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.
Physicians on Pharma’s Payroll: Educators or Marketers?
Thursday, November 18, 2010
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.