Here's some interesting information about the close relationship between physicians and drug companies. Make your own decision regarding how unbiased your physician is when it comes the prescription he/she writes for you...
BY CYNTHIA BILLHARTZ GREGORIAN
Three drug companies paid a Washington University anesthesiologist $255,737 over 18 months to speak to other doctors about some of their products, including pain killers and muscle relaxants.
An analysis of data from seven major drug companies found that Dr. Anthony Guarino, an assistant professor of anesthesiology, was one of the doctors nationwide who received the most money from the drug companies between January 2009 and June 2010. The analysis was done by ProPublica, an independent, nonprofit news organization in New York.
The data show that seven companies - Eli Lilly and Company, Pfizer Inc., Merck & Company Inc., Cephalon, GlaxoSmithKline, AstraZeneca Pharmaceuticals and Johnson & Johnson - together paid more than $282 million to more than 17,000 doctors nationwide.
Critics of such relationships maintain they pose a conflict of interest - that they can color the way doctors educate their peers at company-sponsored events, as well as how they prescribe medications in their offices.
But Guarino, who treats patients at the pain management center at Barnes-Jewish West County Hospital, said he mostly prescribes generic drugs.
"There are situations where I recognize that brand medications would be superior, and in that instance I will prescribe them," Guarino said. "But I do let the patient know that I speak for the company, and if they feel there's a conflict of interest I will not write a prescription for that medicine."
Several of the seven companies in the "Dollars for Docs" database were required to post names and compensation online as the result of legal settlements. ProPublica acknowledges that the data is limited, so far.
New disclosure rules in the federal health care reform law require more than 70 other pharmaceutical companies operating in the United States to start reporting payments to doctors in March 2013.
The data from the seven reporting companies show payments to individual doctors ranged from less than $100 to more than $303,000. More than 230 doctors on the Missouri side of the St. Louis area and 14 in the Metro East area accepted payments.
Charles Ornstein, senior reporter for ProPublica, stresses that it's legal for pharmaceutical companies to pay doctors, and that the database is designed to start conversations between doctors and patients.
"Doctors should feel comfortable talking about this," he said. "If they're uncomfortable answering questions about their relationship with pharmaceutical companies, patients need to ask why."
Educating doctors
Dr. David L. Weinstein, an obstetrician-gynecologist with Consultants in Women's Healthcare in west St. Louis County, made $164,295 over 18 months speaking to other physicians about two osteoporosis drugs, according to the database. He is among the 13 doctors in the metro area who were paid the most by the seven drug companies.
Weinstein says educating other doctors on behalf of pharmaceutical companies has made him a better physician.
"I participate in more conferences on advances in my field, and find myself taking a more holistic approach to patient care, which means writing fewer prescriptions and letting physician audiences know this and why," he said.
Dr. Anthony J. Margherita, a physical medicine and rehabilitation doctor at West County Spine & Sports Medicine, said he and other speakers draw on their own clinical experience in their specialties when speaking to other doctors, most of whom are general practitioners.
"The key is making sure they prescribe and treat correctly," he said. Margherita said he has encountered doctors "who were inappropriately or dangerously prescribing the medicine I was speaking about."
For instance, he said, Cymbalta is not indicated for use by people with severe kidney disease. "I had one doctor who'd been prescribing it to a patient with kidney disease come up after an event and said, ‘Oh, my god, I'm stopping it right now.'"
Eli Lilly paid Margherita $122,274 to speak about Cymbalta.
Dr. Jerold J. Kreisman, a psychiatrist with Allied Behavioral Consultants Inc. in St. Louis, sees benefits in specialists who can talk about specific diseases and conditions reaching out to educate doctors in remote areas. He doesn't oppose the idea of the database.
"Full disclosure is important as long as people understand it in its full context," Kreisman said. "If there's a feeling that it's being done just for money and as a main source of income, for the vast majority of doctors that's really not the case. It's reimbursement for (time away from) their offices, working and seeing patients."
Best in the field?
Some doctors, such as Guarino, say they're chosen by the pharmaceutical companies and reimbursed at such high rates because they're among the best in their fields.
But ProPublica also identified 292 doctors in the database who have been sanctioned or warned by regulators.
Among them are six doctors from Missouri - three from the St. Louis area - who were disciplined for infractions, including inappropriate sexual relationships with patients, failing to get proper informed consent from those participating in clinical studies and not keeping proper records and inventories of controlled substances.
In addition to ethical issues, some experts wonder whether the pharmaceutical companies' programs are necessary.
The FDA-approved labeling and package inserts that come with pharmaceutical products should give doctors all of the information they need for prescribing them, says Dr. Murray Kopelow, president of the Accreditation Council for Continuing Medical Education in Chicago. There's also a wide array of non-commercial sources for doctors to get medical information.
"We have about 2,200 accredited medical education providers and more than 10 million individual registrants in that education each year," he said. "We believe it's unbiased education, without a proprietary interest."
Doctors who speak for certain drugs often don't have all the information about those drugs, said John Abramson, a lecturer on health policy at Harvard University and author of "Overdosed America."
"It's proprietary information, and (pharmaceutical companies) very rarely make it available for outside research or analysis," Abramson said.
For profits or patients?
When information comes from a commercial source, he added, the purpose typically is to maximize profits for shareholders and not to improve patient health.
The ProPublica database provides transparency, but determining to what extent a conflict of interest is at play is nearly impossible, Abramson said.
He said Harvard clamped down this year by instituting a policy that prevents its faculty members from giving promotional talks for drug companies. It also requires doctors to publicly disclose fees exceeding $5,000 a year for consulting or serving as board members.
Locally, the St. Louis University Medical Center encourages collaborations between its faculty and private industry, with the idea that it advances the discovery of better treatments.
Nancy Solomon, communications director for St. Louis University Medical Center, said in an e-mail that the school continually reviews its policies "to ensure faculty members engage with industry effectively, ethically and with the highest degree of professionalism so that research, education and medical decision-making always are driven by what ultimately is best for patients."
Washington University School of Medicine requires its doctors to disclose how much money they receive from pharmaceutical companies each year. If it's more than $10,000, the faculty member must post it on his or her university Web page. A university panel regularly reviews the relationship between that physician and the pharmaceutical company.
For instance, the panel calculates the hourly rate the physicians are earning from the companies, said Dr. James P. Crane, executive vice chancellor for clinical affairs and CEO of the faculty practice plan at Washington University.
"One benchmark we use is how much a physician typically earns in clinical practice, and that varies by specialty," said Crane. "Our upper limit is $500 an hour."
Crane said the university also monitors patterns using its electronic prescribing system to ensure that a doctor isn't prescribing a drug he or she speaks about more than others.
Abramson isn't convinced such measures are good enough because those faculty members also have influence over medical students.
He recalls a student doing a fellowship in rehabilitation and pain medicine at Harvard telling him how he would try to talk to patients about lifestyle changes, only to have physicians come in and prescribe medications instead.
That's the commercial influence on health care, he said.
Dr. H. Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice says public disclosure such as the ProPublica database is healthy, even if it doesn't always reflect well on his profession.
"Patients need to know it doesn't affect all doctors," he said, "but it certainly highlights the fact that money matters in medicine."
