Tuesday, October 19, 2010

American Drug Companies Pay Doctors To Sell Drugs

Do you ever worry a trusted doctor accepts secret payments from pharmaceutical companies at the expense of your life and health? Here's a place to check.

Investigative journalists have made an astounding report in ProPublica detailing how drug companies have cleverly managed to pay so little to get so much in many cases. Many payments they made are for a few hundred dollars in "speaking fees" where doctors tout a drug. It's not surprising doctors would accept the money, since they can be bombarded by drug company incentives. In fact, it's surprising how few did accept payments, at least according to this report, and most payments were surprisingly small (in the hundreds of dollars). But many doctors have accepted hundreds of thousands of dollars. Whether they earned it is not within the scope of this article, although the article mentions doctors sometimes only had to attend seminars to get paid.

ProPublica's report includes a national American database, check-able by state and by name of doctor, linked here. It says there is nothing wrong or illegal about doctors taking money from companies manufacturing drugs. In fact, some doctors assert they do so because they are "so good" at what they do. We cannot verify that advice.The problem is, more than seventy drug companies did not disclose their payments publicly, so this list may potentially be the tip of the iceberg. 

The database is restricted in many ways, unfortunately:
  • Payments to group practices were also excluded from this database; only  doctors practicing alone were included.  
  • Some doctors evidently have not received board certifications. 
  • The government removes older disciplinary procedures from websites.
  • We cannot be sure how long these doctors have accepted payments from drug companies. 
Perhaps that is the true point of the article: not only do we as patients not know how much money doctors make from drug companies and where it comes from, we can't find out how long it's been going on or how it influences their  practice of medicine without asking them, which we wouldn't.

The investigation found proof of practices as sleazy as one would suspect and fear possible. Doctor speakers were dropped if they did not write substantial prescriptions for a company. Doctors accepted "preceptor-ship programs" to allow sales representatives to spend time observing their practices, when in fact the sales reps were paid to use the time to push drugs to doctors. The report found evidence of illegal marketing of "off-label" uses of the drugs, i.e. those not approved by U.S. government regulators. Doctors rewarded for being "top injectors." Even vacation resort fees were covered.

While whistleblowers have tried to level the field,  skepticism about the purity of prescription-givers abounds in America. Consumer Reports found in  a study that 58% of Americans assume doctors give speeches paid for my drug companies, 51% believe that less than $500 could influence a doctor's judgment and 40% would not feel comfortable asking their doctors if they accept payments from a drug company for a drug they prescribe...a low number when considered, as if 60% would ask.

 Do you think all doctors should post how much and exactly what they accept from each and every pharmaceutical company on their waiting room walls and on their websites? Do you think they ever will?

ProPublica has achieved a victory with this report and found a great deal of truth however limited to disclose.

Full-disclosure: hip and spine injections by a Physiatrist have improved my own life immeasurably. While, doctors and drug companies by themselves are not the problem, our problem is with secret payments to doctors from drug companies possibly compromising the judgments of doctors.

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