Review Time: Rationalizations Doctors Tell about Pharma Money

Most of the time I try to keep this blog focused on new information. Still, perhaps once in a while it is valuable to do a review of issues that we've addressed in the past. It's worth keeping track of whether phenomena we described in previous years are still occurring. Also, who knows--an occasional new reader may show up here (perhaps having wandered in thinking this was Facebook) and need to be brought up to speed.


An opportunity to do a rationalization review is provided by this newspaper article by Bill Lascher for the Clark County (Washington) Columbian:

http://www.columbian.com/news/2010/nov/07/pharmaceutical-industry-doctors-Clark-County/

Now, how would I know what's being printed in the Clark County Columbian? Mr. Lascher phoned me and asked for an interview, after he followed up on the new ProPublica database (http://brodyhooked.blogspot.com/2010/10/propublica-launches-database-on-docs.html). Let me first comment on the part of the article that contains that interview. I am sure I was not misquoted and that I said the words that were reported. Yet I still have a sense that my context was distorted, as I come across in this article sounding much more accepting and blase about docs taking money from Pharma than any reader of this blog would be aware of. Anyway if I had the interview to do over again I would certainly approach it differently.That's merely by the way, however, as my main agenda here is to look at what Mr. Lascher found in his home county, and what the various players had to say about it. I'll report that in the form of "Quote" from the article and "Translation" into plain English, stripped of the usual rationalizations.

A good deal of the article discusses a certain Dr. Jeffrey J. Hansen, who topped out the local doc's money list at $107,302, about 5 times more than his nearest competitor. Here's what Dr. Hansen had to say about his take:

Quote: “I don’t believe it influences my prescribing practices because I work with a number of companies,” Hansen said. “I want to make sure that no matter who’s sponsoring my speaking the message is the same.”

Translation: Lots to discuss here. Does it influence his prescribing? The companies surely hope so. We've seen recently--http://brodyhooked.blogspot.com/2010/10/from-propublica-seamy-side-of-pharma.html--yet more evidence that being picked to be on a company's speakers' bureau is more about the volume of their stuff you prescribe and a lot less about your speaking abilities. Does it make a difference if he works for many companies? I wonder how often he recommends exercise instead of drugs for mild to moderate depression, or how often he talks about the body of research that suggests that the newer SSRI antidepressants are little better than placebo in large meta-analyses. Is the message the same? Very unlikely; most companies supply their speakers with the company PowerPoint and demand they stick with the script, since deviating from it could land the company in hot water with the Feds.

Quote: “When I partner with a pharmaceutical company they actually cover the cost of my overhead in presenting this data,” he said. “I enjoy the process of speaking and talking about psychiatry and I do think it improves quality of care for patients.”

Translation: Well, if $107K just barely covers his office overhead, then either he's gone a heckuva lot or else he really makes a ton of money in his office. In HOOKED I described a family doc in California who was said to not schedule any patients between 10:30 and 2:30 each day, so that he could get away to give lunch-time drug talks at any location within an hour's drive of his office--and by doing so cleared an extra $160,000 a year. I'm sure that just barely covered his overhead, too.

Quote: Most of the money Hansen received came from Eli Lilly. Hansen said he spoke ... about a disease state associated with major depressive episodes. He talked about new research on neuroimagery and genetics and didn’t discuss Eli Lilly’s product for the disease....“It’s truly an educational series just based on education related to illness,” Hansen said.

Translation: Since it's education and not marketing, it must be just a coincidence that Eli Lilly pays for this, and pays for it out of its marketing budget. Drug companies know exactly how to teach docs about "the mechanisms and genetics of disease" in such a way that the take home message is that one and only one drug is best for the condition. Or else they just stress drug treatment for the disease in general, knowing that their drug has a certain percentage of market share, and that if docs prescribe any drug, they'll pick up that percentage.

Now we'll give the good Dr. Hansen a respite and go to the section of the article about local hospital systems and their regulations about conflicts of interest.

Quote: Southwest Washington Medical Center prohibits pharmaceutical representatives from holding raffles, drawings or “other activities that lead to personal gifts for providers or employees.” The policy also says doctors — most of whom are not employees of the hospital but partner with its Southwest Medical Group — “should not directly solicit or receive personal gifts from pharmaceutical companies.” Southwest does not prohibit doctors from receiving payment for work that they do with pharmaceutical companies, however.

Translation: Southwest has no effective rules.

Quote: Legacy Health System’s policies say payments, reimbursements or subsidies should not be accepted to cover travel or to compensate for time spent away from practice. Limited exceptions apply for doctors who incur out-of-pocket expenses, and only then under certain conditions. Legacy directly employs about 900 people in Clark County, 30 to 40 of whom are doctors, spokesman Brian Willoughby said. Legacy’s administrative policy — which is updated every three years, most recently in January — prevents doctors with whom it contracts from accepting cash or cash equivalents. It also prohibits doctors from accepting gifts totaling more than $75 per year from any given vendor. Willoughby said the policy covers foundation board members and members of Legacy’s management team, not just its doctors. “We hire people with integrity,” Willoughby said.

Translation: Legacy seems to be starting off from a serious stance about physician COI. The next question is that now the data on physicians' take from Pharma is starting to become available, whether anyone at Legacy has consulted the figures for their physician employees, to see if they are actually complying with the policies.