Ethics? What is that, seems to ask the US pharmaceutical industry. Hundreds of doctors accused of professional misconduct have been hired by major pharmaceutical companies to promote their products, it has been revealed.
An investigation by journalism group ProPublica found that 17,700 healthcare providers received such payments. Most of the money went to physicians, but nurses and pharmacists were also included. More than 380 doctors received at least $100,000 from drug companies, according to the research, called Dollars for Docs.
Drug companies often say they pay expert physicians to educate their peers about drugs and conditions. These sessions are often seminars held alongside major medical meetings but sometimes they involve briefings at vacation resorts.
As part of the investigative project, reporters, reviewing state medical board disciplinary records, found more than 250 of the doctors paid to speak had been sanctioned for activities such as inappropriately prescribing drugs or having sex with patients.
It said 40 others had been warned by the U.S. Food and Drug Administration for research misconduct, had lost hospital privileges or were convicted of crimes.
The ProPublica, a respectable nonprofit, has now created a comprehensive database that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. The companies include Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck and Pfizer.
It is also pointed out that the payments relate to the last 18 months, and not all of these companies have even disclosed their payments for that whole period of time, so it could be substantially more, just for those seven companies.
Charles Ornstein of the ProPublica told NPR radio, "For many years, the pharmaceutical industry has been paying doctors to speak and consult on their behalf, but the names of those doctors have largely been a secret. So, for the first time we're seeing from the companies who they're paying for. Now we have a chance to take a look at their backgrounds and what they're doing for the money."
The drug companies rely on doctors to speak locally and travel around the country to educate other doctors about the risks and benefits of the drugs. And they can get paid a lot of money.
Ornstein said, "We found several dozen of the top speakers did not have board certifications — which means they were not certified in their medical specialties — and then we found more than 250 doctors who had some type of sanction taken against them by a state medical board. And we just looked at a sampling of states."
Some of the discipline was really quite serious. The Ohio Medical Board, for example, voted a couple of years back to revoke the license of William David Leak, whom they accused of performing unnecessary nerve tests on 20 patients and subjecting some to an excessive number of invasive procedures. Dr. Leak is appealing the penalty, and his license is still active, but since 2009 he has received $85,000 from Eli Lilly and Co.
Another one is a hospital disciplinary case out of Georgia — the state appeals court in Georgia in 2004 upheld a hospital's decision to kick Dr. Donald Ray Taylor off its staff. He's an anesthesiologist, and he admitted to giving young female patients rectal and vaginal exams without documenting why. He had also been accused of exposing women's breasts during medical procedures, and when he was confronted by a hospital official, he said, "Maybe I am a pervert; I honestly don't know."
Dr. Leak did not return the investigators' phone calls, but Ornstein did talk to Dr. Taylor. He said that these incidents happened long ago, that they were old news and happened in the 1990s and didn't want to talk about them, so he didn't comment one way or the other, but he did say that nobody raised any issue one way or the other about his medical practice.
A recently unsealed whistleblower lawsuit against Novartis , the nation's sixth-largest drug maker by sales, alleges that many speakers were chosen "on their prescription potential rather than their true credentials."
To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians' specialties.
In numerous cases, little information turned up.
The case of Nashville cardiologist Hal Roseman is quite interesting. He vehemently argued the case for Avandia, the diabetes drug whose access has now been severely restricted. He is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center, but in 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.
Asked about Roseman's credentials, a Glaxo spokeswoman said he is an "appropriate" speaker.
Roseman acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Getting paid to speak "doesn't mean that your views have necessarily been tainted," he said.
Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard have begun banning their staffs from accepting pharma money for speaking, he said. "It irritates me that the debate over bias comes down to a litmus test of money," Roseman said. "The amount of knowledge that I have is in some regards to be valued."
While the practice of engaging doctors to popularize drugs might not be a bad idea, they might have saved lives and provided new line of treatments for several difficult diseases, the question is whether or not the drugs that are being excessively promoted are indeed essential and life-saving.
Like, how important is GlaxoSmithKline's Avodart, the anti-prostate enlargement drug? But aggressive promotion has found the sale of its quadruple.
Anyway, of what use the database can be put? Charles Ornstein answers, "If you see your doctor as receiving money from a company that makes your drug, it's good to ask if there are alternatives that are less expensive, if there are alternatives that have fewer side effects, and to just exercise a degree of caution — not necessarily to distrust your doctor at all, but to ask questions to make sure that this is the drug that's best for you."