Monday, March 11, 2013

Update from Dollars for Docs, ProPublica: Is Transparency Having an Impact?

Tracy Weber and Charles Ornstein at ProPublica have issued an update on the newest data posted on the Dollars for Docs website:

The investigative reporting group launched this site in 2010 to gather in one convenient, searchable place the various disclosures of payments to physicians that some drug firms had been forced to issue as part of legal settlements and in some cases voluntarily. Next year, such disclosures will be legally mandated by the Sunshine Law provision of the Affordable Care Act, so we can hope that some of the current limitations of reporting will be overcome.

In general, Weber and Ornstein's report shows that many docs are still making a killing off speaking and consulting for drug companies, with the highest rollers being psychiatrists--but other docs are seeing their take diminishing, and some drug companies are investing less money in these contracts. How much of these changes is cause-effect relationship with increased transparency is anyone's guess.

The top dog in the story is Nashville psychiatrist Dr. Jon W. Draud, who took in more than $1M between 2009 and 2012. Close behind was a neighbor of mine, psychiatrist Dr. Rakesh Jain from Lake Jackson, TX, who scooped up $582,049. Dr. Jain seems a good example of somebody who doesn't yet get it: “'I am not a marketer, I am an educator,' Jain said. ...[He] acknowledges the excesses of the past and said he does not excuse them. But he said he sees real value in the new brands because they give psychiatrists options if their patients are not responding to older drugs. ... Having the financial support of drug companies does not lessen the value of this teaching, he said." (Weber and Ornstein note that Drs. Draud and Jain probably make more money than they list, as some of the firms who pay them are not yet disclosing.)

Another psychiatrist, Dr. Gustavo Alva of California, stated, “I actually enjoy the aspect of educating my counterparts about developments in the field.” I admit that I would probably enjoy it too if it netted me $663,751 since 2009, as it did for Dr. Alva.

But a different picture emerges from the experiences of Dr. David Rizzieri, a Duke cancer expert:

"Ten of the doctors dropped from making about $100,000 a year to less than $20,000 in 2012. Some doctors whose payments declined spoke about drugs the companies are no longer pushing. Others, like ...cancer expert ...Rizzieri..., faced new restrictions from their employers.

"Rizzieri had been a speaker for Cephalon, GlaxoSmithKline and Novartis in 2010 and 2011. But after Duke restricted participation in speakers’ bureaus, his speaking pay dropped markedly in 2012, the new data show. All told, Rizzieri has received at least $567,300 in speaking and consulting payments since 2009.

"Dr. Ross McKinney Jr., director of the Trent Center for Bioethics, Humanities and History of Medicine at Duke, said university officials 'had multiple discussions' with Rizzieri, who 'is getting more restrained.'

"McKinney said Duke physicians can deliver paid talks about diseases, but only if they use their own slides and presentation materials. 'The general tone is a little bit more distant and less cozy than it used to be,' he said.

"In an email, Rizzieri said he still did some paid speaking that is allowable within Duke’s new guidelines, but has focused his attention on a series of educational talks developed by the Division of Cellular Therapy at Duke."

Also, some of the companies profiled by ProPublica have dropped their reported payments. GlaxoSmithKline, for example, spent $52.8M on physician speakers in 2010, $24.1M in 2011, and $7.6M in the first 3 quarters of 2012. But all companies who were willing to talk to ProPublica claimed that any reductions were strategic business decisions, depending on how many new drugs they had in their pipeline at any given time, for example. No one was willing to say out loud, at least, that transparency had discouraged any spending. Overall, Dollars for Docs has logged in more than $2B in payments since it began in 2010 reporting 2009 figures. If estimates of annual US Pharma marketing spending as high as $57B are to be believed:
--then this almost for sure lowballs the true figures.

Ironically, some of the new transparency actually aids the drug companies themselves, according to Dr. Susan Chimonas of the Center on Medicine as a Profession at Columbia:

"At a recent conference, Chimonas said she heard that pharmaceutical companies themselves are using the disclosures about payments to 'push back on doctors who are greedy.'

“They can say, ‘No. We see you’re taking this amount of money from our competitor. Why should we give you more than that?’ she said."


Anonymous said...

“There is at least one exception to the the reporting requirements – manufacturers and GPO’s are not required to report ownership or investment interests held by teaching hospitals.”

Teaching hospitals, i.e. Academic Centers, which run a lot of CME, can both not reveal their stakes in the products and can also launder money to KOLs.

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