Most people getting a prescription for a drug don’t ask if their doctor is getting paid to promote that drug. But thousands of physicians all over the country get paid by pharmaceutical companies to speak about brand-name medications. Some have made more than $300,000 in the last 18 months. And at least 1,500 of these speakers are licensed in New York. All these details have just come to light after the investigative news organization ProPublica compiled a database based on disclosures made by seven pharmaceutical companies after federal lawsuits.
(See a list of New York's top earners and check and see if your health provider has received funds here.)
For more than 20 years, psychiatrist Richard Schloss has been treating Long Island patients with schizophrenia, bipolar disorder and social phobias. But he has another job. Pfizer has paid him thousands of dollars to tell other psychiatrists about a drug the company sells, an anti-psychotic medication called Geodon.
In all his years of speaking for Pfizer, the company’s never asked Schloss (right) about an embarrassing stain on his state record. In 2001, the New York State Health Department suspended Schloss and then put him on probation for five years for helping supply Vicodin for a year and a half to six patients who were drug addicts. Schloss says he didn’t know at the time those patients were lying to him about their pain symptoms.
“I was just trying to be compassionate and was misguided and maybe a little naïve, but that was 10 years ago that the disciplinary action occurred based on incidents that occurred 13 years ago. So I feel like I’m a different doctor than I was then,” said Schloss, “and it doesn’t really detract from what I know and what knowledge I can impart about the medications that I speak for.”
Drug companies say the goal of their speaker programs is to educate -- and that they merely pick the best experts to teach fellow doctors about the latest drugs. But many people in the medical community disagree with those claims and want to see the practice end. They say the way drug companies recruit and script their speakers has less to do with education and more to do with marketing.
Speakers With Tainted State Records
Among the 17,000 speakers in the ProPublica database are hundreds of doctors like Schloss -- doctors with tarnished state records who have been paid by drug companies to teach other physicians about the latest medications. Schloss says he doesn’t know if Pfizer even knows about his record.
“They didn’t bring it up, and I didn’t volunteer it but if they asked, I would have been forthcoming, obviously,” said Schloss.
ProPublica’s database for New York doctors shows GlaxoSmithKline recruited a physician after he was suspended for unzipping his pants and fondling himself while examining a female patient. An Eli Lilly speaker wrote fake prescriptions for Ritalin to feed his own addiction. And Johnson & Johnson hired a doctor who lost his New York license after giving patients drugs that weren’t approved for human use. Medical ethicists are now asking if drug companies are checking the state records of their speakers.
“It shows that drug companies aren’t necessarily that selective in who they’re using to promote their products. They will take people who will do what they need them to do,” says Susan Chimonas, a researcher at the Center on Medicine as a Profession at Columbia University. “Their number one concern is making money for their shareholders. That is their legal obligation. And if they can’t find enough physicians with unblemished records to go out and push their products for them, they will take who they can get.”
When WNYC asked Pfizer and other companies how these doctors ended up on their speaker lists, none would grant interviews. Some of them have told ProPublica they do conduct background checks on their speakers, but are now re-evaluating the process.
Targeting High Prescribers
To be clear, the doctors with blemished state records only comprise about one percent of the New York speakers in the database. That is about the same percentage of doctors who are disciplined every year in New York. But evidence from these speaker programs raises troubling questions that go far beyond doctors with blemished records. The companies insist these programs are purely educational, and they get the best teachers they can find. But documents and interviews with several physicians chip away at that claim.
First, the industry says it picks the doctors who are the most knowledgeable about the drugs. But Schloss said Pfizer first picked him because he was a high prescriber of Geodon.
“What they do is they get the pharmacy records, and they know who’s prescribing what,” said Schloss, “and they can come in and say, ‘I see you’re prescribing, you know, a lot of, in this case, Geodon. What do you like about it?’ And you if say nice things, they say, ‘Will you be interested in speaking for us?’”
Schloss said he agreed to be a speaker because he genuinely believes in Geodon, and he enjoys teaching. But even he admitted the speaking has actually changed the way he prescribes.
“You know, I may use Geodon maybe 10 percent more than I did before I was a speaker,” said Schloss. “I use it 10 percent more because I’ve spoken about it so many times, and thereby, learned a lot more about what the drug can and can’t do.”
Keeping Speakers On Script
The talks themselves are completely legal. Here’s how they work: Schloss shows up at a restaurant in front of a group of doctors and leads them through a PowerPoint presentation about the benefits and side effects of Geodon. All of the almost 80 slides are written by Pfizer. Pfizer and other companies say they need to make sure all the content complies with Food & Drug Administration regulations.
The rule is Schloss can’t go off script, even if he may know a lot about the drug that isn’t mentioned on the slides. And that’s another reason critics say these talks aren’t really about educating. Companies say they pick speakers based on their expertise, but they make those experts stick to a script.
“A monkey can read the slides at this point. Well, a monkey that can read can read the slides,” said Stephen Friedes, a psychiatrist in East Hampton. For three years, he has been paid by Eli Lilly for speaking about the antidepressant Cymbalta.
Friedes has been on probation since 2008 for prescribing drugs in dosages and combinations that violated FDA guidelines. Friedes said the charges were unfair, and that he was just trying to treat complicated patients by thinking outside the box.
“The state of New York did not like me thinking outside the box,” said Friedes. “I don’t think at all it implies I don’t know about the medications because I know very well about all psychopharmacological drugs. And generally, I’m pretty well-respected.”
But Eli Lilly never brought up his record and kept paying him $1,000 at a time to speak about Cymbalta. Friedes finally decided to resign from the company’s speakers’ bureau this January. Only then did he realize his Eli Lilly contract had required him to disclose his disciplinary record. Friedes said he would have told the company about his probation if he decided to renew his contract, but regurgitating the company slides was starting to get boring. He said he felt like he was just reciting the package inserts that come with the drugs.
“The problem now is, it’s like Stalinist Russia,” said Friedes. “There’s no freedom of speech and I have to say the party line, and it took away all the fun and all the educating aspects of it.”
Scripting Even the Top Experts
Friedes said drug companies can’t use sales reps to give the same speeches. Instead, they need doctors to serve as speakers because the presentations are more believable when they come from an expert’s mouth. And that’s why companies will pay the biggest bucks to get the biggest experts to read their slides. Experts like Franklin Lowe (right) from Columbia University’s medical school.
Lowe is one of the top urologists in the country. He’s also one of the highest paid speakers in the database for New York City. He does up to 40 talks a year and has worked for 15 different drug companies. In the past 18 months, GlaxoSmithKline paid Lowe more than $150,000. He speaks about their drug Avodart, which treats enlarged prostates.
Lowe said pharmaceutical companies refer to him as a “Thought Leader.” It’s a term the industry uses for the crème de la crème of the profession -- influential physicians whom other doctors listen to. These doctors are the industry’s most prized speakers because they’re the most credible.
The scripted slides don’t bother Lowe. He said he can go a little off-script when doctors ask him questions, but even when he’s on script, he said he’s doing valuable teaching.
“When new drugs come out, the general doctor has no clue about the new product,” said Lowe. “You know, when I go out to Wichita, Kansas or Kansas City or Asheville, North Carolina, where there are no significant medical schools associated with them, I actually provide a real service in terms of education -- even if the talks are scripted.”
But for talks that are supposed to be purely educational, there seems to be a lot of secrecy. WNYC called the seven companies in the ProPublica database, and asked if it could observe a presentation. Each company declined. And none would send copies of their slides. Lowe wouldn’t provide a copy either. He said the slides were company property and he could get into trouble if he passed them out. But Lowe maintained he himself has nothing to hide and that he’s proud to speak about company products.
“I’m educating my colleagues about products that I’ve researched and used and believe in,” said Lowe.
Disapproval From Top Medical Schools
But Lowe’s position on his speaking activities puts him squarely at odds with Columbia’s medical school, where he teaches. After WNYC interviewed Lowe, it found out Columbia’s policy now “strongly discourages” its faculty from giving talks about company products, especially with company slides.
Anne Taylor is the Vice Dean of Academic Affairs and oversees compliance with the school’s ethics guidelines. She said physicians and the pharmaceutical industry should collaborate in the research and development of drugs, but dinner talks are different. They’re marketing talks, not educational lectures, because they focus doctors on a single product.
“We have certain standards that we think a Columbia University faculty member should adhere to, and one of those is intellectual independence,” said Taylor. “We don’t want our faculty to use their Columbia University titles as a marketing tool.
As of January 2011, Taylor (right) says Columbia will prohibit all faculty members from getting paid by drug companies to talk about specific products.
A small, but growing, number of medical schools are following this trend. Harvard University’s medical school will have the same speaking ban next year. It’s a movement medical ethicists are glad to see.
“How can patients you’re treating, readers of your articles, listeners of your lectures -- how can they trust that you are unbiased in what you’re telling them when you’re getting so much money?” said Carl Elliott, a professor at the Center for Bioethics at the University of Minnesota, who has written extensively about the relationship between doctors and pharmaceutical companies.
WNYC asked Franklin Lowe if he knew Columbia’s policy on his speaking activities. Lowe said he was surprised. In all his 25 years of teaching at Columbia, he said he never heard the school discourages its faculty from giving these kinds of presentations. And he didn’t think it was the wisest policy.
“Certainly one would think that you’d like to have the best and brightest and your smartest who are the ones that are out there doing the education for the pharmaceutical companies,” said Lowe in a phone interview.
Lowe says he’s not sure he really will quit the dinner talks next year. And he may not have to right away. Vice Dean Taylor says Columbia still hasn’t decided how it will actually enforce its new speaking ban, even though at last count, four of the ten highest paid speakers in the ProPublica database for New York City are Columbia professors.
Dollars for Docs is an ongoing investigation by ProPublica and other news organizations. Partners for this story include WNYC radio, The Dallas Morning News, The Detroit News, San Francisco Chronicle, Health News Florida and Colorado Public Radio.
Ailsa Chang is an award-winning journalist who covers criminal justice, terrorism and the courts for WNYC. She found her way into public radio after practicing law for five years, and can definitely say that walking the streets of New York City with a microphone is a lot more fun than being holed up in the office writing letters to opposing counsel.
Comments [20]
If all you doctors disagree with the practice mandated by the FDA, what are you doing about it?
How is the public supposed to know what choices to make when their doctors are being paid by private companies? How is that not a conflict of interest?
I'm sure many of you do have the integrity to do what's right, but bad things still happen, and that's the point. The whole system needs to change. The incentive for these companies can no longer be profit. Money cannot come first. It is just asinine.
Doctors and patients alike should DEMAND full disclosure. It is about time we stop allowing these companies to decide no only what is best for us, but what we are allowed to know in the first place.
"This is America," is that really Lowe's justification for doing something that could potentially be very damaging? Is he serious?
Well, on second glance, perhaps he has a point. Americans are used to industry stepping all over them, disregarding responsibility, compassion, and rights of the public. Thank goodness we are in a country where money talks and the more you have, the more damage you are allowed to create! What was it that Jefferson said every human is entitled to? "Life, liberty and pursuit of industry dollars." Something like that...
Physicians are (slowly) rebelling about showing "company slides."
See Benbadis SR et al. Open letter (and invitation) to the pharmaceutical industry: "No, we cannot just present your slide deck …" Epilepsy Behav 2010 Sep 10. [Epub ahead of print] No abstract available. PMID: 20833110
Besides coming across as a pompous jerk (as if Wichita and KC didn't have medical schools, and Asheville wasn't 30 mi from Knoxville and the UT Medical School), Dr Lowe overstates his affiliation with Columbia. He is just a "clinical " associate professor there (which essentially means he is allowed privileges to operate/admit patients to NY-Pres). A quick peek at the Columbia Urology dept faculty list shows he's not a member. In fact, given where his office is, I bet he mostly hangs out at St Lukes. Not to take responsibility from Columbia, which should be a little more selective in handing out its titles.
As the first physician mentioned in this story, I am frankly puzzled by the intent. I was told that this was to be a story about the relationship between physicians and the pharmaceutical industry. But the beginning of the story seems more like an "expose" on how pharmaceutical companies are hiring "tainted physicians." Except that, as the story points out, I was scammed by 6 drug-seeking patients in the early part of my career, which hardly puts me in the same category as a sex-offender, even though a physician who committed a sex offense is mentioned immediately after me. Then my colleagues and I are portrayed as trained puppets because we are not permitted to deviate from the prepared slides unless asked a question, even though, as other comments attest, we are actually adhering to strict FDA guidelines by doing so.
I'm a big fan of WNYC but was quite disappointed with this story. The reporter leads with the most sensational part of the story (pharma paying docs with "blemishes" to speak about their drugs) then, almost in passing, mentions that these physicians only represent about 1% of the docs on a list of 1500. You have to admit that this shows a significant bias. In the competitive world that we live in, drug companies, like all companies, intensely promote their product. And, like it or not, drugs are products. Also, the reporter suggested that these companies are hiding something by insisting that the speakers only speak to the slides that they were given by the drug company. She neglected to mention that this practice is mandated by the FDA. If the companies promote anything beyond their FDA label they will not only be fined by the FDA but there'll be another story about how drug companies are trying to make more money by promoting off-label. These companies are no saints but it is clear this story was reported with a bias.
I still love WNYC!
Sooooo... everybody can work for profit, like lawyers and grocers and CEO's and, uh, journalists, but God-forbid anyone in healthcare should make a profit, is that what we're saying? People in healthcare should just get up in the morning, work their bloody %&$####'s off all day so all of us ingrates can enjoy a healthy tomorrow, and they should do it for as little recompense as possible, because, after all, they DON'T have student loans and families and mortgages and school tuitions like the rest of us? Well, don't be surprised if nobody wants to do it anymore, and then we can all go to CANADA for our healthcare. And don't complain when the next infection you get is resistant to every drug available, because the drug companies have no incentive to invent new ones. Why not an expose about how there aren't enough new antibiotics in the pipeline, or new diabetic drugs to combat our national indulgence in obesity?
I'm sure WNYC, with Chesire cat smile, wants us to think that a major public service is being done with this hard hitting expose. Why then as mentioned above,did they lead with the irrelevant 1% compromised doctors part? There is no conflict of interest. These are legal, generally safe, well-researched medications, that are already being prescribed. New medications, such as Geodon, are vastly superior to and safer than their predecessors. When possible, they should be chosen over less safe, older drugs. To be clear, as a physician, if I am not prescribing this expensive drug, I will be prescribing that expensive drug. When these go generic, I will continue to prescribe them, unless there is a superior new drug. Be content that drug company promotions cancel each other out. We just enjoy the camaraderie and the venue.
The editor of propublica, the news agency associated with this story makes $570,000.00/year. The funding for this agency is grant dollars. Some of the top earners cited in dollars for docs, make $150,000.00/year as state or city employees. They augment their salaries speaking for pharma. One key question that has not been addressed, are these products they are speaking for better than pre-existing ones? If they are it should be up to the audience listnening to the thought leaders to decide wether to use them or not.
The story is a very important one and right on target. But I was a bit disappointed that the reporter failed to focus on a lynch pin of the process -- why are pharmacies allowed to sell medical data to marketing firms?
I'm in pharma marketing and if pharma companies wish to pay thought leaders in the medical world to discuss products, I'm fine with that. (Though I'm okay with disclosure of this.)
But the pharma companies are learning how much business each individual doctor is writing for each individual product because our national privacy laws are terrible and thus the pharmacies are able to sell the data to marketing firms, which compromises both doctor and patient privacy.
Why are there not privacy laws to stop this? This is terribly important when our city is rapidly becoming serviced by two large pharmacy chains.
The story is a very important one and right on target. But I was a bit disappointed that the reporter failed to focus on a lynch pin of the process -- why are pharmacies allowed to sell medical data to marketing firms?
I'm in pharma marketing and if pharma companies wish to pay thought leaders in the medical world to discuss products, I'm fine with that. (Though I'm okay with disclosure of this.)
But the pharma companies are learning how much business each individual doctor is writing for each individual product because our national privacy laws are terrible and thus the pharmacies are able to sell the data to marketing firms, which compromises both doctor and patient privacy.
Why are there not privacy laws to stop this? This is terribly important when our city is rapidly becoming serviced by two large pharmacy chains.
Most of the jobs require that you disclose issues that could pose conflict of interest. Why is there no oversee or control over the most important issue such as health care where your doctor could easily be influenced by the monetary rewards? I cannot believe why Columbia University did not focus on such an important issue. Why are the durg companies not holding seminars were they could inform doctors about new drugs and their benefits without monetary involvement.
ProPublica's findings are exactly on target. Having been in Pharmaceutical Sales, Marketing and Advertising I know that they use the IMS audits to learn who the high prescribers are of a drug the company needs to increase sales for in a given representatives territory. The rep is then responsible for getting that MD to speak or accept gifts. Then you do see an increase in sales. While the MD's may not realize what they are getting into, they are being used. The fact that the drug companies do their own research and tell the MD's what to say should alert us that something is up. Short story, quite a few years ago, I was told by a physician that he took patients off of my antihypertensive because my sister company was offering a trip to Hawaii if he were to put as many patients as possible on their antihypertensive. Something has been wrong for a long time and it has been known, but the Pharmaceutical Lobby is too stong.
Doctors & Physician Assistants receive weekly phone calls to sign up for "Phone Seminars" from pharmaceutical companies to learn/hear about their product fro 1 hour. We then get "rewarded" for our time with points towards free medical products - i.e. new stethoscopes, etc.
The Atlantic has an article on this this month. There's a "thought leader" who writes what the pharmaceutical company would like to say (or avoid) and then the physician signs off on it.
Often, the "thought leader" just gets approved with no changes.
It is a real disappointment to hear that Columbia has not effectively communicated its standards for ethical behavior to the MDs on faculty. I hope that WNYC will follow up in January 2011 to see how that failure has been rectified. If Professor Lowe is unwilling to sacrifice his earnings from dinner talks (which are doubtless a small percentage of his total income given his specialty) then he should seek a position at a medical school that has lower ethical standards. His most important teaching opportunities are at the College of Physicians and Surgeons and in the teaching hospital. There, he influences not only the future medical practices of his students. He also teaches, by his own example, professionalism and medical ethics. Currently, he is providing a lesson in need of serious revision.
I think the practice should end. I think its not a surprise that's this is going on. I work in a large doctors practice in a major medical center in manhattan and my best friend is a doctor at another institution. Its always about $$$$$. Any comment you find on this page stating the opposite opinion is from someone who works for drug companies, or is one of the doctors that are in it for the money. ( I dont think there's alot of doctors in it for the $$$ but certain practices there are ie. dermatology, pediatrics on the other hand there are few) Stop the practice of drug pushing for profit.
I have two problems with this segment.
1. If only one percent (1%!) of the doctors in the database show "blemished records", then it seems sensationalist to lead with it, dwell on it for several minutes, and only barely mention it.
2. My wife is a doctor. Just last night, she went to one of these meetings. In her words, "There's NO WAY the presenter was totally 'on-script'!...Was it educational? Yes! I got a chance to update myself on insulin treatments."
And, she insists, it was presented without limiting the discussion to specific products.
It sounds like the journalist here made the same mistake our 7th grader did last week on a research paper: Did just enough research to make her point and then stopped.
Thanks Ailsa for this interesting article.
You on Twitter?
Am @DenisLondon there.
Keep up the good work! :)
Glaxo whistle-blower gets $96 million.
The case with the Zyprexa scandal is that Eli Lilly drug company pleaded guilty to criminal wrongs ("viva Zyprexa" campaign) the Zyprexa saga was rotten through and through.
Eight Lilly EMPLOYEES got millions each as supposed informant 'whistle blowers'.Lawyers on BOTH sides got millions and millions......most patient claimants who got sick are 'mentally challenged' and less able to advocate for themselves.
The Class action Lawsuits in the US had payouts of $85,000 BUT the lawyers got 45 percent and then the govt got most of the rest for having to take care of the victim/patients medical expenses.Soooo,,,,$85K turned into about $9,000 for Zyprexa claimants many had their food stamps and other state benefits taken away because of their *windfall profit* making them worse off in the end.
*
Daniel Haszard Zyprexa victim activist and patient who got diabetes from it. http://www.zyprexa-victims.com
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