Pharma caught off-guard again: big gaps between state payment data, company numbers
An investigative outfit’s consolidation and analysis of payments that drug companies made to doctors has refocused attention on state efforts to shine light on the financial ties between doctors and drugmakers.
Currently three states—Minnesota, Massachusetts, and Vermont—require drug companies to disclose payments to prescribers and make some of that data public. While each of these states takes a different approach to collecting and making the payment data available to the public (more on that here), information from all three have been extremely valuable in demonstrating the dimensions and scope of these marketing relationships. And now a new value to the state data has emerged: demonstrating that pharma isn’t keeping very good track of who it’s been paying what.
The ProPublica report in Monday’s Minnesota Star Tribune and here online found a series of big discrepancies between what a company said it paid a doctor on its website and what it told the state of Minnesota it paid the same person. Right now, ProPublica can only crosscheck the seven companies that have posted payments on their own websites.
Big pharma has been caught off-guard again. Like the reports earlier this fall that hundreds of sanctioned doctors were still making cash on the side with speaking gigs, some companies seem not to know who they are paying what. Despite spending billions of dollars to develop and manufacture drugs, and spending other billions to market them to prescribers and armchair prescribers (i.e. consumers), the folks who brought you Lipitor, Effexor, Zyprexa and that one that will send this to your spam folder, don’t seem to know what they paid docs to give PowerPoint presentations.
The report also gave some doctors the opportunity to say strange things:
Dr. Randy Shapiro, one of the doctors whose take was under-reported to Minnesota told ProPublica that if anything, patients should want to see their physician among the speakers on these payment lists. “If their doctor is not on the list,” he said, “maybe they should look for a different doctor.”
That’s…an interesting take. We’re not aware of any links between participation on speakers bureaus and clinical excellence or bedside manner. Based on some earlier findings (we’re thinking of the Risperdal, Biederman, and all these folks) we’re not sure that would be our prescription. (In fact, based on the mounds of evidence about the influence of even small gifts, we tend to think finding a pharm-free physician or one who is engaged on clinical projects she’s happy to tell you about, and not just the PowerPoint circuit, is the way to go).
And the top-paid physician in Minnesota, Dr. Todd Hess, a pain specialist in St. Paul who made over $364,000 last year, told ProPublica that the media is unfairly lumping these educational talks with the old pharma ways.
“This is a mountain-molehill thing,” Hess told ProPublica. “I know the problems of the past. I know what pharma has done to change those. People just can’t get over the past.”
Maybe he knows something that we don’t know, but it might not be a problem of a press corps with a too-long memory. Recently, awkward chuckles went up through the pharma news sphere when word of Abbott’s celebratory pig roast for a Maryland doc who managed to implant 30 stents in one day showed up in a Senate Finance report.
That wasn’t back in the high-flying, anything-goes 90s depicted in the recent pharma-flick “Love and Other Drugs.” It was two years ago. Teachers are warned not to grade 30 papers in one day (and this blogger can vouch for that advice). We’re pretty sure, like the Senate Finance Committee, that 30 stent operations in a day is an even worse idea.
Despite what headlined docs and pharma spokespeople say, there is still a lot of money changing hands for things of questionable clinical value. The thing about the ProPublica data is: it’s current. The stories about hundreds of millions of dollars going to sanctioned docs, the Massachusetts reports that just came out–those payments are all from 2009-present. And now we see it isn’t being recorded very well. Maybe some of these companies really did believe no one would bother to look.
“If all the reports are true I’m outraged,” Maryland delegate and physician Dan Morhaim told the Baltimore Sun.
According to the Sun, “Maryland’s General Assembly has explored limiting financial relationships between doctors and drug or device makers, but no laws have come from it,” but Morhaim said ‘it’s a continuing topic of interest’ in the next legislative session.”
While there are real and beneficial relationships between academic medicine and industry, Pew Prescription Project Allan Coukell told a Memphis paper this week that “patients deserve to know if their doctors are receiving money from drug companies.”
And patients and state lawmakers are right to be concerned about what add up to significant financial exchanges between industry and doctors willing to pitch drugs to their colleagues. We wouldn’t be surprised to see more states explore ways to keep track of or limit the types of payments industry makes to doctors. Regardless, pharma should take this opportunity to get its house in order so everyone’s on the same—accurate—reporting page by the time Physician Payments Sunshine kicks in.
–Kate Petersen, PostScript blogger
December 31st, 2010 at 8:00 pm
I HAVE READ WITH INTEREST THE TOPIC of Pharma payments and the recently enacted “sunshine law agreement”.
I think it a right step relative to disclosuring and more transparency in payments and the process in the business of medicine and disease in the USA!
However, I did not want to document the issue of the many gaps with the Sunshine Law diclosure agreement, which I recently communicate with Propublica.org about.
Part of the email noted to them is listed below:
Sunshine Act Disclosure- OUTAGES
The question/input relative to the SUNSHINE ACT LAW (SA) and reporting. I believe SA has been needed for a long time; however, although a good start, the overall compliance and reporting has major outages which your site should discuss and why it occurred?
Following are the findings/issues
1) Sunshine Act (SA) only discloses USA Md’s, excluding international Md’s, where manipulation also may occur.
2) SA data is unaudited, and seems to be easily manipulated. For example, a simple “work around” would be as an Md, instead of using their Fed ID (SS), one could set up a Sub S Corp, for example, and manage to hide the payments. It would be fairly simple and I can see seminars on this already.
3) Clinical Trial payments delayed- this is THE MAJOR OUTAGE in reporting as its excludes for 4 years, or drug approval (which averages 8 years!) the payment reporting for the investigators/MD’s.
I have seen, for example, in another hospital, the process where a fully funded pharma study, and I undertook a study run by the Primary Investigator of the study. This is a major payment issue and the avenue drug companies use for drug approval– thru Md’s.
The delay in payment reporting misrepresents overall Md reporting and reflects only “half the glass” relative to “dollars for docs”. Clinical trials are the #1 area which is most at risk relative to driving new drug approvals, and an important factors in FDA and medical community acceptance. Having clear and timely tranparency is important.
4) SA reporting is voluntary?- I am not sure about this one, but I am assuming the SA is voluntary for the pharma companies. However, I am not sure about this, but this could explain why Roche Group (Genentech) “will not disclose payments”.
5) Penalties for non reporting are too low!- As noted in the “fact sheet” the penalties for not reporting :
“…failure to report, fines of up to $10,000 will be applied, not to exceed $150,000 annually. For each knowing failure to report, fines of up to $100,000 will be applied, not to exceed $1,000,000″
For the most profitable companies in the world, big pharma companies, these penalties are “lost in the rounding” and much too LOW to be an impact. I can not believe this is the penalty for non disclosure, and makes the SA a “paper tiger”! As you can see, one company ROCHE, decided to pay the penalty and NOT REPORT!
These outages need to be documented, discussed and see if the gaps can be closed. Congrats for the first steps, however, lets outline where the gaps are and not get carried away with the overall reporting at this point. There is still much to cover to make the business of disease management TRANSPARENT! We do it, to a degree with public companies, compensation and disclosures, why not with the most profitable business in the USA?
If I am correct in my issue, I would recommend this web site and others disclose the “opportunities” in the SL disclosures and note as “watch-outs” for the users. SL is a start, as our US health care plan is, but with plenty of gaps and outages to go before it truly becomes a “game changer” we so much hear about in the clinical trial business of new drugs!:)
Thanks again for the information and your great site!