Sacramento Pharmaville

Drug companies spent millions on payments to Sacramento-area doctors from 2009 through the beginning of this year, part of roughly $89 million the industry spent in California during that time. Nationally, pharmaceutical manufacturers spent about $761.3 million, according to new figures from the public-interest watchdog organization, ProPublica.

The fees are at the center of ongoing efforts to make financial ties between the pharmaceutical industry and physicians—relationships that can be as slippery as a tube of medical ointment—more transparent.

While doctors serve as critical advisers for corporate research and innovation, and in turn, corporations provide important sources of research funding, there is an escalating concern that industry influence can go too far.

See “Top 10: Sacramento-area docs collect drug-industry fees” for a list of the local physicians in the region who received payments from drug companies.

“There is a great deal of financial links between pharmaceutical companies and medical-device manufacturers and physicians,” said Allan Coukell, a pharmacist and director of medical programs at the Pew Health Group for the Pew Prescription Project, a consumer-safety organization. “It’s not that they are being bought off, because that would be illegal, but a question of the subtle influence those [fees] have. Influence that may encourage a person to speak more favorably about a company, or be more receptive to their message.”

Those financial links include payments for such things as meals, travel, consulting and talks, with some of those arrangements coming with explicit promotional ties.

Eli Lilly—a large Indiana-based corporation that has spent more than $700,000 on payments to doctors from Roseville to Elk Grove to Davis—told SN&R it requires its speakers to use their literature.

“Our speakers must use materials approved through Lilly’s promotional materials review process,” Scott MacGregor, a company spokesman wrote in an email, while also stressing the information was also prescreened by medical, legal and regulatory officials. He added this screening was important to meet Federal Drug Administration rules and also for accuracy.

“Speakers are always entitled to suggest modifications or additions to materials we propose be used—but they can’t use such new material without our first reviewing and approving for that use—again, to remain in compliance with FDA regulations on promotional materials,” he explained.

Yolo County public health fficer, Christian Sandrock, who has received more than $200,000 in fees from Pfizer since 2009, however, said his role as a speaker was to provide expertise rather than to promote products.

“I performed content development for education, gave lectures, webcasts and led educational forums around severe pneumonia over the course of 2010,” Sandrock, a specialist on influenza and severe infections, told SN&R.

Earlier this year, Sacramento doctor Thomas Aoki, also told SN&R, that some of the money is critical for funding research, especially in a down economy. “I get nothing personally from it, and all the money goes to the research [institute]—I try to keep it going every which way I can,” Aoki, who runs the Aoki Diabetes Research Institute, said (see “Drug money,” SN&R Frontlines, February 13).

Still, there is also concern that some of the relationships may be too cozy, with profit at times taking precedent over unbiased decisions.

ProPublica, for instance, found that the 12 companies represented in its database (companies ranging from AstraZeneca to GlaxoSmithKline to ViiV) comprised about 40 percent of the U.S. prescription drug-sale market in 2010. As part of that, doctors on a drug company’s payroll may also be prescribing the same company’s medications, or be a corporate investor.

Many of these companies also spent more on doctors than on donations to political campaigns, politicians and trade groups. According to the California Secretary of State’s office, for instance, Pfizer contributed more than $500,000 in 2009 and 2010 to these political causes, far less than it spent statewide on payments to those in the medical field. Eli Lilly, a major local payer, spent more on fees to Sacramento Valley doctors than it did to political groups and politicians across California in 2009 and 2010.

With such concerns in mind, new federal rules will soon kick in to make how much corporations are paying doctors, and for what services, clearer.

At the moment, it is up to each company or the individual doctor to decide what to disclose. By March 2013 this will change. Then, all pharmaceutical companies and medical-device manufacturers will have to disclose their payments to doctors and other health-care professionals such as pharmacists and nurses, and make them publicly available. (Some in the industry are already doing so, including those on ProPublica’s database.)

“There has been a lot of work on appropriate ways to track what doctors are being paid—there are a lot of freebies in the profession,” Coukell said, pointing to research by the Association of American Medical Colleges and other groups about the influence of gifts and fees.

“The consensus is that better transparency is the best way to address that.”

Top 10
Sacramento area docs who collect big fees

1. Dr. Samuel Louie
$567,236
Pfizer

2. Dr. Christian Sandrock
$265,820
Pfizer

3. Dr. Janak Mehtani
$205,641
Eli Lilly, Novartis, Pfizer, AstraZeneca, Johnson&Johnson

4. Dr. Thomas Aoki
$181,075
Astra Zeneca, Merck, GSK,

5. Dr. Javeed Siddiqui
$173,679
Pfizer, Merck, GSK, ViiV

6. Dr. Bradley Chipps
$147,168
GSK, Pfizer, Merck, AstraZeneca

7. Dr. Nancy Lane
$144,604
Eli Lilly, GSK, Pfizer, Merck, Novartis

8. Dr. David W Smith
$140,557
Eli Lilly, Pfizer

9. Dr. Michael Wise
$136,989
Eli Lilly

10. Dr. James Kirk Clopton
$128,360
Eli Lilly, Pfizer, AstraZeneca

* From ProPublica’s “Dollars for Doctors”

** Fees included payment for travel, speaking, consulting and meals from 2009 to the present.