Seven pharma firms pay US doctors $257.8m
This article was originally published in Scrip
Seven pharmaceutical firms made payments totalling $257.8 million to some 17,700 US doctors over 2009 and 2010 for speaking, consulting and other duties, according to research by ProPublica, a US investigative journalism news site that gets funding from philanthropic donations. However, the Pharmaceutical Research and Manufacturers of America (PhRMA) says doctor-to-doctor educations programmes are valuable.
The payments averaged $14,560 per health care provider (most money went to doctors, but some went to pharmacists and nurses): 384 of the 17,700 health providers earned more than $100,000 for promotional and consulting work for one or more of the seven companies; and 43 made more than $200,000, including two who made more than $300,000.
Six of the firms – Pfizer, AstraZeneca, GlaxoSmithKline, Lilly, Johnson & Johnson and Cephalon – had to make the declarations on their websites because they were required to do so as part ofsettlements with the US Justice Department. It is difficult to make comparisons between the firms as some reported two quarters while some went up to five or six quarters (see table for details).
From March 2013 all pharmaceutical companies will need to disclose payments to doctors as a result of the Physician Payments Sunshine Act, which was introduced as part of the US health care reforms earlier this year. (It will mean that each year from 2013, drug, device and biotech companies are to report electronically gifts, compensation or other things of value of more than $10, given to physicians and teaching hospitals. The Act establishes civil penalties for non-compliance; scripintelligence.com, 1 April 2010.) Making payments to physicians for promotional work is not illegal, but questions have arisen on conflicts of interest, as activities such as speaking at conferences can influence prescribing.
The seven companies had combined 2009 sales of $109 billion, making up some 36% of the $300 billion US prescription sales. ProPublica warns that although the seven firms represented a substantial share of the US market, more than 70 pharmaceutical firms operate in the US, and the data may not be wholly representative of the industry.
The "Dollars for Docs" database lists all the healthcare practitioners that received money from the seven drug firms, so that patients can also do searches – Scrip asked ProPublica for the number of hits on its database, but that number was unavailable. ProPublica warns that some companies included a middle initial for a doctor, while others did not, and some companies listed different cities for the same individual. It believes that this may have happened because professionals may have practices in multiple locations or because they provided different addresses for payments to the companies. The database also lists each company's payment by state.
ProPublica also checked the credentials and disciplinary records of some of the doctors – "something not all companies do" – finding sanctions against more than 250, including some of the highest paid. Misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients; some doctors had lost their licences. More than 40 had received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes.
"This accounting is by no means complete; many state regulators don't post these actions on their web sites," ProPublica says in an article. The investigation goes into some detail on some of the alleged misconduct. Lisa Beri, a pharmacy professor at the University of California, who has studied conflicts of interest, told ProPublica that disciplinary actions reflected on a doctor's credibility and willingness to cross ethical boundaries.
US pharma response
Following the ProPublica research, the US pharmaceutical industry expressed support for peer education programmes. John Castellani, president and CEO of PhRMA, said: "Peer-to peer-information exchange improves the health of patients by providing physicians with practical knowledge and experience from their peers in using new and existing medicines."
He also stressed that firms only wanted to work with the most ethical healthcare professionals. "Make no mistake, the very small minority of doctors who have engaged in inappropriate practices have no business being part of these sessions. In the rare instance when a
speaker falls short of these high standards, companies take corrective action."
He pointed out that the FDA regulates the materials presented at these sessions
and holds companies accountable for their content. He also thinks companies exceed federal standards through self regulation, namely, the PhRMA Code on Interactions with Healthcare Professionals. "Under the code, company decisions regarding the selection of healthcare professionals are based on defined criteria such as medical expertise, reputation, knowledge and experiences in a particular therapeutic area, and communication skills."
Company | US sales (2009), $billion | First disclosure date | Average per quarter paid to doctors, $ million (No of quarters) | Total Paid to Doctors $ million |
|
Pfizer | 27.8 | 3/2010 | 9.9 (2 qtrs) | 19.8 |
|
Merck | 19.8 | 10/2009 | 4.7 (2 qtrs) | 9.4 |
|
AstraZeneca | 18.3 | 8/2010 | 11.4 (2 qtrs) | 22.8 |
|
GlaxoSmithKline | 15 | 12/2009 | 17.4 (5 qtrs) | 86.9 |
|
Lilly | 13.2 | 7/2009 | 20.4 (5 qtrs) | 102.2 |
|
Johnson & Johnson | 12.8 | 6/2010 | 2.6 (2 qtrs) | 5.2 |
|
Cephalon | 1.8 | 1/2010 | 1.9 (6 qtrs) | 11.3 |
|