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Prescription for bad medicine?

Prescription for bad medicine?

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Imagine giving an hourlong talk about your job at a conference in, say, New Orleans.

You fly business class, eat some nice meals, deliver your speech.

Then you get a check for $10,000, plus another $1,500 for travel and food.

Doctors in Greensboro recently earned at least $3 million doing similar work for drug companies, according to ProPublica, an independent, nonprofit news organization.

That includes payments for travel, meals, consulting and speaking fees from 2009 to 2012, but that doesn’t include money for medical research.

This practice raises questions about whether doctors are subtly — and maybe not so subtly — influenced by these companies.

Such arrangements are common, though recent reforms have slowed the once-free flow of cash, meals and gifts.

Hundreds of Greensboro doctors show up on this list compiled by ProPublica.

The amount earned by local doctors likely is higher than $3 million . Some, but not all, drug companies voluntarily released the data to ProPublica, but they’re not required by law to do so.

That will change this fall. The Physician Payment Sunshine Act, part of the Affordable Care Act, will force drug companies to make public all payments to doctors.

The list will include payments for food, travel, consulting, speaking, gifts and royalty or licensing fees.

Public access to such data never has been more important because current estimates show that Americans spend roughly $200 billion a year on prescription drugs. That’s likely to rise as the baby boomer generation ages and consumes more health products.

“Patients trust their doctors to prescribe the right drugs for them and not be influenced by financial interests,” said Charles Ornstein, a senior reporter for ProPublica who covers health care.

Medical experts and patient advocates said consumers can ignore the information, which will detail legal payments in an industry that’s highly scrutinized for conflict of interest.

Or they can use it as another way to vet their doctors — in much the same way they scrutinize other professional services.

Finding your doctor’s name on the list doesn’t necessarily mean he or she has lapsed ethically, said Richard Saver, an ethics professor at the UNC law school who also teaches at the university’s medical school.

But in some situations, he said, it’s a good reason to do more research.

“It’s hard to say that the payments alone are problematic,” he said, “but they certainly warrant more investigation.”

Value of collaboration

Some experts, including Saver, said patients can benefit from a working relationship between doctors and drug companies.

After all, doctors — not drug companies — hear directly from patients.

That makes doctors uniquely suited to design clinical trials with the patients’ issues in mind, said John Murphy, assistant general counsel at the Pharmaceutical Research and Manufacturers of America, an industry trade group.

Murphy said there are only beneficial outcomes when doctors and drug companies collaborate. He said patients should take heart knowing that doctors are learning about the latest medical advances — information he said comes from drug companies.

He said he hopes the full value of such relationships will be apparent when the complete database becomes public this fall.

“The vast majority of physicians in the U.S. have the best interests of the patient in mind,” he said.

Others experts, including some physicians, said financial arrangements between doctors and drug companies create biases, even if they’re subconscious.

Dr. Ross McKinney is a pediatric infectious-disease specialist at Duke University Medicine Center. He’s also chairman of the conflict-of-interest committee for Duke’s Trent Center for Bioethics, Humanities & History of Medicine — meaning he spends time investigating the ethical implications of drug company payments to doctors.

McKinney said patients definitely should pay attention to this data.

Doctors paid to tout the benefits of a drug are legally bound to discuss only its federally approved uses.

A doctor speaking about a drug for migraines, for instance, must stick to how it works on headaches and not mention its unintended “off-label” use, such as curbing appetites.

In other words, the doctor’s talk sheds no new light on the drug. And that’s simply using a doctor for a marketing campaign, McKinney said.

“All they can do is act as a company spokesperson,” he said.

McKinney points to another pitfall: A doctor also might prescribe one blood pressure drug over another because of he or she works for a particular company.

He asked: “Are you putting this metal-on-metal device into my hip because it’s what is best for my hip or because of your relationship with the company?”

The doctor may have the best of intentions, he said. And the drug or device the doctor chooses may be the most appropriate one for the patient.

But a doctor’s relationship with a drug company makes that truth harder to tease out, he said.

“People tend to see things in a way that benefits them financially,” McKinney said.

The party is over

As recently as the 1990s, medical conferences were part science, part street festival.

Drug companies showered doctors with lavish gifts. They offered wine tastings. They hired bands and sometimes even magicians to perform.

And they stationed attractive representatives — often men and women fresh out of college — at every booth.

“It was a spectacle,” said Dr. Richard Weinberg, a gastroenterologist and a professor at Wake Forest School of Medicine.

One doctor, best-selling author Robin Cook, even penned a thriller in 1985 based on the premise that drug companies controlled the minds of doctors.

In “Mindbend,” a company invites doctors on a cruise, then brainwashes them into using their drugs and their drugs alone.

While the reality was never that dramatic, drug companies did enjoy unfettered and unrestricted access to entice doctors to use their products.

That started to change about a decade ago because of tougher laws from state and federal governments.

Drug companies no longer can provide free catered lunches to doctor’s offices, something large medical practices once could expect every day.

Drug companies can’t hand out gifts any more, either. The ban includes small things, such as pens or notepads, and larger items, including flash drives for computers, calculators and stethoscopes.

Late last year, pharmaceutical company GlaxoSmithKline said it no longer would pay doctors to speak. The company cited a change in its marketing strategy.

Some doctors see the increased scrutiny as a slam to their professionalism, McKinney said.

That may explain why the News & Record had difficulty finding local doctors willing to discuss the issue.

The News & Record contacted individual doctors and large medical practices across the city — in all, reaching out to about three dozen physicians.

Some appear in ProPublica’s database as accepting payments from drug companies; some don’t.

Most of the doctors didn’t acknowledge the requests. Others sent messages through office workers that they weren’t interested in discussing the matter.

In addition, officials with the N.C. Medical Board and the Greater Greensboro Society of Medicine didn’t respond to requests for help in finding doctors for interviews.

And representatives from four large, regional hospitals were unable or unwilling to do so.

“I think (doctors) feel like it has gotten overblown,” McKinney said. “In truth, there are biases that happen. They should recognize them, but they don’t. It’s an interesting type of blindness.”

A matter of trust

Sometime in September, you’ll be able to research all of your doctors’ recent earnings from drug companies.

Meals, travel, research, speaking and consulting — all of it will be public.

Consumer advocates said an informed public is a smarter public. People can look at the data, they said, and decide whether to question their doctors.

But should you question your doctor about every $500 check he or she earns for a consulting gig?

Is $10,000 a more appropriate threshold? What about $150,000?

“It’s almost impossible to know when to start asking questions,” McKinney said.

He offers this advice: If you discover your doctor earns money from a drug company, adjust your skepticism appropriately.

View the information as you would other criteria: the doctor’s bedside manner; his or her reputation; whether the doctor considers your needs first.

But Saver and Weinberg said the data by themselves won’t give you a clear picture of your doctor’s ethical standards.

Doctors know more than most patients about medicine, Weinberg said, regardless of his or her ties to drug companies.

And at the end of the day, he said, you need more than a spreadsheet to decide whether to trust your doctor.

“That takes the central part of the doctor-patient relationship — which is trust — and puts it on the chopping block,” he said.

“Numbers can’t tell you who to trust.”

Contact Margaret Moffett Banks at (336) 373-7031, and follow @mmbanksNR on Twitter.


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