It's no secret that many doctors get paid by pharmaceutical companies to talk to other docs—about general conditions, research trends or specific drugs—or to provide expertise for company research. But what has long been undisclosed is the amount of money that these drugmakers were giving physicians for their time.
Thanks in part to some high-profile U.S. federal court settlements, some of that information has started to come into public view. But because payment information has been reported differently by different companies, it's been hard to glean a clear sense of just how much money many of these doctors were making. Although figures on prescription patterns are difficult to obtain, many worry that money, meals and trips from pharmaceutical companies could bias doctors' prescribing habits.
A new "Dollars for Docs" database, assembled in part by the investigative journalism organization ProPublica, now allows people to look up the names of their health provider to see how much they might have collected recently from some of the major pharmaceutical companies—a figure that might have been unclear even to the doctors themselves, Tracy Weber, a ProPublica reporter who worked on the project, said in a conference call on Thursday.
In all, the data cover some $257.8 million dollars in pharma payments to doctors made since the beginning of 2009.
The totals in the database, however, are not the full picture. In fact, only seven of the dozens of drug-makers that give speaking awards and other honoraria to doctors, have made their payments public. The companies included in the database (AstraZeneca, Cephalon, GlaxoSmithKline, Johnson & Johnson, Lilly, Merck and Pfizer) make up a little more than a third of all prescription drug sales in the U.S. in 2009, Charles Ornstein, a ProPublica senior reporter and collaborator on the project, noted during the call.
Although the group went to great lengths to standardize the data, some companies provided only six months of payment data whereas others have supplied as much as a year and a half's worth, making totals inconsistent. And the types of payments reported are not yet the same for all companies (with some listing only fees for speaking engagement and consulting and others including pay for travel and meals).
So although a quick doctor search might pull up a few thousand dollars—or a few hundred thousand dollars, in some docs' cases—in drug money, without more consistent and long-term data, "it's difficult to draw any broader conclusions," Ornstein said. He and Weber also cautioned database users to be careful when adding up a doctor's dollars as many clinicians—even those in the same state—can have the same name, or a doctor might be listed in some cases with a middle initial and in others without (or with a different initial altogether).
With only a handful of companies reporting on their monies flowing to physicians so far, though, many doctors might not yet be on the ProPublica list, and those who are might only be shown as receiving a portion of what they actually have taken in.
As Ornstein and Weber pointed out during a conference call on October 21, just because a pharmaceutical company is paying a doctor to speak on its behalf, doesn't mean the doctor is tainted and will be more likely to prescribe the company's drug. And because data on how much a doctor prescribes a particular medication are not public, it is difficult to draw simple conclusions about the impact of this money on doctors' drug-doling habits. Rather this information should prompt "important conversations" between patient and doctor, Ornstein noted. Previous research has shown, however, that something as simple as seeing a drug's name on a notepad can sway medical students toward prescribing that treatment.
And, Weber said, as court documents have made clear, drug companies seem to have firm control over the content of drug company-funded talks—providing presentation slides and scripts that often at least mention a company's drugs. Some doctors were paid handsomely for speaking to an audience of one, and others were paid to be trained by a company that had no intention of sending them out to talk. ProPublica's report also revealed that many of the doctors who were backed with pharma money lacked proper specialist credentials for the field they were discussing or were even under investigation for medical or other misconduct.
ProPublica plans to update the database as more figures become available in the future. But with the inclusion of the Physician Payment Sunshine Act in the recent healthcare overhaul, all payments to doctors from pharma companies will be required to be made public by 2013. "That will make our database obsolete," Ornstein said. "We welcome that."
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