Money Talks: Drug companies don’t pay doctors out of altruism | syracuse.com

Physicians who hold the lives of patients in their hands are only human themselves. A recent report by The Post-Standard’s James T. Mulder, in collaboration with the investigative journalists of ProPublica, confirms it. Reviewing records obtained from seven of the nation’s 70 largest pharmaceutical firms, ProPublica found they paid more than 17,000 doctors a total of $257.8 million in “speaking fees” between January 2008 and last June. More than $900,000 went to 51 Central New York medical professionals, Mulder reported. That money was not just meant to increase medical understanding.

Many doctors consider such payments no big deal. If the drug company’s product is good, why not speak on its behalf? Besides, the money is usually chump change, so any suggestion the doctor is shilling for drug makers is an insult.

“I find it hard to believe some people would write a (prescription for) a medication just because they are a speaker,” said Central New York’s top physician-speaker, who collected $180,000 in fees during the period studied. Visits to specialists who otherwise would not have access to his expertise are so worthwhile, he said, “I would be happy to do these gratis.” Another local physician told Mulder such payments do not influence prescribing decisions.

But Dr. Greg Eastwood, former president of Upstate Medical University and an ethics and conflict-of-interest expert, points to studies suggesting a wide range of compensation — from speaker’s fees to free pens and notepads — can have a subtle or not-so-subtle effect on prescribing habits.

Upstate recently barred its doctors from giving talks “scripted” by drug companies to promote products, though it still allows staff to speak on the companies’ dime. Other hospitals are not so discriminating — and drug companies aren’t either, signing up hundreds of doctors who have been disciplined by state boards, accused of misconduct, or who lack the appropriate expertise.

All too often, companies and speakers cross the line. The makers of Botox settled with the government for $600 million in September after its “advisory boards” urged overuse of its product and rewarded top injectors. Another firm paid $425 million after “speakers” prescribed its drug — but never did any speaking. Altogether, drug companies have paid nearly $7 billion to settle such cases over the past three years, ProPublica found.

Doctors may consider themselves incorruptible, but the public isn’t so sure. In a Consumer Reports survey, nearly half of respondents said they would be concerned if their doctor took as little as $500 from a drug company.

There is value in physicians sharing their expertise. But there is at least a perception of conflict when drug companies pay the bill. Otherwise, why would compensation details from most drug companies remain secret?

Starting in 2013, all drug companies will have to disclose their payments to doctors under the new health care law. That should rein in the worst abuses, and might even nudge physicians and their pharmaceutical mentors toward a less conflict-prone relationship.

via blog.syracuse.com

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