ProPublica's Updated Sunshine Database

The good folks at ProPublica:
http://www.propublica.org/article/piercing-the-veil-more-drug-companies-reveal-payments-to-doctors
--announce that they have updated their "Dollars for Docs" database:
http://projects.propublica.org/docdollars/

They note that they are offering a sneak preview of 2013 when the Federal sunshine provisions in the health reform law take effect, and disclosures that are now semi-voluntary become required. (I say "semi" because some of the companies now disclosing are doing so under orders from court settlements.) The total database accounts for $760M betweeen 2009 and 2011. Given Gagnon and Lexchin's estimate several years ago that the US pharmaceutical industry spends a total of $57B annually on marketing, and given that at least some of the money on the database is in the form of research grants which at least officially is not marketing, we still have to ask how much of the total picture we are seeing.

To my mind the big news from ProPublica's initial analysis of their data is the possibility that sunshine is having an impact. There is some evidence of cutting back on the amount companies pay to speakers, in particular. The companies pitch this as a purely business decision, but it has several twists:

• A mini-scandal erupted when the media noted that a number of drug company speakers were in trouble with their state licensing boards. This has led some companies both to pare back and also to be more selective about paid speakers. (They also mention it's smarter from a business point of view to pay fewer speakers to give more talks each; saves on training.) But that scandal was indirectly due to the sunshine of Dollars for Docs, as that provided the database for enterprising journalists to compare to the lists of in-trouble docs.


• Some universities with policies prohibiting their faculty from being paid speakers had not been enforcing those policies, but Dollars for Docs makes them look pretty silly and has emboldened more of them to search the database for names of their own faculty. Apparently anticipating this scrutiny, some of those docs have chosen to withdraw from speakers' bureaus.
  

Indirect evidence that the Dollars for Docs is having an impact is the fact that PhRMA seemed to feel it necessary to come out with a preeptive-strike news release just before the update was announced, in which they defended their payments to physicians.

Expect to see more stories from the database as journalists around the country now start peering into their local doctors' names and tracking down what they are up to.