Drug firm payments to doctors declining
Rules in Mass. restrict speeches
By Liz Kowalczyk, Globe Staff / September 8, 2011
Total payments to doctors for promoting pharmaceutical companies' products to their colleagues appear to be falling in Massachusetts, suggesting that new restrictions designed to distance doctors from industry are leading some to abandon the lucrative speaking circuit.
Eli Lilly and Co., one of the nation's largest drug makers, paid health care providers here $866,919 in 2010 for speaking about their drugs, a 46 percent drop from 2009, according to an analysis by The Boston Globe and ProPublica, a nonprofit online investigative journalism organization. Payments from GlaxoSmithKline fell at least 29 percent to $884,850, and probably more because the company's 2009 data did not include the first quarter.
The data also show that many Harvard-affiliated doctors have dropped out of company speakers bureaus, a sideline that has allowed many physicians to earn tens of thousands of dollars.
In 2009 and the first half of 2010, doctors and researchers affiliated with Harvard Medical School - a brand prized by pharmaceutical companies as a powerful tool in promoting drugs - collected a large portion of the speaking fees paid by drug companies, according to a similar analysis the news organizations conducted a year ago. But new data for 2010 and the first quarter of 2011 reveal that many Harvard doctors have stopped giving promotional talks as new limits have been phased in.
"There's just a growing recognition, at least for academic physicians, that participation in speakers bureaus is inappropriate,'' said Eric Campbell, a health care policy professor at Harvard.
This time, ProPublica and the Globe analyzed data posted on the websites of 12 companies, which are disclosing payments because of pressure from lawmakers or as part of settlements of federal lawsuits. Eight companies that reported payments for all of 2010 doled out $3.7 million to Massachusetts speakers. Comparisons with 2009 could be made for only Lilly and GSK.
Partners HealthCare, the parent organization of Harvard-affiliated Massachusetts General and Brigham and Women's hospitals, prohibited doctors from participating in promotional drug company speakers bureaus as of January 2010, out of concern that physicians could lose their objectivity, and might be viewed as mouthpieces for industry rather than as unbiased caregivers.
A similar ban by Harvard Medical School took effect this July. Other academic medical centers in the state have likewise adopted rules limiting company-sponsored speaking, during which doctors typically show slides created or approved by the company that are designed to promote specific drugs or the diagnosis of diseases treated by those drugs.
The state Department of Public Health last year also began publicizing data it collects from drug companies about their payments to Massachusetts health care providers - and has banned doctors from eating in restaurants on a drug company's tab, erasing a popular venue for promotional speaking.Continued...
"It's just a rough environment,'' said Dr. Lawrence DuBuske, an allergy specialist in Gardner. "The industry wants very little to do with Massachusetts.''
DuBuske, who has been a top speaker for GSK and AstraZeneca about asthma medications, resigned from Brigham and Women's last year, rather than give up his speaking appearances. Since then, he has landed a job at George Washington University School of Medicine and Medical Center in Washington, D.C. He commutes to Washington to treat patients and teach while continuing to do a lot of speaking for companies. His new employer, he said, reviews his work for drug companies to make sure it complies with certain standards, but does not prohibit it.
GSK and AstraZeneca reported that he earned $258,925 in speaking fees for parts of 2009 and 2011 and all of 2010.
For the first quarter of 2011, the most recent data posted by five companies - AstraZeneca, Cephalon, GSK, Lilly, and Pfizer - DuBuske ranked sixth in Massachusetts in the amount he earned for speaking, $16,750.
Lilly and GSK said they could not attribute the decline in speaking payments in Massachusetts to the state's more restrictive environment - even though their payments nationally declined just 10 percent and 15 percent, respectively, according to the ProPublica analysis.
Lilly spokesman J. Scott Macgregor said the decline is due to "normal year-to-year fluctuation'' and to technology that lowers costs by allowing doctors to speak via webcasts.
GSK spokeswoman Mary Anne Rhyne said the company has reduced the number of speakers by 50 percent nationwide. "We felt it would be a better use of our resources to use fewer speakers more often. This reduces training costs and the number of contracts needed.''
Aside from being forced to limit activities in Massachusetts, Campbell said, companies also are making a business calculation. "It used to be if a doctor was not prescribing enough drugs, you'd put them on your speakers bureau. The industry is realizing the old marketing model of giving things to doctors in exchange for writing prescriptions doesn't work any more.''
Christopher Clark, who oversees compliance for Partners, said that while critics questioned whether Partners would enforce its new rules, the apparent decline in Partners doctors giving company-sponsored talks indicates that it's keeping a close eye on its physicians.
For the first quarter of 2011, Dr. Andrew Kowal, director of the pain clinic at the Lahey Clinic, was the top-earning speaker in Massachusetts, receiving $47,000 in fees from Pfizer. The company has since updated its website with second-quarter payments, bringing his fees for the year for speaking to $63,000 - despite the policy the hospital adopted last year barring doctors from joining speakers bureaus.
Kowal, a critic of the overuse of addictive opiates, said in an interview last year that he talks about alternative treatments such as Pfizer's Lyrica for fibromyalgia. At the time, he vowed to continue speaking free of charge.
Kowal declined to be interviewed last week. But Lahey's chief executive, Dr. Howard Grant, said while Pfizer listed Kowal as a speaker for its "expert-led forums,'' he did not violate hospital policy because his presentation discussed only fibromyalgia and not a specific drug, and because Pfizer did not make changes to the slides he used. Kowal gave the talk nearly 30 times.
"He did abide by our policy by maintaining full control over the materials,'' Grant said. "It does not promote the company or product in any fashion.''
Still, he said, Kowal did not properly report his moonlighting for Pfizer and the hospital has taken corrective action.
Critics like Campbell say that companies pay doctors to talk about diseases because even that leads to increased use of drugs for the disease. And, Partners, for example, limits doctors to roughly six talks a year for one company even when they are not given as part of a promotional speakers bureau, Clark said.
A number of Harvard doctors who are no long speakers did not respond to requests for comment. Dr. Om Ganda, a Harvard professor who sees patients at Joslin Diabetes Center, was not on the companies' lists of 2011 payments after earning $67,887 in 2009 and 2010.
"I have been following the Harvard Medical School guidelines in place,'' he said.
Liz Kowalczyk can be reached at firstname.lastname@example.org.