Area doctors get pharmaceutical money for talks about drugs

By Alan Bavley, Kansas City Star, December 08, 2010

A prominent cardiologist who’s written a diet book. A urologist who’s part of a booming group practice. A family practice doctor, two psychiatrists and two specialists in pain and rehabilitation.

They are area members of the $100,000-plus club — physicians paid six-figure sums by drug companies.

For their paychecks, the doctors give promotional talks to other doctors about the drugs the companies make. They lead forums. They serve as industry consultants.

More than 100 area doctors are taking money from drug companies for speaking gigs and other work, according to data from the nonprofit journalism organization ProPublica. From the beginning of last year through the first half of this year, area doctors have received at least $2.2 million.

The drug industry and the doctors themselves said they were doing an important job by teaching colleagues how to use medications and giving them the benefit of their experience dealing with patients.

Critics said education is not the only reason — or even the primary reason — why drug companies paid so much to doctors. They say it’s all about promoting the companies’ products.

And, critics said, the practice could lead to doctors prescribing drugs too often; prescribing problematic drugs; and writing prescriptions for more-expensive medications when cheaper ones would do.

Payments to physicians by drug companies is an issue that has simmered for years in the medical community.

The Association of American Medical Colleges and the Institute of Medicine have questioned whether doctors should participate in speakers’ bureaus for drug companies.

But Kansas City cardiologist James O’Keefe doesn’t see himself as a marketer, but as an educator.

Three drug companies paid O’Keefe a total of $188,225, ProPublica’s data show.

“I’m not there to sell (doctors) a drug,” O’Keefe said. “I’m there to discuss the data and the pros and cons of a therapy. I don’t feel I directly influence them in choosing a certain branded pharmaceutical.”

• • •

Some of the 125 local doctors that The Kansas City Star gleaned from the ProPublica database have received as little as $100 from drug companies. Most got thousands of dollars.

ProPublica came up with the data by analyzing numbers from seven drug companies that publicly released information on their physician payments. Nationwide, some 17,700 doctors and other practitioners received $282 million in the same period, ProPublica found.

The seven companies had prescription drug sales in 2009 of $109 billion, about 36 percent of the market. Other drug companies — accounting for more than 60 percent of the market — haven’t reported physician payments, suggesting that total pharmaceutical industry payments to doctors are substantially higher.

“The medical profession has been awash in drug company money. It doesn’t seem strange or problematic to them,” said Susan Chimonas, a researcher with the Institute on Medicine as a Profession at Columbia University, and a critic of the financial relationships between doctors and the drug industry.

Chimonas said drug companies hire doctors to deliver their message.

Cutting Edge Information, an industry research company, advises drug makers to “invest in thought leader development to generate widespread market acceptance” in a recent report.

Physician speakers go through drug-company training to make sure they focus their talks on information approved by the Food and Drug Administration. That’s a requirement of the Pharmaceutical Research and Manufacturers of America ethics code.

Drug companies often provide doctors on the speaking circuit with the sets of slides and other materials they use during their presentations. Those slides must be submitted in advance to the FDA.

The FDA requires that the slides be scientifically accurate and truthful and that they strike a fair balance between a drug’s benefits and risks, said Jeffrey Francer, the pharmaceutical group’s assistant general counsel.

“A medicine should only be promoted in ways consistent with its FDA approval,” Francer said.

But drug companies have methods for presenting their products to their advantage, Chimonas said.

For example, on slides listing many drugs, the company’s product will be listed first, with the others in alphabetical order.

“Doctors selected by pharma are selected for a marketing role. They may not even be aware of the marketing role,” said Adriane Fugh-Berman, a Georgetown University physician who directs PharmedOut, a research and education project addressing industry influence on prescribing.

Those roles vary from doctor to doctor. And there’s a definite hierarchy.

Doctors who aren’t prominent in the medical community may be offered speaking engagements simply because companies know they prescribe a lot of their drugs, Fugh-Berman said.

Companies may offer these doctors $750 or $1,000 to speak to small groups at a local restaurant. The primary goal isn’t to promote more prescribing among doctors attending the dinner but to reinforce the prescribing habits of the speaker.

Higher-paid regional or national “opinion leaders” have a different role. These doctors often are widely known in their field and may have published substantial research.

But they are selected, Fugh-Berman said, because their views mesh with the drug companies’ marketing goals.

These doctors may hold the opinion that more people should be taking the kind of medication that a company makes, or that a particular medical condition — one for which a drug company has a product — is more prevalent than generally recognized.

An example of how industry opinion leaders helped steer doctors and patients to a problematic medication was the promotion of hormone replacement therapy as a treatment for menopause symptoms, Fugh-Berman said.

The replacement hormones were being prescribed to millions of women when a government study in 2002 found that they raised the risks of breast cancer and heart disease.

Researchers recently examined published studies on whether drug industry marketing influenced doctors’ prescribing practices. Evidence that marketing led to more prescribing or to prescribing more-expensive drugs was inconclusive, they said.

But the researchers also found there was no evidence that the information drug companies gave to doctors led to the more-effective or safer use of medications.

• • •

O’Keefe’s name appears on dozens of articles in respected medical journals. Along with his wife, a registered dietitian, he’s written a popular diet book.

The drug companies he speaks for consider him a national key opinion leader, O’Keefe said.

“My professional passion, my personal passion, is preventing cardiovascular disease,” he said. “We’ve learned that the best way to improve risk factors is through diet, lifestyle and medication.

“I know there’s distrust of Big Pharma, but they’ve done a good job at helping prevent heart attacks and stroke. I’ve always felt good — proud — that they asked me to speak.”

O’Keefe gives a couple of talks a week, generally over lunch or dinner. A couple of times a month he speaks out of town.

For Merck, he talks about the diabetes drug, Januvia. For GlaxoSmithKline, he speaks about Carvedilol for heart failure. For AstraZeneca, it’s the cholesterol drug, Crestor.

O’Keefe said he took Crestor himself, “and it’s not because I’m speaking for the drug company.”

“I feel like I’m objectively educating physicians about medications,” he said. “Doctors need education on how to use new drugs. The pharmaceutical reps don’t have the science and clinical background that physicians do.”

O’Keefe said he made sure to tell doctors about cheaper generic alternatives to brand name drugs. Most of the drugs he prescribes to his own patients are generics.

“It’s not that I’m talking about Crestor all the time. I’m talking about other options,” he said.

• • •

A recent national survey found that fewer doctors said they were taking payments from drug companies — 14 percent in 2009 compared with 28 percent in 2004.

The decline may be due to recession-forced cuts in marketing budgets, the survey authors suggested. Or, they said, public reporting of payments, tighter rules at some hospitals and medical schools and increased press scrutiny may have made doctors more reluctant to accept drug company offers.

That scrutiny is bound to increase in the next few years. Tucked into the health overhaul legislation is a measure that will require all drug companies to publicly report their payments to doctors beginning in 2013.

“It’s going to give us a really good picture,” Chimonas said.


Kansas City area doctors in the $100,000-plus club

These seven area doctors are among 384 health providers nationwide who earned $100,000 or more from one or more of seven drug companies in 2009 and early 2010, according to ProPublica. (Doctors may have offices in more than one location.)

•Steven Nash, Kansas City

Board certification: urology

Total received: $205,902

From: GlaxoSmithKline, Pfizer

Declined to comment.

•James O’Keefe, Kansas City

Board certification: internal medicine, cardiovascular disease

Total received: $188,225

From: GlaxoSmithKline, AstraZeneca, Merck

Quote: "I’m not there to sell (doctors) a drug. I’m there to discuss the data and the pros and cons of a therapy. I don’t feel I directly influence them in choosing a certain branded pharmaceutical."

•Srinivas Nalamachu, Leawood

Board certification: Not determined by ProPublica

Total received: $177,509

From: Cephalon, Eli Lilly, Johnson & Johnson

Quote: "I’m just getting paid for my time. In any profession, you are entitled to be paid for your time. … Physicians should not be taking money from drug companies unless they are doing something valuable."

•James LaSalle, Excelsior Springs

Board certification: Not determined by ProPublica

Total received: $166,400

From: GlaxoSmithKline, AstraZeneca

Declined to comment.

•Steven M. Simon, Leawood

Board certification: physical medicine and rehabilitation

Total received: $138,659

From: Eli Lilly, Cephalon, Pfizer, Johnson & Johnson, GlaxoSmithKline

Quote: "I have asked myself: Is this ethical? Absolutely. I would hope why I use a product is because it’s the best product for the patient. … I hope I am honest enough that I wouldn’t speak about any drugs I haven’t used or had success with."

•Stephen G. Huk, Leawood

Board certification: psychiatry

Total received: $135,708

From: Eli Lilly, Pfizer

Despite repeated attempts, could not be reached for comment.

•Kevin Mays, Leawood

Board certification: psychiatry

Total received: $119,406

From: Eli Lilly, AstraZeneca, Pfizer, GlaxoSmithKline

Quote: "My position gives me the opportunity to provide real world explanation with the scientific background of a practicing physician. … Attendees have come up to me and directly thanked me for imparting information that they hadn’t previously considered."

To reach Alan Bavley, call 816-234-4858 or send e-mail to abavley@kcstar.com. | ProPublica, The Star

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