Several doctors paid to speak on behalf of big pharmaceutical companies aren’t, in fact, the thought leaders consumers often consider them to be, but instead have been sanctioned for various forms of misconduct. And psychiatrists collect more in speaking and consulting fees from pharma companies than doctors in any other specialty.
Those were some of the findings of the investigative journalism group ProPublica, which, in concert with other media outlets, scrutinized $258 million in payments made over a recent 18-month period from seven large pharma companies to about 17,700 physicians for speaking, consulting, meals and travel. The database the group amassed and made public in late October is interactive; consumers are encouraged to check it to see if their own doctors are listed.
According to the group’s research, two doctors were shown to have made more than $300,000 in such payments from pharma companies during an 18-month period between 2009 and 2010. There were 41 doctors who received more than $200,000, and 384 physicians made $100,000 or more.
Among those who earned $100,000 or more, more than one in nine did not have board certification in any specialty. ProPublica’s review of physician licensing records in 18 states found sanctions against more than 250 doctors, including some on the high-earners’ list. Some had lost their licenses. More than 40 had received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more had had two or more malpractice judgments or settlements. ProPublica’s database shows that one physician accused of sexual misconduct with female patients was the pharmaceutical company Cephalon’s third-highest-paid speaker in 2009.
ProPublica reported that five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they said they rely on self-reporting and checks of federal databases. ProPublica found 88 Lilly speakers who have been sanctioned.
The nonprofit ProPublica released its report in a media blitz with National Public Radio, the PBS Nightly Business Report, the Chicago Tribune, The Boston Globe and Consumer Reports, each of which ran its own story raising questions about the ethics of paying physicians to help increase drug sales.
Pharmaceutical Research and Manufacturers of America (PhRMA) wouldn’t comment or answer questions on the ProPublica report directly, but instead is referring reporters to a statement from its president and CEO John Castellani. In it, Castellani 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. Doctors attend these sessions because they find the information valuable to their practice.
“Biopharmaceutical research companies only want 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.”
Both Eli Lilly and GlaxoSmithKline responded to the ProPublica revelations by launching their own investigations. In a statement, GSK said, “We do have criteria in place to evaluate potential speakers. However, ProPublic has raised issues to our attention that we are investigating further. We will also use this information as we continue to improve the processes by which our speakers are evaluated.”
Of the seven pharma companies on ProPublica’s list—Pfizer, GSK, Merck, Johnson & Johnson, AstraZeneca, Lilly and Cephalon—only Merck and GSK volunteered the information about doctors they had paid. ProPublica procured the rest from disclosures the other five companies were forced to make as a condition of false-claims and other settlements.
Also of interest: of the 384 doctors who earned $100,000 or more, 116 were psychiatrists, led by Roueen Rafeyan of Chicago, who took in $203,936 from Lilly, AstraZeneca, Johnson & Johnson and Pfizer during the 18-month period. (Rafeyan did not return calls.)
Upon examining the breakdown of the drug market, it is not surprising that psychiatrists make the most money for talking about pharmaceuticals. According to research firm IMS Health, in 2009 the dollar value of antipsychotic drugs was $14.6 billion, putting them above all other therapeutic groups. Antidepressants were fourth on the list, valued at $9.9 billion.
After psychiatry, the next largest specialty in ProPublica’s $100,000 group of doctors was internal medicine. Note, however, that many of the 114 physicians shown as board certified in internal medicine also are certified in fields such as endocrinology, neurology, cardiovascular disease and medical oncology.
Carol Bernstein, president of the American Psychiatric Association (APA), agreed that using physicians for marketing to other physicians has gotten out of control. “There’s clear evidence that heavy marketing by the pharmaceutical industry does influence physicians, and if you’re constantly in the business of collecting big sums of money from them, it may taint your capacity to be very objective about the data you’re presenting.
“We really have to find new and different ways to have academia interact with the pharmaceutical industry in a manner that preserves the capacity to develop new treatments,” she said. “I don’t have any easy answers about how to do that, but awareness is the first step.”
ProPublic said it will keep going, adding information from more pharmaceutical companies to its list. It will likely have to wait a while, though. Under federal healthcare reform legislation, 70 additional companies will be required to disclose payments—but not until 2013.
Since its launch in mid-2008, ProPublica has won many of the nation’s top journalism awards, including a Pulitzer Prize last year. Its funders include the Gates, MacArthur and Ford foundations.