This year promises to bring an unprecedented expansion in
publicly accessible data on the relationships between doctors and
pharmaceutical companies. In September, the federal government plans to release details on payments
made by drug and medical device companies to all U.S. doctors from August to
December 2013, as required by a provision of the Affordable Care Act.
ProPublica has been tracking this
issue closely for years and has assembled Dollars for Docs, our
comprehensive database of payments made by 15 companies that currently report
the information to the public. Earlier this month, we
updated the database to include payments through the end of 2012; it now reflects
about $2.5 billion in payments overall.
Using the database, this week we
published a story about 1,300 researchers who have personal or promotional
ties to the drug companies that fund their clinical trials.
We thought this would be a good time to take a step back and
explore the types of stories journalists can write now and in the future using
payment data.
We’ve made our Dollars for Docs easy to search and customize
by state, year, drug company and type of relationship,
so that’s a good place to start. Of course, it’s important to note that data on
payments is just the first step. Talking to physicians and patients is
important to understand details about how the relationships work, how they may
affect patients and how they may be changing.
Who
are the highest-paid speakers/consultants in your area? ProPublica
has looked at data for several years and found that some doctors make hundreds
of thousands of dollars a year working with pharmaceutical companies. That is
in addition to what they earn from their day jobs. What do they do and why do
they do it? What are their qualifications? An example of what we found: The million-dollar doctor.
Who’s in/who’s
out? Dollars for Docs includes data for some companies dating back to 2009.
That presents a chance to look at changes over time: which doctors have started
accepting funds from a company, which continue to accept funds and which no
longer do so—and why.
Are the
top-paid doctors in your area actually “experts”? When we first looked at
the data, we found that many of those who made the most money weren’t experts
in a traditional sense. They didn’t work at academic medical centers. They
didn’t have research publications. They weren’t leaders in their specialty
societies. Some didn’t even have board certification, meaning they didn’t have
special credentials in their fields. And some had been disciplined by their medical boards.
What are
the rules at your local medical schools—and are faculty members following
them? Many academic medical centers and teaching hospitals have put in
place policies prohibiting faculty from serving on pharma
speakers bureaus, believing doctors should not serve as company pitchmen. But
we found that some faculty did so anyway. What’s going on in your area? Are
schools/hospitals adopting restrictive policies, and more importantly, are
faculty members following the rules?
How much
do drug company dinners cost? Some doctors, we’ve found, receive hundreds
and even thousands of dollars’ worth of meals each year from a single drug
company. How much do folks in your area get? How often do you have to get
company meals to add up to thousands a year?
Do big prescribers
of brand-name drugs in Medicare Part D have financial relationships with the
makers of those drugs? We found
that for many highly advertised drugs, the top prescribers also received
speaking money from the maker. Is this the case in your state?
Do
doctors have overlapping relationships with a company? We looked at how
many doctors received research money from a company, as well as speaking or
consulting payments. What type of unique conflicts of interest does this pose?
Why You (and Your Audience) Should Care
Patients trust their doctors to prescribe the
right drugs for them and not be influenced by financial interests.
More than a dozen drug companies have been
required to disclose payments to physicians as a condition of settling lawsuits
alleging improper marketing and/or kickbacks to physicians.
All companies (pharma
and medical device) will be required to disclose payments to doctors this fall
under the Physician Payment Sunshine Act. A story now about these relationships
could help prepare the public—and the medical community--for the huge
amount of data that will be available later this year. More information on the
Open Payments system can be found at go.cms.gov/openpayments.
There are a number of basic questions patients
can ask their physicians about financial relationships in a non-confrontational way.
