Thursday, November 4, 2010

2nd of 2 articles on doctors and drug company payments

Drug firms' payments to doctors raise ethical concerns for many
By Colleen O'Connor
The Denver Post
Posted: 10/31/2010 01:00:00 AM
Following the money from seven pharmaceutical companies to Colorado's medical experts — payments for things such as lectures, consulting, travel, meals and patient-education programs — shows that over the past two years, nearly $4.9 million has been disbursed around the state.
It's gone to doctors at National Jewish Health, the Rocky Mountain Cancer Center and the Heart Center of the Rockies; to a family dermatology practice in Westminster, a nurse practitioner in Fruita; and a bone-research center in Lakewood.
A database compiled by the national investigative news service ProPublica analyzed the financial ties between doctors and the seven drug companies in the U.S. that currently disclose the figures. The seven make up 36 percent of the sales market.
These payments are legal, but controversial, and there is a national effort by state lawmakers, Congress and academic medical institutions to shine light on the financial relationships between doctors and the pharmaceutical industry.
Proponents say that these paid speeches fill an educational gap, especially in rural places where primary-care doctors have a hard time keeping up with the latest treatments.
But critics say that travel, meals and other expenses paid by drug companies add to the cost of medications for everyone. They also say paid lectures amount to bribery by the drug companies, because the doctors talking about how to better recognize a condition may also recommend medications to treat it.
Patients uneasy about pay
Patients also are critical, according to the second annual prescription drug survey released this summer by Consumer Reports.
Fifty-eight percent said they were concerned by drug companies' buying meals for doctors and their staffs, while 72 percent were not happy with payments made by pharmaceutical companies to doctors for testimonials or for serving as a company spokesperson for a given drug.
"These financial relationships present a conflict of interest in which the physicians might be tempted to put their own interests ahead of their patients," said Catherine DeAngelis, editor in chief of the Journal of the American Medical Association, in an e-mail interview with The Denver Post.
In Colorado, two of the top earners of payments from the seven drug firms work for National Jewish Health.
Ronald Balkissoon, a pulmonologist, received more than $220,000 for speaking and consulting, while Joseph Spahn, a pediatric allergist, received more than $155,000.
Education vs. appearances
National Jewish Health has a conflict-of-interest policy that requires doctors each year to report if they received more than $10,000 from any private company in the past year. The department chair and chief compliance officer then decide whether there is a potential conflict of interest, said spokesman William Alstetter.
None was found in either case, he said.
Most of these doctors' talks were given to other doctors, especially in rural outposts, educating them about diseases and the companies' drug treatments, he said.
Alstetter declined to make either Balkissoon or Spahn available for interview.
Although both doctors commonly prescribe medications by GlaxoSmithKline and AstraZeneca, which paid their speaking fees, "we like to believe that education is the dominant part of the talks, understanding better how to manage and diagnose the disease," Alstetter said. "There are diseases that are poorly managed, or not even diagnosed, and this can do a lot in getting doctors to understand and recognize them."
John Tucker Hardy, a child and adolescent psychiatrist based in Pueblo, is another top earner in Colorado, receiving more than $167,000 from the seven companies.
He declined requests to speak about his fees.
The national movement for increased transparency also affected the health care reform bill, which requires that by 2013, all pharmaceutical companies must disclose payments to physicians to the federal government, which will post the information on a website. More than 70 drug companies operate in the U.S.
On the state level, Gov. Bill Ritter this summer signed legislation that will require the Colorado Department of Regulatory Agencies to post this information on its website.
"Right now, this is an area of intense discussion across the board, at institutions and at the government level," said Heather Pierce , senior director of science policy and regulatory counsel at the Association for American Medical Colleges. "There have been a lot of specific incidents that brought this to the forefront."
A central incident was the 2008 congressional investigation into how a renowned child psychiatrist at Harvard failed to disclose to the school that he received $1.6 million in consulting fees over a two-year period from a drug company that made the anti-psychotic that he'd been prescribing.
"The interest is exponentially more now than it was five years ago, which was exponentially more than it was five years before that," said Richard Krugman, who has served as dean of the University of Colorado School of Medicine for 20 years.
"Overall, there's a lot more public scrutiny of physicians and public employees in a world where money is now tight, and people want to know what their money is being spent on," he said, especially in "the health care industry, which is 16 percent of the gross domestic product — trillions of dollars."
It's a delicate balance, especially for medical schools.
Walking a fine line of trust
Pharmaceutical companies frequently collaborate with physician investigators and scientists at these institutions to create medical breakthroughs and perform clinical trials to determine the safety of promising new therapies.
"To maintain the public trust, it is imperative that these relationships not be or appear to be influenced by factors other than the pursuit of knowledge or the best interests of the patient," according to the disclosure policy of the Feinberg School of Medicine at Northwestern University, which requires its faculty to report all externally compensated professional activities, no matter how small the amount. The disclosures are then posted on the school's public website.
Institutions such as the Stanford University School of Medicine and Harvard Medical School have banned their doctors from participating as paid consultants and lecturers in the drug companies' speakers' bureau.
CU med school guidelines
In Colorado, physicians at the CU School of Medicine are allowed to participate in speakers' bureaus, but industry representatives are not allowed to select speakers or topics and cannot preapprove the content of educational programs.
Physicians are not allowed to accept meals or other hospitality from drug companies.
"We have a lot of national and international experts in their fields, and pharmaceutical companies are one of many different groups that may be interested in their opinion," Krugman said. "There's nothing inherently wrong with having a contract with a company. It depends on what the work is for and whether it fits into place with our policies."
As with most medical schools in the country, the main watchdog of enforcement is a physician's integrity.
"The guidelines and professional behavior assumes that you will act professionally, and it's on the honor system," Krugman said. "Generally speaking, that works. There are times when information comes to us that suggests there may be a problem, and then we look into it."
Colleen O'Connor: 303-954-1083 or

Read more: Drug firms' payments to doctors raise ethical concerns for many - The Denver Post


  1. Red flags went off immediately as soon as I finished the 5th paragraph. Since when have pharmaceutical companies nice enough to cut into their profit margins to pay doctors to give speeches to raise awareness? As altruistic as the seven companies may seem, any health professional would spot their true motives. By compensating the physicians for the speeches, physicians make treatment recommendations for the illness that they talk about, and it just happens that the recommended drugs come from same companies that paid the physician. This, in turn, provides the seven companies with revenue. A win-win situation for the caregiver and provider, but the losers here are the patients. The cycle would and have been causing excessive and mis-prescribed medication, causing patients to get sick in other areas, ultimately leading to more expenses in the healthcare system. The medical schools that allow its faculty to engage in these behaviors assume their faculty follows professional behavior guidelines and the honor system. The most notable honor system in the medical profession is the Hippocratic Oath. Leaving the physicians who participate in speeches alone with the Oath without any vigilance organization could result in further compensation.

    -Handi Wu

  2. It honestly baffles me when people wonder why our country cannot seem to have universal health care, and why so many people are in debt! One major step is to break this unethical and selfish game doctors and pharmaceutical companies are playing. Clearly for many doctors, their roles as physicians are overshadowed through bribery. This power and money hungry attitude in society has led us into greater financial debt. I'm pretty sure doctors are well off that they can afford their own meals and travel tickets, and if they really were concerned for the good of our country and educating society, they would WANT to pay out of pocket in order to help alleviate the current debt of our health care. I believe a doctor's motives behind prescribing these high cost drugs should be reevaluated; whether they have tried all other possible alternative methods of treatment that have been proven to be as equally effective. These unnecessary costs and benefits given to doctors and hospitals need to be immediately cut so that those with lower socioeconomic standing are able to seek treatment.

  3. In agreement with Handi, it seems to me that physicians are abusing their power (and by power I mean from an educational standpoint) to join forces with pharmaceutical companies to generate higher profits for the pharmaceutical companies, which in turn means more money for the physicians. Its apparent that pharmaceutical companies are acting in a manner that will only benefit themselves by generating more profit from their product by using physicians (trustworthy figures) to promot their drugs. For a physician to truly believe the only reason to give these lectures for "educational" purposes, is a complete lie. Most physicians are getting paid an undisclosed amount by pharmaceutical companies to "educate" the public about this new drug in order to bring more profit to the pharmaceutical companies in turn to make more money for themselves. It's a never ending vicious cycle.

    Sasha Sheftel

  4. Although I believe what the pharmaceutical companies are doing is completely wrong and selfish, from the standpoint of a capitalistic society, they are simply trying to generate enough business and revenue to survive as a company. That being said, I think this is just a small part of what is wrong with our society as a whole. We will never achieve an ethical, universal healthcare system if we continue acting as a capitalistic society. In this country, pharmaceutical companies are businesses, not healthcare systems that are trying to help people, and the physicians are their forms of marketing. This is manipulative and wrong. Physicians from rural areas will only hear of these specific medicines, thus will only be able to prescribe these particular medicines. Patients, who rely on their physicians, will only have access to these medicines. In the end, just the pharmaceutical companies and the physicians make money. As Sasha said before me, it is a never-ending cycle.

  5. I think its unethical what these companies are doing. They know that if they are paying the doctors they will be getting the majority of their patients. But another thought that occurred to me was, what if they were better medications out there or even cheaper ones that were not getting prescribed because they do not have enough funds to pay the doctors. Its sad and at times not fair to their patients.

  6. I don’t believe that it’s unethical for doctors to receive compensation from pharmaceutical companies. I do realize and respect the counterargument that greed can sometimes take over but this is a possibility in every career. I deem there is a fine line that should not be crossed when it comes to paying physicians outrageous amounts and a committee should be constructed to monitor the amounts physicians receive from such companies. But if the drug works and the knowledge saves lives then I believe the benefits outweigh the costs.
    However, I have a hard time understanding why everyone talks about the prestige and power that comes with receiving a medical degree but in the same breath no one believes they should be allowed to make a decent living. Like many other careers, medicine is driven by money just as much as Wall Street and although many people disagree about money being a driving force in medicine the realization is that it is. The supply of the market demands competition in order for the best goods to be produced whether you’re talking about computers or a new vaccine. These pharmaceutical companies, although many people think they are the devil, do have some redeeming qualities and have helped foster modern medicine. Yes, problems do still exist, but imagine for a second, where we would be today without the advances they have fostered.
    Therefore, giving incentives to physicians who give lectures and speeches about new technology, advancing treatment, and new diagnosis in disadvantage areas; helping to better future generations, seems like a small price to pay for the well-being of society.
    Julianne Barlow