Beyond the Data as Drug Makers Reveal Fees to Doctors - Duff Wilson NYT

Pfizer recently became the latest big drug maker to start disclosing payments to doctors who act as consultants or speakers. But many followers of the pharmaceutical industry are still finding it far too difficult to follow the money. Industry bloggers and advocates for financial disclosure say the companies’ Web sites are not easy enough to use for patients or others who want to know which doctors are the most financially entwined with drug makers.

“More translucent than transparent,” is the way John Mack, editor of the Pharma Marketing blog sums up the doctor payment databases.

GlaxoSmithKline, Eli Lilly and Merck are among the other drug makers that now operate such databases, as a response to critics who say the payments can overly influence the way doctors practice medicine and prescribe drugs.

In some cases, as with Lilly and Pfizer, the databases were also set up as part of settlements of federal criminal investigations into illegal marketing of drugs to doctors. But those companies say they planned to start making the disclosures anyway.

The money disclosed in such databases can be substantial. Pfizer, for instance, listed $35 million in payments to 4,500 doctors and 250 research organizations from June through December 2009.

But among the various databases it can be hard to add up the money for one doctor from several sources, or to identify the biggest recipients, or to list them all for a hospital or a city, without laborious data work by a computer expert.

Starting in 2013, under the new federal health care law, these databases will become mandatory for all drug companies and medical device makers. And they will be subject to stricter disclosure requirements aimed at making them much more transparent. Those new rules, under a subset of the health care law called the Physician Payment Sunshine Act, are also expected to make it easier for the public to track a doctor’s payments from all companies.

Meanwhile, though, there may be a business opportunity and public interest in Web sites like PharmaShine. The site is operated by a start-up company, Obsidian Healthcare Disclosure Services, founded by a former lawyer for Merck.

Obsidian mines all the doctor disclosure data posted in disparate forms. That includes not only five drug makers’ databases, but payment disclosures from six medical device companies and two states that already require such listings, Vermont and Minnesota. Johnson & Johnson and Astra-Zeneca have announced they will begin disclosing physician payments later this year; Obsidian plans to mine their data, too.

PharmaShine has more than 21,000 physician listings, said George A. Duncan, who founded Obsidian in 2008 in Jersey City, N.J., and started the Web site last August.

The company does not yet have paying customers. But it says it hopes to sell the information from one big, constantly updated database to hospitals and health systems, medical colleges — and even to drug companies eager to cross-check which physicians are taking money from whom.

At a price of $799 a month, the service also includes e-mail alerts whenever select doctors are reported. Mr. Duncan said four major medical schools and a number of hospitals have expressed an interest.

And for consumers, Mr. Duncan said, individual doctor look-up will be “free for the foreseeable future.”

Allan Coukell, director of the Pew Prescription Project, said the government and university officials in charge of disclosure compliance could also use PharmaShine to check whether the proper reports were being made and to monitor their doctors’ outside business activities.

“You could do it one by one, but that would be awfully time-consuming,” Mr. Coukell said. The Prescription Project, a consumer interest effort of the nonprofit Pew Charitable Trusts, was a tester of PharmaShine before its official introduction.

Senate researchers have found that some prominent doctors at academic medical centers have failed to disclose millions of dollars in drug company payments, despite university requirements that they do so. Federal prosecutors say some payments are really kickbacks for illegal or excessive prescribing.

Industry supporters, meanwhile, say they are trying to restore public trust, and they emphasize the importance of collaboration between pharmaceutical companies, academia and physicians to advance medicine.

Some of the transparency issues are supposed be resolved when the Physician Payment Sunshine Act begins in 2013 to force fuller, more accessible disclosure of all drug industry payments to doctors worth more than $10.

But until then, the disclosures come in a disparate variety of subjects, sites, thresholds and usefulness.

Among the four leading drug companies making physician payment disclosures, Mr. Coukell said, Eli Lilly, which was the first to disclose, presents data as an Adobe Flash image, which he said was impossible to download or to sort. “They’ve gone out their way, I think, to present it as a Flash document,” Mr. Coukell said.

Mr. Duncan said Obsidian had to retype all the Lilly data.

Carol Puls, a Lilly spokeswoman, said the company purposely made its report impossible to download "to protect the integrity of the data." Lilly was concerned someone could change numbers and create a false report outside the company’s Web site, Ms. Puls said.

Merck and GlaxoSmithKline display physician fees in Adobe PDF files, which must be laboriously copied if they are to be used in a sortable database.

Jim Edwards, a contributor to the BNET blog who tracks the pharmaceutical industry, said all the industry disclosures were good — but limited.

“Even though we know who’s receiving money and what they received, we don’t really know in many cases why they received it, or what they did,” he said.

Pfizer, which released its first batch of data on doctor payments on March 31, said its Web site made it easy to look up individual physicians. Dr. Freda Lewis-Hall, Pfizer’s chief medical officer, said the company was “committed to ensuring these relationships are transparent to the public and are carefully managed.”

But the company declined to identify its top recipient.

Only after exporting the Pfizer data to another computer program and analyzing it could The New York Times determine that the largest Pfizer payments had gone to Dr. Gerald M. Sacks, a Santa Monica, Calif., anesthesiologist and pain expert. He was paid $146,500 from Pfizer from June through December 2009 for “expert-led forums.”

Dr. Sacks declined to return several messages seeking comment.

via nytimes.com

Posted via web from Jack's posterous