by Nicholas Kusnetz
ProPublica
Nov. 23, 2010, 10:48 a.m.
This week, Massachusetts became the first state to post an online database of payments from drug and medical device companies to the state’s health care providers. The searchable database covers reports from more than 280 companies and subsidiaries.
The new database, detailed on Monday by the Boston Globe — one of our Dollars for Docs partners — is a result of a 2008 state law regulating industry conduct. The database lists nearly $36 million spent from July through December of 2009 for speaking, consulting, food, educational programs, marketing studies and charitable donations.
Minnesota has for years posted similar payments in that state, but has not compiled each company’s reports together into one database. Minnesota’s list also does not include medical device manufacturers.
Dollars for Docs, our ongoing project examining the relationship between the pharmaceutical industry and physicians, captures payments for drug promotion and marketing across all states from seven major drug companies. The reports in Minnesota and Massachusetts are just snapshots of the national picture and, in the case of Massachusetts, a limited snapshot at that.
Massachusetts’s law requires manufacturers to report their activities each July to cover the previous calendar year, from January through December. But compliance did not go into effect until July 1, 2009, so this first release covers only half of last year.
Drug and device companies do not necessarily spend money consistently throughout the year. For example, a search for Dr. Andrew G. Kowal in the Massachusetts database shows that he earned $11,324 from Eli Lilly and Co. in the six-month period covered. But Dollars for Docs shows that Lilly paid Dr. Kowal $48,200 in 2009 (Massachusetts’s data does show Kowal received payments from companies not included in Dollars for Docs). So until next year, we won’t really know how much these companies are spending in Massachusetts over the course of a year.
The Massachusetts data includes other kinds of payments, such as charitable donations and payouts to hospitals and clinics, which are not included in Dollars for Docs. The state’s Office of Health and Human Services allows you to look at some prepared reports, do your own query, or even download the whole dataset from their site.
The patchwork of different reporting from state to state and company to company will end in 2013, when all drug companies will have to report their payments to the federal government.
What don’t people understand about the fact that medicine is a business, almost like every other? The pharmaceutical companies develop a drug which they think will be efficacious and hence profitable. The pharm companies, themselves not doctors, need to market the drug in order for it to sell and be profitable, which will encourage the companies to continue production and to work on other therapies. Doctors provide a service to pharmaceutical companies by evaluating their medications through their research on the drug, based on their previous experience with patient care. For this they receive COMPENSATION, not BRIBES. What’s wrong with the doctors getting compensated for their time and effort?? Do you want doctors to evaluate medications for free? And why is it anyone’s business how much the doctor receives for his/her service?
Please don’t tell me that doctors just sell meds to their patients based on from who they receive money. 95% of doctors (and I know MANY) would not even consider that. The majority of physicians entered the field not to become millionaires (not that there’s anything wrong with that) but to help patients while making a comfortable living.
Fellow med students, if we don’t stand up for our individual rights and demand the respect our profession deserves, no one else will. If we allow ourselves to be taken advantage of, we will end up as slaves to the government and to non-deserving, lazy citizens.
It’s not like any other business. In any case, as a med student, you can see how the whole profession is organized in a way to make sure we don’t get treated just like any other business. Being a non-trad and having owned businesses, it’s very clear that physicians certainly do not get treated at all like a business. If you want people to put physicians as any other business operators, you’re opening a door where you may not like the consequences.
In any other field, this would be considered a conflict of interest. Has the drug that’s being pushed been shown to be better than the current standard of care? In many cases, it has not – it has the same outcomes but is ten times as expensive.
“Please don’t tell me that doctors just sell meds to their patients based on from who they receive money. 95% of doctors (and I know MANY) would not even consider that.” – Quote from John Galt’s post
It is not that doctors are making conscious decisions that they are going to sell more of drug X because that company paid them to give a speech about it. I think you underestimate the amount of doctors for whom that thought would never cross their mind and let’s go ahead and assume 100% of doctors would never even consider this. But people have a habit of responding to incentives, even if subconsciously. And if a doc is paid to give a speech about a drug, that takes time, energy and focus to prepare for. He is much more likely to think first of that drug when prescribing for a patient simply because he’s been thinking about it more.
This is what the pharma companies are counting on. They have access to data to see exactly how much of their drugs a doctor sells. They continue to pay a doctor to do things which increase his sales so long as the sales he brings in is greater than the money they pay him. It’s simple economics.
We don’t want to structure the incentives in this way. Yes pharma companies have to make money to have an incentive to make more drugs, but in this system we are rewarding the companies with the best marketing strategies (utilizing doctors as advertising tools whether or not the docs perceive it that way). So the company with the best marketing gets the most drugs prescribed, sells the most drugs and had the biggest incentive to continue to produce new drugs.
The incentives SHOULD be structured such that the company with the most effective drug gets prescribed most often, sold most often, and has the biggest incentive to develop new drugs. Once upon a time we had a system reasonably similar to this. Medical research was done by and large by Universities and institutions wholly divorced from any revenue generated by the results of their findings. They produced non-biased (one would hope) journal articles which physicians used to evaluate the effectiveness of a drug. Now that the majority of research is done by the company which developed the drug all that has changed.
Bottom line if you would be embarrassed for your patients to know who you took money from, you probably shouldn’t be taking that money. Regardless of whether you think doctors are crooks or completely honest with only the patients best interest in mind, it is completely unrealistic to believe that their prescribing decisions are not swayed by a company who pays them thousands of dollars each year. They may not think that the money affects their decisions, just as we might not think that television advertising influences what we buy. Marketing companies and pharmaceutical companies know better.
“Please don’t tell me that doctors just sell meds to their patients based on from who they receive money. 95% of doctors (and I know MANY) would not even consider that. “
You’re absolutely right.
-from a physician
Yea, I’m sure physicians are immune from psychology….
The drug companies are stupid – they keep paying money to get no advantage in return.