69 Wisconsin doctors show up on Pfizer payroll - JSOnline

Posted: April 8, 2010 |(7) Comments

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An occassional series examining doctors, drug companies and conflicts of interest.

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• Senate hearing details influence of drug companies in doctor education
• Some UW doctors get 6-figure sums from drug, medical firms

Sixty-nine Wisconsin doctors were on the payroll of the world's largest drug company, Pfizer, during the last six months of 2009, working as speakers, consultants and researchers and pulling in more than $200,000 combined, according to a list made public by the company.

Topping the list of doctors who worked primarily as Pfizer speakers were Pamela Wilson, a retired Madison doctor who got $42,000 for the six-month period, and Daniel Duffy, a Cedarburg family practice doctor who got about $17,000.

Nationally, the average pay for a Pfizer speaker during that time period was $3,400.

During nine months last year, Duffy also pulled in about $50,000, mostly as a speaker, from Eli Lilly, which recently made public its doctor payments, according to the Lilly list.

Promotional speaking for drug companies can lead to biased information being delivered to other doctors who are expected to write more prescriptions for expensive brand-name drugs after hearing the talks, critics say.

The payments come as Pfizer joins Lilly and three other drug companies that in recent months have revealed payments to doctors, a practice that eventually will be mandated for all drug and medical device companies as part of the health care overhaul signed into law last month.

Together, the legislation and the drug company lists create a higher level of transparency for patients who, for the first time, can find out if the drugs they are on are being prescribed by doctors who are moonlighting for the companies that make the medicines.

But shining a light on the problem doesn't end it, doctors say.

"Some will always step up and take the money if the drug companies are offering it," said Norman Fost, director of the bioethics program at the University of Wisconsin School of Medicine and Public Health.

The law, which was co-sponsored by Sen. Herb Kohl (D-Wis.) and Sen. Chuck Grassley (R-Iowa), is designed to expose doctor conflicts of interest by requiring drug and medical device companies to report all gifts and payments to the U.S. Department of Health and Human Services.

The department will post the information on a Web site and can levy fines of up to $150,000 a year on companies that don't comply with the law.

Drug company payments to doctors have become a huge industry, Kohl said in an interview.

"Patients have every right to be aware of what their doctors are receiving," said Kohl, who has been trying to get the Physicians Payments Sunshine Act passed since 2006. Grassley and Kohl have been investigating financial relationships between doctors and the drug and medical device industry.

While the legislation won't take effect until 2013, the preliminary lists put out by Pfizer, which made its list public last week, and four other companies provide the first real insight into the pervasiveness of conflicts of interest by doctors moonlighting for drug companies.

The names of nearly 200 Wisconsin doctors and 15,000 nationally show up on the lists of just those five companies.

Doctors cautioned that merely creating lists of drug company payments to doctors does not put an end to the misleading, costly and potentially harmful information that can come when doctors are used to promote expensive drugs.

"Most of the major pharmaceutical companies have shown they are not trustworthy," Fost said.

In the last few years, several drug companies have been investigated by the federal government for illegal promotion of their medications, leading to fines and other payments totaling billions of dollars.

In addition, the lists may not be complete, said Eric Campbell, an associate professor at Harvard Medical School.

"I have absolutely zero confidence in these lists until they are audited by an independent third party," he said.

Pfizer's includes payments to 4,500 doctors and other health care professionals who got payments totaling $35 million, including about $20 million for speaking and consulting.

In Wisconsin, 69 professionals got payments ranging from less than $1,000 up to $42,000 each for marketing and drug development activities.

Pfizer's list of doctor payments was mandated as the result of a huge government investigation of illegal promotion of its drugs for unapproved purposes, including the use of doctor speakers.

Pfizer spokeswoman Kristen Neese said the list is designed so patients can look up their doctors.

It is the latest in a series of developments at the company designed to increase transparency, she said.

However, the list also was mandated by a corporate integrity agreement Pfizer signed in August.

It joins GlaxoSmithKline, Eli Lilly, Merck and Cephalon, which have put out similar lists in recent months. Like Pfizer, the Lilly and Cephalon lists were part of settlements of government investigations of illegal off-label promotion of drugs that included having doctors give speeches to other doctors.

The Pfizer drugs included Geodon, a medication approved to treat bipolar disorder that allegedly was illegally promoted for other conditions such as depression, anxiety, dementia, attention deficit disorder, autism and obsessive compulsive disorder, including in children.

The company offered illegal payments to doctors to induce them to promote and prescribe Geodon, according to the settlement agreement.

So-called off-label promotion of drugs for unapproved uses can be harmful to the health of patients.

Last year, Eli Lilly was found to have illegally marketed Zyprexa, a drug approved to treat only schizophrenia and bipolar disorder, for elderly patients with sleep disorders, agitation, hostility and dementia, according to the U.S. Department of Justice and details it released about the settlement. Lilly hired doctors to speak to other doctors about using Zyprexa off-label, though the company knew the drug caused weight gain, which could lead to high blood sugar and diabetes, according to the settlement.

The drug is a sedative that calms hallucinations.

Duffy, the Cedarburg family practice doctor, lectures locally and nationally on bipolar disorder and depression. For instance, in 2005 Pfizer sponsored a talk by him about bipolar disorder at a medical conference in Green Bay.

He did not respond to several attempts to reach him.

It is not known what Duffy discussed in his talks for Pfizer. The company declined Wednesday to answer questions about Duffy's speaking.

Lilly spokeswoman Carole Puls said he was paid to take part in two Zyprexa-related activities for the company in 2009, including a training program for Zyprexa speakers.

In October, the Wisconsin Academy of Family Physicians gave Duffy its 2009 Family Medicine Educator of the Year Award.

Wilson, a retired University of Wisconsin-Madison specialist in pulmonary medicine, said she gave three talks involving Pfizer's controversial drug Chantix during six months of 2009.

She declined to say how many Chantix talks she gave in the last two years.

"I have been an advocate for the prevention and treatment of lung disease and tobacco use throughout my professional career," she said in an e-mail.

Last year, Chantix and another smoking cessation drug, Zyban, got the strongest safety warning from the Food and Drug Administration. The drugs were associated with serious mental health risk.

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