The ProPublica database attempts to provide transparency in a field where there can be a fine line between doctors who are too cozy with the drug industry, and those fulfilling a legitimate role as researchers and educators.

-Team@CMHF

• Eleven pharmaceutical firms paid Virginia doctors and other health professionals $7.8 million in 2010, according to a database created by the journalism organization ProPublica.
• Some of the money paid for research that was vetted by medical review boards, but doctors also took in $5.2 million for speaking and consulting fees.
• There has been growing concern about pharmaceutical payments to doctors.
• Consumer groups contend that payments, particularly those for promotional talks, gifts, meals and free samples, can cause doctors to be more likely to prescribe their patients medicines from those companies, and to overlook better or less expensive treatments.
• Some doctors, though, say they play a role in educating their peers about medication options, and in informing the general public about diseases and the best treatment options.
• The bottom line is, this is an area where there’s a lot of argument, debate and disagreement about what behavior is appropriate and what is not, said Dr. Thomas R. Pellegrino, associate dean for education at Eastern Virginia Medical School.
• Years ago, drug and medical device companies would lavish doctors with gifts, travel, meals, trips to the Virgin Islands to learn about a certain drug. There’s been a growing recognition that that sort of thing is inappropriate.
• ProPublica first built the “Dollars for Docs” database in 2009 when some drug companies began releasing the information as a condition in settling lawsuits. Other companies have since joined in, and 40 percent now publicly disclose payments to doctors, according to ProPublica.
• The Pharmaceutical Research and Manufacturers of America organization released a statement defending the industry saying physician speakers help their peers stay up-to-date on clinical data and medicines
• Unfortunately, when taken out of context, the statement said, publicly available information about physician interactions with biopharmaceutical companies does not convey the value of these relationships, which advance science and promote high-quality patient care.
• The range of payments varies widely, with doctors receiving $1 to hundreds of thousands of dollars in compensation.
• A Consumer Reports National Research Center poll released last year showed that about half of Americans said they would be concerned about the quality of care or advice they were given from a doctor who accepted as little as $500 from a drug company, and two-thirds said they’d be concerned if a doctor took $5,000 or less.
• Dr. William Yetter, a local psychiatrist said that the innuendo that docs who accept money are doing something sinister adding that he believed the pharmaceuticals have not defended themselves enough on how they do educate docs, provide free meds and cost reduction options to patients.
• Dr Robert Hansen, a pain-management physician said the money he receives pays him to teach other doctors ways the companies’ medications can be used to treat pain and added he would never support something that he didn’t know, didn’t use, and didn’t think was helpful
• Sometimes the money can be attractive to doctors struggling with insurance programs such as Medicaid that don’t fully reimburse their costs, said David M. Belde, vice president for mission and ethics with Bon Secours Virginia.
• Dr. David Maizel, president of Sentara Medical Group, said he looks at whether an activity will benefit the physician, the organization as a whole, or the patients.
• A lot of research indicates that physicians do change their practice patterns based on their relationships with vendors.
• So if one has the potential of getting swayed by external gifts, external relationships – the potential for that, is problematic.
• Universities and medical institutes have also received money from drug companies, often for research.
• Payments for university research are cleared through medical review boards and federal guidelines that monitor the ethics of such projects.
• The boards make sure patients are appropriately informed of the risks of a clinical trial and that the project is conducted in a way that would make the research valid.
• Research that stacks the deck in favor of the company’s drug would not meet Federal Drug Administration regulations.
• Pre-market approval is needed for drugs and to restrict that type of research would mean delaying development of lifesaving drug therapies, said Dr. Jerome F. Strauss III, dean of the Virginia Commonwealth School of Medicine.
• Elizabeth Wiley, vice president for internal affairs at the American Medical Student Association, said research funds also should be scrutinized, because not all doctors belong to institutions that have medical review boards.
• In the past, she said, some doctors have been guilty of “ghostwriting” research for companies to cast their drugs in favorable lights.
• In 2008, only 14 percent of medical schools made an A or B grade.
• That rate increased to more than 50 percent on the most recent report, issued in December. The organization also has developed model policies.
• Wiley said one of the easier changes for schools is developing a disclosure policy. But many schools have taken even stronger measures, such as prohibiting paid promotional speaking and accepting free drug samples, as well as interaction with sales representatives and industry-funded education.
• Strauss said VCU has tightened its policies during the past several years, and even started posting drug payments to affiliated doctors on the school’s website.
• He said VCU officials use the ProPublica database to check against disclosures their doctors submitted to the school to make sure all payments are reported. It’s a valuable public service, he said.
• There have been instances of physicians being dismissed for not disclosing ties to the drug industry. The school is continually reviewing the issue. The most recent policy being reviewed prohibits using industry-prepared slides in class presentations.
• EVMS has a model policy on disclosure, but not on consulting and speaking, according to the 2010 report.
• The PharmFree website’s description noted: “Gifts are not meaningfully prohibited and use of language such as ‘discouraged’ in the vendor access policy does not adequately restrict their access to patient care areas.”
• But EVMS Dean Gerald Pepe said adjustments made to the ethics policy in June addressed many of those areas, and he believes the school will pull up its score this year.
• Gifts, entertainment and meals are now prohibited.
• The one place we didn’t make significant change was in the area of drug samples, Pepe said adding that given that we care for many indigent patients, those samples are a benefit to them.”
• Physicians who have these external relationships need to be able to justify them in a way that makes sense to their patients and to the profession as a whole,” said Belde of Bon Secours. “That, I think, is something that has largely been under cover.”
• Strauss said it can be tough for a patient to use public information to make medical decisions, but that generally, institutions and doctors who are transparent about disclosure prove they have nothing to hide.
• Wiley said that we advise people to make informed choices about who they select as a provider, and make sure the doctor-patient relationship is sacred and not driven by insidious marketing.
• It’s not necessarily the most obvious line to draw, but we believe there needs to be transparency.
• Not every payment is a reason for panic, while some connections are so tight that you might not get all the options of a drug or device because your doctor is in a provider’s pocket.

For further reading log on to: http://hamptonroads.com/2011/09/consumer-groups-warn-about-drug-firm-gifts-doctors