Monday, February 14, 2011

Dollars for Docs: "Would You Be A 'Thought Leader' for us?"

Short of outright bribery, doctors view the practice as helping patients, while critics (as you might imagine) view the practice rather differently.

Back in October 2010, the non-profit newsroom Propublica introduced a database called "DOLLARS FOR DOCS" of payments made to thousands of U.S. doctors so now you can easily find out some of the money drug and biotech companies are paying them. The reality is that this is the first public database that consolidates disclosures that the courts demanded from just eight (8) drug companies (specifically Eli Lilly & Co., GlaxoSmithKline, AstraZeneca, Pfizer, Merck, Johnson & Johnson, and Cephalon, and a few tidbits from Novartis — whose sales collectively make up about a third of the market) covering $257.8 million in payouts to over 17,000 doctors since 2009. Initially, the database contained data for only 7 companies, but some data from Novartis was added after the launch of the database went public, hence the count is now up to 8. Of note is the fact that these payments were mostly for speaking engagements, consulting and various other duties. They now have a widget for the Dollars for Doctors database, which I have included HERE:

Typically, this money has been the medical profession's dirty little secret.

The medical profession has happily accepted money from drug, biotech and medical device companies for years as "thought leaders" (more on that below) without anyone other than the IRS knowing about it and most doctors vehemently deny these payments represent any "conflict-of-interest" although a growing body of evidence seems to suggest otherwise.

As "Diabetes Update" blogger Jenny Ruhl eloquently WROTE in her post (one of the few diabetes bloggers who even wrote about it) on this subject "These payment revelations were forced (emphasis mine) out of the companies, after they lost lawsuits that proved these companies had broken the law with how they marketed their drugs."

The disclosures come as medical institutions and lawmakers are working to try and rein in potential conflicts-of-interest, curbing these type payouts, we need to keep in mind that numerous other drug and biotech companies still fail to disclose this information because they haven't been caught breaking the law (that doesn't mean they aren't paying docs to speak about their products, only that the courts haven't forced them to disclose it).

The good news is that under the new U.S. healthcare law, starting in 2013, ALL drug/biotech/medical device companies selling products in the United States will be required to disclose this data in a public database to be operated by the U.S. Department of Health and Human Services. Let's just call the Propublica "Dollars for Docs" database a sneak peak at what we're likely to see much more of in the next few years!

I cannot hope to do adequate justice to this topic other than to say that I was not surprised that the endocrinology and metabolism field actually received far more money than I had expected to see. We all know that the neurology field and psychology has seen widespread abuse, but perhaps the biggest surprise in the diabetes medical business was that the leading recipients of payments weren't the names you might expect, but what could best be described as ordinary doctors not known for their frequent medical journal submissions or anything else who have managed to collect an EXTRAordinary amount of money from the drug industry.

NPR did a very interesting story about this which you can read about at the link below, although for convenience, I have included the audio for the story right HERE. It is only a few minutes in length, but I think quite objective reporting on the subject:

The practice of using money for elaborate vacations for doctors consisting of golf trips to Pebble Beach, or weekends at luxurious South Beach or Scottsdale resorts largely disappeared in 2002 when the drug industry trade-group known as PhRMA (which stands for the Pharmaceutical Research and Manufacturers of America) changed it's member policies on what was rapidly becoming a legislator concern in Congress. The organization banned the lavish vacations, dinners and miscellaneous trinkets such as pens and notepads that remain in my doctors' offices to this day. But as NPR reporter eloquently indicates:

"The practice of trying to influence doctors with money hasn't disappeared, it's shifted."

Today, the free pens and post-it pads with the drugs' names may very well be history, but there is still one, almost foolproof way to accomplish the task of getting a doctor to speak on behalf of a drug being sold by the drug sales rep: asking them to become what is known euphemistically as a "thought leader". When doctors speak about a treatment, their prescriptions for that brand of drug tends to increase, too.

Equally interesting was the following VIDEO from PBS:

One thing you might try doing is searching for your own endocrinologist's name in the ProPublica database; you could be surprised!

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