Thursday, November 18, 2010

More from ProPublica: Disciplined Docs Get Pharma Cash

I had some nice conversations earlier this week with a couple of reporters for the Dallas Morning News, around this latest investigative reporting venture from ProPublica:

Earlier, ProPublica had announced their "Dollars for Docs" database of physicians receiving drug company payments (, and had done some initial reporting about what these figures showed in collaboration with several major newspapers:

This latest dip into the seamy world of physician bribes from Pharma has focused on a simple recipe: first get the database of docs getting money from the drug industry, then access the public databases showing physicians who have been disciplined by their state licensing boards, and stir. The result was that after they had eliminated the minor infractions that seemed not to implicate the physicians' quality of patient care, some 290 names showed up on both lists--and 70 names indicated multiple disciplinary actions.

Two physicians were interviewed in the ProPublica article linked to above, and each denied any wrongdoing that actually affected patient care. And I think fairness requires the acknowledgement that there are times when an innocent physician is being unfairly accused before the licensing board, and the sheer time and expense of fighting to clear one's name leads to the prudent decision to accept a plea-bargain agreement (I am familiar with several physicians railroaded into such a situation when their only "offense" was prescribing adequate opiates for patients with severe chronic pain. I was also told that if one wishes to fight an unfair ruling of the Texas Medical Board in court, plan to spend at least a quarter of a million dollars.)

It would have been nice if ProPublica had told us what percentage of the docs in their database this 290 makes up-- is it 20% or 2%?

All that said, there are a couple of important implications of this finding. First, I hope that once again these data will put a nail in the coffin of the idea of "Key opinion leaders." The industry has always claimed that the reason it paid big bucks to Doc X is that Doc X is the most talented and knowledgeable guy on this particular disease on the planet. This in turn has led others like the FDA (before the new leadership took over) to claim that if they tried to exclude docs with financial conflicts of interest from review panels, guideline committees, etc. they would lose the input of the best and the brightest. If it turns out that the folks selected for these payments/bribes actually include a fair number of medicine's bottom feeders, then we can see even more clearly that these bribes are nothing but rewards for high prescribing and have nothing whatever to do with the talents and knowledge of the recipients.

Another great point was made in the ProPublica piece by my bioethicist colleage Josephine Johnston at the Hastings Center. She points out that when you are sitting on the fat bankrolls of the major drug firms, you can afford to do most anything you want--including prescreening docs for licensing violations before you sign them up. The fact that the industry never bothered to do this is therefore somewhat telling.

ProPublica obviously struck a nerve. As the article notes, at least four major drug firms, on being interviewed for the piece, said that they would immediately review their procedures to see why these physicians had been signed up and consider better screening in the future.

And, no matter what the content, it is sort of nice to see that investigative reporting by newspapers has not completely died out.

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