Charles Ornstein of ProPublica. Welcome.
CHARLES ORNSTEIN: Thanks, Robert.
SIEGEL: First, what's your best estimate of how much the pharmaceutical companies pay doctors, not in support of research but for other purposes?
ORNSTEIN: I think that's pretty clear that we're talking about billions of dollars a year that go to things like promotional speakers, consulting, meals and there's a whole list of other things that don't constitute research.
SIEGEL: Does a relatively small share of the medical profession receive most of the drug money or is it spread around a large number of doctors?
ORNSTEIN: What we've found as we've looked at our Dollars for Docs data is that hundreds of thousands of doctors get some form of payments. Most of those are just small meals. They are a relatively small group of doctors who receive a lot of money. And by a lot of money, I'm talking about individually hundreds of thousands of dollars a year.
SIEGEL: And what is tomorrow's federal reporting likely to show or what questions do you hope it will answer?
ORNSTEIN: Well, going back years and years, there's been this sort of opacity surrounding, what drug companies spend on doctors and who receives the money? So I think we will begin to answer that question tomorrow. There's some problems with this federal release. First of all, we're only going to see the data from the last five months of 2013. So you're not going to get a full picture. But we're going to begin to fill in some of the blanks that we haven't seen until now.
SIEGEL: Now, the criticism of doctor's taking money from drug companies is that they will effectively endorse a product, not just because of its efficacy, but because they've been paid to do that. How do doctors typically respond to that criticism?
ORNSTEIN: Well, many doctors view that as an assault on their professionalism saying that they would never compromise the patient in front of them for a meal, or a pen or even money to speak on behalf of the drug. But there's a whole body of research that suggests that payments do have an effect on doctors and the way that they think about the industry and particular drugs. And a number of critics of the practice say the pharmaceutical industry, which is a money-making business, would not spend hundreds of millions or billions of dollars on this if it weren't returning a reward to them.
SIEGEL: You quote a cardiologist from Newark, New Jersey as defending his fair-size income from drug companies, I gather - over $200,000.
ORNSTEIN: He received $270,000 from just six of the companies that we track. So it's possible he made more than that. I think he thinks that he only speaks on behalf of drugs for which there is a robust body of clinical evidence. But when you talk to outside experts, what they say is if you make so much money that perhaps your second home, or your vacations or your child's college tuition is dependent upon your relations with industry, how independent can you truly be? And are you likely to prescribe a drug that perhaps your patients don't need or convince other doctors to do that?
SIEGEL: Your website says that the Dollars for Docs project of ProPublica has been consulted more than 800 million times the last four years. What are patients learning and how are they reacting to the information that you provide them with?
ORNSTEIN: Look, I think some patients go into it and just implicitly trust their doctors. And that's fine. I think patients should be able to have whatever relationships they want with their physicians. But there are a number of patients who have doubts about what their doctors are prescribing for them. And I think for those patients, if they see that their doctor prescribed a drug that they already have questions about and then subsequently see that their doctors getting money from that company, sometimes it causes a patient to find another doctor. But the very act of having the information is very empowering to patients because then they actually are a party to all of the information that goes into the transaction.
SIEGEL: Charles Ornstein, thanks for talking with us.
ORNSTEIN: Thanks very much.
SIEGEL: Charles Ornsetin of ProPublica on the organization's Dollars for Doctors research. Tomorrow the federal government is set to release new data about payments to doctors by drug and medical device companies. Transcript provided by NPR, Copyright NPR.
300x250 Ad
300x250 Ad