ProPublica, a nonprofit investigative journalism group, released a report this week accusing the pharmaceutical industry of hiring docs who are incompetent or worse to shill their products.

The result of a collaboration between ProPublica, National Public Radio, PBS’s "Nightly Business Report," the Chicago Tribune, The Boston Globe, and Consumer Reports, the “Dollars for Docs” project centers on a database with details about payments made to 17,700 healthcare professionals by seven pharmaceutical companies in 2009 and 2010. The database shows that the payments totaled $258 million and that some were made to docs who had sanctions made against them. ProPublica developed the database by pulling physician payment information from the Web sites of companies that have made the information public, either due to legal settlements or voluntarily. The companies included in the database are Eli Lilly and Co., Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co., and Pfizer.

By examining physician licensing records in 18 states, the reporters found dirt on “almost 250”—or 1.4 percent—of the 17,700 HPCs in the database. Sanctions included FDA warnings for research misconduct, lost hospital privileges, and in one case having inappropriate sexual contact with patients. Two of the companies told the reporters they did check the state board Web sites the reporters used to unearth discipline against doctors; the remaining companies had until now relied on self-reported information and federal databases for background checks.

The report also includes a piece on whistleblower lawsuits that have been brought against companies alleging they used illegal marketing practices to sell their products. The authors also encourage the public to search the database themselves to see their doctors’ payment records.

While the report authors, Pulitzer-prize winning journalists Charles Ornstein and Tracy Weber, do acknowledge that “payments to doctors for promotional work are not illegal and can be beneficial,” they also say that “for the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it.”

Journalism or Hatchet Job?
Those who believe that industry and healthcare professionals can collaborate ethically have taken exception to the report. “This is the best organized hatchet job on medical marketing I have seen in my 30 years in Washington,” says John Kamp, executive director of the Coalition for Healthcare Communication, and former professor of journalistic ethics. “It is not responsible journalism. It is orchestrated defamation.” Kamp also chaired the planning committee for last week’s 21st Annual Conference of the National Task Force on CME Provider/Industry Collaboration, which included a session on how to get the word out about the value of collaboration between medical educators and industry.

Thomas Sullivan, president and founder of the medical education company Rockpointe Corp. and a vocal proponent of industry/provider collaboration, called the report “a coordinated effort by organizations unfriendly to physician/industry collaboration.” He also noted that Pew Charitable Trusts, which has a history of advocating for controls on pharma/physician interaction, gave the investigative journalism group $1 million earlier this year. (Sullivan has posted more of his thoughts about the database and report, and the project as a whole, on the Policy and Medicine blog.)

Two days after the report was released, John Castellani, president of CEO of Pharmaceutical Researchers and Manufacturers of America, issued a statement saying, “Biopharmaceutical research companies only want to work with the most ethical healthcare professionals. Make no mistake, the very small minority of doctors who have engaged in inappropriate practices have no business being part of these sessions. In the rare instance when a speaker falls short of these high standards, companies take corrective action.” He adds that the Food and Drug Administration regulates the materials presented in these sessions and holds sponsoring companies accountable for their content, and that the PhRMA Code on Interactions with Healthcare Professionals also requires companies to select individuals on criteria such as medical expertise, reputation, knowledge and experiences in a particular therapeutic area, and communication skills.

The Local Spin
The article in The Boston Globe sorted through the database’s Massachusetts subset to determine that physicians affiliated with Harvard Medical School accounted for 45 percent of the $6.3 million in payments to that state’s healthcare providers. While the payments could be for consulting as well as for services on a company’s speakers bureau, the article focused mainly on the speaker role, which generally entails presenting FDA-mandated company-approved presentations about specific drugs or diseases. The article also says that, due to Massachusetts’ strict pharma marketing code that limits the venue for these meetings to a healthcare environment, those who provide their lectures over dinner have moved their meetings out of state.

The Chicago Tribune asked the top-earning Illinois-based physicians listed in the database for their take on serving on pharma speakers bureaus. “They said they appreciated the chance to teach colleagues about various illnesses and research supporting the use of medications,” the article reports. “Compensation reflects the travel, preparation and time away from patients and family often involved in giving talks, doctors said.”

While this database includes just the seven companies that are currently reporting their physician-payment data either voluntarily or because of requirements stemming from legal settlements, the Sunshine Act provision of the Affordable Care Act requires that all drug companies disclose payments to healthcare professionals by 2013. But in his editor’s note, ProPublica Managing Editor Stephen Engelberg says, “We saw no reason for readers to wait three years for information that is already beginning to become available to anyone who could penetrate and scrape data from pharma’s labyrinthine Web sites.”

What do you think of the ProPublica database and report? Leave a comment below or e-mail editor Sue Pelletier with your thoughts.

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