PharmExec Blog

Pharma Gets the ProPublica Treatment

Alternative news organization and media allies investigate the industry’s payments to doctors—launching a fresh assault on the ethical status quo.
By Walter Armstrong

Last week, Big Pharma’s practice of paying doctors to do medical education, promote its products, or both was the focus of a multimedia blitz launched by ProPublica in collaboration with National Public Radio, the PBS Nightly Business Report, the Chicago Tribune, the Boston Globe, and Consumer Reports. In what must be seen as a wake-up call for the industry on its handling of compliance issues, each of these major media outlets ran its own major story raising questions about the ethics of paying physicians to help increase sales of medicines. Whether the avalanche of data and juicy anecdotes of physician behavior found in ProPublica’s “Dollars for Docs” report actually answered any of those questions l depends on your point of view.

That pharma sales strategies can encompass elements of fraud, kickbacks, and other funny-money exchanges isn’t exactly news. Billion-dollar settlements with the Department of Justice have become so ho-hum over the past decade that the chorus of threats of criminal prosecutions of drug-company executives by officials at Justice, HHS, and FDA is reaching almost credible levels. What is news—and ProPublica’s new contribution to the debate—is the searchable database for consumers containing the names of some 17,700 US doctors and other practitioners who raked in a total of $257.8 million in pharma payments since mid-2009, a considerable technological feat (aided by Google Refiner) given the mix and sloppiness of the data. The list remains far from complete—it records the fees for speaking, consulting, researching, or related activities paid to doctors by only seven of the top pharma firms: Pfizer, Glaxo, Merck, J&J, AstraZeneca, Lilly, and Cephalon. Of the seven, only Merck and Glaxo volunteered the info; ProPublica got the rest from disclosures the other five companies were forced to make as a condition of false-claims and other settlements.

The sharing of its database with other news organizations (and ultimately the public) is central to ProPublica’s alternative business model. The nonprofit Internet news organization’s mission is public-interest investigative journalism—a resource-consuming enterprise increasingly viewed as nonessential by an industry in financial free-fall. Since its launch in mid-2008, the group has earned its credibility, winning many of the nation’s top journalism awards, including a Pulitzer last year for investigative reporting. It counts among its funders the Gates, MacArthur, and Ford foundations; its newsroom is led and staffed by veteran editors and reporters from the New York Times and the Wall Street Journal. By lending its pharma-physician database to other national and local news outlets—and orchestrating a simultaneous delivery—ProPublica ensured that it got maximum bang for its investigative buck. And the investigations into the pharma industry’s financial ties continue this week with a report based on research into its payments to lobbyists and to political campaigns.

In the week since the stories broke, many lines of debate have developed among readers, including physicians, sales reps, patients, and pharma analysts. There is the usual shouting match between the pro- and anti-pharma lobbies, but the conclusions that emerge from ProPublica’s analysis are based on data that has been independently sourced from credible third parties.  ProPublica’s analysis contradicts a  few of the pharma industry’s most frequent justifications for the practice of putting the very professionals who write prescriptions for its products on its own payroll.

Contrary to drug makers’ claim that they only hire thought leaders and other top specialists to move their message, the sheer volume of names in the database indicates this contingency is broadly framed. Among the 384 doctors who earned $100,000 or more during this period, more than one in nine had no board certification in any specialty at all. A search of physician licensing records in 18 states found that more than 250 doctors who accepted speaker fees, including some very high earners, had been sanctioned for misconduct, not surprisingly including inappropriately prescribing drugs. More than 40 got slapped by the FDA for research wrongs, lost hospital privileges, or had criminal convictions, while at least 20 others had two or more malpractice judgments or settlements.

These numbers inevitably give rise to some unsettling questions. For example, why is pharma paying anything at all to doctors who have been sanctioned for professional misbehavior?

When asked if background checks are done on doctors, only Cephalon and J&J said that they review state websites. Nevertheless, ProPublica data base shows that one physician accused of sexual misconduct with female patients was Cephalon’s  third-highest-paid speaker in 2009.

Critics of the ProPublica presentation, including healthcare journalists, point out that the accounting was incomplete, even unfair, because it failed to put the final tally in perspective. Most notably, only 1.5 percent of doctors on company pay  had been sanctioned, while the average payment to a physician came to $15,000, not exactly small potatoes but not necessarily an amount worth risking your reputation over. But at the same time, in a survey by Consumer Reports that accompanied its own reporting, about half of all Americans said that they would be concerned about the quality of care from a doctor who took even as little as $500 from pharma.

According to Medscape, pharma paid more psychiatrists than any other specialists—they also had the highest number in the $100,000-plus club, 116 out of 384. This frequency may be explained by the fact antipsychotics topped the 2009 list of best-selling drugs, while antidepressants came in at no. 4. In addition, the off-label use of these drugs is among the highest for any category.

Neither ProPublica nor any of the other news organizations reports in significant detail about the content of the speaking or consulting or researching for which pharma is paying these many thousands of doctors. While PhRMA reps and many physicians have been quick to point out that all materials must strictly conform to the product label and are regulated by FDA and other agencies, it’s an open secret that many of the scripts and slides that doctors rely on are produced by agencies paid by drugmakers and never vetted by any official. Companies invest in such information in order to reach as many prescribers as possible with a message about a brand-name drug that is as positive as possible. Whether you call this medical education or product promotion is beside the point. ]

Starting in 2013, the new US healthcare reform law requires all drugmakers to publicly disclose the amount and date of every physician payment, the name and address of the physician, and the drug or device that the doctor helped promote. This is should help build confidence in the integrity and accuracy of the data, which some experts have questioned as leading to extreme conclusions when accessed by investigative journalists.   Until then, the ProPublica-based media blitz will continue to spark controversy and conversation over the ethics of industry practices.

To their credit, both Lilly and GSK responded to the ProPublica revelations that the companies had sanctioned doctors on their payroll by launching their own investigations. In a statement, GSK said “we do have criteria in place to evaluate potential speakers.  However, ProPublic has raised issues to our attention that we are investigating further. We will also use this information as we continue to improve the processes by which our speakers are evaluated.”  Likewise, Lilly noted that “reporting by ProPublica and other media outlets has raised valid and important questions about some of our processes, which we take seriously.” And over the past week, all seven of the drugmakers featured in the stories have commented on the reporting. The PBS Nightly Business Report has posted these responses on its website.  Hence the debate continues—and soomer rather than later, expect the investigations to spread to practices in other countries led by renewed regulator interest in provisions of the 1977 Foreign Corrupt Practices Act.

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  1. Bill Cooney
    Posted October 28, 2010 at 12:07 pm | Permalink

    Correction: Pharma and other manufacturers must start collecting data on all payments and “transfers of value” (TOVs) to US physicians starting on January 1, 2012, not 2013. It is correct that the 2012 data must be sent to HHS by March, 2013. But the 1/1/12 date is most important, because that’s when the data becomes irreversibly on its way to public eyes. The ProPublica report covered just a tiny fraction of the expenditures that will become mandatory to report under the Physician Payment Sunshine Act (PPSA). Pharma companies have just 14 months to consider their payment and TOV practices, and institute any needed reforms. For instance, regarding meals to attendees of dinner meetings and lunch-and-learns, can any one pharma company defend $10-$20 million in “free meals” to US physicians? ProPublica is an object case of how spending data can and will be used aggressively to harm the reputation of the pharma industry. Individual companies need to consider the potentially damaging outcomes of the much larger PPSA-mandated reporting of current spending levels, and make changes before 2012.

  2. Ronald Warrick
    Posted October 28, 2010 at 6:52 pm | Permalink

    Big Pharma CEO’s look at billions in settlements as part of the cost of doing business. Nothing will change until some of these guys are looking at jail time and banishment from corporate government, and that won’t happen unless ProPublica, et al, can prove that companies are knowingly harming people with drugs approved by FDA. Until then, ProPublica can just enjoy their grant money and Pulitzer Prizes.

  3. Posted October 29, 2010 at 9:43 am | Permalink

    I recently authored a blog about “5 Ways to Eliminate the Financial Influence of Big Pharma.” The simple solution to this is to not allow Pharma companies to pay healthcare providers for anything. No speaker programs, no consulting fees, and no compensation for doing clinical trials. In the spirit of independent research, education, advancing science and medicine, and the promotion of the health professions, all healthcare providers, universities, and Medical Schools should be required to do any Pharma related activity for free. This would eliminate all concerns about financial influence by Pharma.

  4. Pat
    Posted November 6, 2010 at 5:30 pm | Permalink

    Not all of ProPublica’s information was factually correct and Mr. Ornstein admits to this. However, there have been no noted corrections on the site. . They tried to make an association that there were physicians cited for misconduct that were speaking for the drug companies. One such physician was cited but the facts were not checked. First, that individual had been speaking for the drug companies long before the accusation and judgment. Second, the physician did not speak or is no longer speaking since the judgment occurred..

    Second, there are various degrees and inconsistencies regarding Medial Board judgments against physicians. Some are more benign like documentation others sexual misconduct to gross negligence (a legal term which has MANY different meanings) leading to death of the patient, and other cases that concern “off label promotion” — now a hot point.

    One has to look and understand fully the specific case at hand to make an associated that a physician “is not qualified” to practice or for that matter, speak on a drug or practice medicine. You would be shocked how many reputable academic and other well respected community physicians have been hit with either malpractice or Medical Board accusations. By the way, once an accusation is filed, you have little chance of having all of them (or it) removed. You essentially plea bargain or go to court, wihich is an administrative court — there is no jury, and the expert witnesses chosen by the Board are skewed. A recent case cited a “Board expert” who moonlighted for Blue Shield. Part of the accusation files was that the doctor prescribed a drug “that was not indicated” for that particular clinical situation — this, despite publications and general consensus to support it. You will not be surprised to note that the accusation was upheld and the doctor found guilty — this, being “gross negligence.”

    To put things into perspective, ProPublica should do an article on just how Medical Boards operate — based on complaints, not investigative law. The accused physician rarely has the opportunity to present a witness on his or her behalf, which is not the case for the claimant.

    None of this was put into perspective.

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  6. Posted August 7, 2011 at 12:36 am | Permalink

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