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Drug Companies Face Scrutiny over Deals with Docs

Who better than a doctor to speak to other doctors about when to prescribe a particular drug for their patients?

The answer is so obvious that for decades, pharmaceutical companies have retained doctors to speak at promotional seminars, often complete with free samples and free dinners for physicians and staffers who attend.

The validating stamp of “doctor approved” is of even more use when a company’s new drug needs a clinical trial before application for FDA approval. Who better than doctors to sign-off on studies of how a new drug works on patients?

While the practice of paying doctors to promote particular drugs has long been questioned, knowledge of the extent of its use and documentation of its impact is relatively new. Beginning in 2013, the Patient Protection and Affordable Care Act (PPACA) will ensure broad transparency by requiring any drug company that has a product covered by Medicare or Medicaid to disclose all payments to doctors who are not its own employees. The payment data will be posted on a website where it will be accessible to the public.

Until 2009, pharmaceutical companies carefully guarded the lists of their medical collaborators and the amounts paid. However, after a number of drugs that passed clinical trials and were widely promoted turned out to have serious downsides or were pulled back by regulators, some companies were compelled to release details of their marketing and consulting partnerships.

According to ProPublica, a public interest advocacy group that has compiled the released data, large numbers of doctors receive consulting, speaking or promotional payments; many earn hundreds of thousands of dollars. Analysis by The New York Times shows that “about a quarter of doctors take cash payments from drug companies or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.”

In recent years, some doctors have pulled back from product promotion, and some medical schools are beginning to enforce previously ignored rules against drug endorsement speeches by their staff. In addition, some state medical boards have sanctioned speakers (often, doctors with clouded disciplinary records), and some drug firms have pledged to strengthen their screening procedures.

The retreat is driven by changes in the marketplace as well as a questioning public and studies that show that doctors who take money from drug makers sometimes practice medicine different from those who do not. According to the Medical Payment Advisory Commission (an independent agency of Congress), “There is evidence that at least some interactions are associated with rapid prescribing of newer, more expensive drugs and with physician requests that such drugs be added to hospital formularies (Wazana 2000). There is also concern that manufacturers’ influence over physicians’ education may skew the information physicians receive. The line between appropriate and inappropriate interactions may not always be clear, but there is no doubt that those relationships should be transparent.”

More information on drug company payments to doctors is available at ProPublica’s Dollars for Doctors website.

[Steve Clark]

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