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Amplify’d from www.ydr.com

Why drug companies might be paying your doctor to tout their products

Critics say the fees create a conflict of interest. Doctors say they get compensated for their expertise.

By TOM JOYCE Daily Record/Sunday News

·How patients can use the data. York, PA - On Tuesday afternoon, Dr. James I. McMillen drove to Palmyra to talk to other doctors about Nucynta, a new acute pain medication. Johnson & Johnson, the pharmaceutical company that makes Nucynta, would pay McMillen for that service. "You feel good about helping other doctors to treat their patients," said McMillen, a rheumatologist and pain specialist with a practice in Dillsburg. According to a recent report by public interest investigative newsroom ProPublica, the practice is quite common. It's all legal, but, the report also says, the practice raises ethical questions. The ProPublica list included $278 million paid to 17,700 medical professionals in 2009 and 2010. Most were doctors, but the list also included pharmacists, nurse practitioners and dietitians. That money came from seven pharmaceutical companies that disclosed the payments on their websites -- some as a result of legal settlements. Several lawsuits brought by former drug-company employees alleged that the companies were rewarding doctors for prescribing their medications, ProPublica reported. The report lists at least 14 medical professionals from York County who have accepted money from major pharmaceutical companies for speaking engagements in 2009 and 2010. Federal government gives approval Tony Jewell, a spokesman for pharmaceutical manufacturer AstraZeneca, said his company provides the medical professionals who give the talks with all of their material. The federal Food and Drug Administration must approve the contents. Dr. Asit P. Upadhyay, an osteopath with a York practice, received more than $20,000 combined in 2009 and 2010 from three different companies for talking about their medications. He said it's something he does a "couple times a year."

Although the presentations incorporate the products from the companies, he said, they're more about an overall treatment strategy than a simple product pitch. They might involve subjects such as how to manage pain from cancer. Upadhyay said he's not paid to prescribe certain medicines. And regulations limit what speakers are permitted to say. For example, any fact he cites must be borne out by at least two controlled studies. "If you're an expert in your field, everyone's going to ask you to lecture," Upadhyay said. "We're really out there to educate." Still, the practice is controversial. One patient advocacy group characterizes the arrangement as inherently suspect. Dr. Sidney Wolfe argues that the set-up creates too cozy of a relationship between doctors and drug manufacturers. Wolfe is director of the Health Research Group for Public Citizen, a public health advocacy group based in Washington, D.C. According to Wolfe, medical professionals who get paid by a pharmaceutical company might be more inclined to prescribe its medication over one manufactured by another company, or a generic equivalent that costs less. Basically, Wolfe said, physicians should be concerned first and foremost with the welfare of patients. Any arrangement where they're being paid to act on behalf of pharmaceutical companies creates a potential conflict of interest. "Patients should be very worried about this," Wolfe said. Disciplinary problems on list The ProPublica investigation found hundreds of medical professionals paid to lecture for the pharmaceutical companies who lacked credentials or had been accused of professional misconduct or disciplined by state boards. None of the York County medical professionals on the list was subject to any reprimands from state licensing boards between 2005 and the present, according to the Pennsylvania Department of State. ProPublica also pointed out that the FDA had ordered McMillen to stop "false or misleading" promotions of the painkiller Celebrex in 2001. McMillen acknowledges that the FDA issued that order. He said it came about because, during his presentations, he criticized a drug called Vioxx that a rival company was making, and that company orchestrated a campaign to stop him. He still maintains that the drug he criticized was dangerous -- it has since been withdrawn from the market over safety concerns -- and makes no apologies for the presentations that prompted the FDA warning. He also acknowledges that the system of doctors being paid to speak on behalf of the companies can lend itself to abuse, and he noted the incidents of misconduct that the ProPublica report identifies. For example, ProPublica reported that hundreds of doctors paid by drug companies had been accused of professional misconduct, were disciplined by state boards or did not have credentials as researchers or specialists. "You would never want your kid learning from a bad teacher," Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry's influence on physicians, told ProPublica. "Why would you want your doctor learning from a bad doctor, someone who hasn't displayed good judgment in the past?" And McMillen's own experience in 2001 with Vioxx shows that drug companies can sometimes engage in ruthless practices, he said. Still, McMillen believes the arrangements do more good than harm. He said he personally speaks about medications he's worked with and found to be helpful. He said he has no financial incentive to prescribe certain medications against his patients' best interests. He would make about the same amount of money by staying in his office and treating people rather than lecturing, he said. And if he intentionally prescribed prescriptions that harmed or failed to help his patients, he would only be sabotaging his own practice. "I feel we are doing a great service in helping the doctors use these drugs in a safer manner," he said.

York County medical professionals on list Using data made public by pharmaceutical companies, ProPublica compiled a nationwide list of doctors who have been paid by those companies to promote their drugs in lectures to other doctors. The practice is not illegal, but some raise questions about whether it could inappropriately influence doctors to prescribe certain drugs. The following are the medical professionals who practice or have practiced in York County who ProPublica listed as having received such payments. Attempts to track down Robert Tuliszewski and Barbara L. Hoffman were unsuccessful. Other than James Irving McMillen and Asit Upadhyay, the others on the list did not respond to requests for comment. --- Kimberly Binaso of Dillsburg -- pharmacist GlaxoSmithKline: $300 --- Dr. Daniel Efion Ekaha of York -- oncology Eli Lilly: $1,875 --- Dr. Wanda Filer of York -- family physician Merck: $12,625 --- Dr. Bruce Frantz of York -- urology Pfizer: $1,346 --- Dr. Puneet Gupta of Spring Grove -- occupational medicine AstraZeneca: $12,900 --- Dr. Barbara L. Hoffmann of York -- family practice Johnson & Johnson: $1,500 --- Dr. Jimmy Ibikunle of York -- psychiatry Johnson & Johnson: $1,850 --- Dr. James Irving McMillen of York -- internal medicine Cephalon: $126,000 Eli Lilly: $88,985 --- Dr. Hugh Palmer of York -- internal medicine Eli Lilly: $1,950 ---Dr. Neal Ranen of York -- psychiatry AtraZeneca: $50,700 --- Dr. Barry E. Shapiro of York -- psychiatry Eli Lilly: $1,500 --- Dr. Dan Sotirescu of York -- hermatology/oncology Cephalon: $3,500 --- Dr. Robert Tuliszewski of York -- urology GlaxoSmithKline: $22,700 --- Dr. Asit Upadhyay of York -- physiatry (physical medicine and rehabilitation) Cephalon: $14,300 Johnson & Johnson: $5,007 Pfizer: $700 Investigation reveals some misconduct Using data made public by pharmaceutical companies, ProPublica compiled a nationwide list of doctors who have been paid by those companies to promote their drugs in lectures to other doctors. "Payments to doctors for promotional work are not illegal and can be beneficial," ProPublica reported. "Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments. "There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress." ProPublica provided the following facts about its investigation. --- The data includes seven companies that have disclosed payments on their websites, some as the result of legal settlements. More than 70 drug companies operate in the country, so the data might not be wholly representative of the industry. The companies included are: AstraZeneca; Cephalon; GlaxoSmithKline; Eli Lilly; Johnson & Johnson; Merck; and Pfizer. ---  The companies said they use the most-respected doctors in their fields to lecture on the benefits and risks of their drugs, ProPublica reported. But the review of physician licensing records in the 15 most populous states and three others found sanctions against more than 250 speakers. None of the sanctions was against a York County professional. --- 384 of the approximately 17,700 people in ProPublica's database earned more than $100,000 for promotional and consulting work on behalf of the pharmaceutical companies included. Read the whole project at propublica.org/docdollars/. Read more at www.ydr.com

 

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