October 24, 2010|By Meredith Cohn and Andrea K. Walker, The Baltimore Sun
Hundreds of Maryland doctors have accepted fees, some exceeding six figures, from pharmaceutical companies in the past two years to promote their drugs to other doctors — a practice that is not illegal but raises ethical questions about the industry's influence over patient care.
Large companies such as Merck and Eli Lilly have disclosed $258 million in payments nationwide in 2009 and the first half of 2010, with about $6 million going to Maryland physicians and a handful of nurses. There were more than 450 Maryland recipients from Johns Hopkins, the University of Maryland, a half-dozen Baltimore-area community hospitals, private practices and other institutions around the state.
The disclosures come as medical institutions and lawmakers have worked to rein in potential conflicts of interest, curbing these payouts as well as company-funded dinners and cruises. Ethicists and consumer groups say industry wouldn't pay if it weren't getting a return, like a boost in sales. And patients don't usually know that their doctors might have a monetary incentive to prescribe certain drugs.
"The more money you take, the more likely you are to present their drugs in a positive light, and the more likely you are to do research that is favorable to the drugs," said Dr. Carl Elliott, a professor in the University of Minnesota Center for Bioethics and the author of a book on ethics in medicine. "For whatever reason, doctors like to pretend the money has no effect on them."
But doctors who have received the money defend the paid speeches as educational for fellow physicians. And they say they are not influenced in caring for patients.
Gene Ransom, chief executive of MedChi, the Maryland State Medical Society, which represents more than 22,000 Maryland physicians, said: "Doctors take an oath to do no harm. Doctors, for a couple of hundred or a couple of thousand dollars, aren't going to risk their livelihoods or the lives of their patients."
The extra pay doctors collect for speeches and consulting from seven drug companies — whose sales make up about a third of the market — were compiled in a database by reporters at ProPublica, an independent investigative journalism organization that partnered with several media outlets. But there are more than 70 other companies that have not disclosed whether they are making payments to doctors. Those totals and recipients could remain a secret until 2014, when the federal health care reform law will require such disclosure.
The known payout to Maryland doctors constitutes just over 2 percent of the nationwide total in ProPublica's database. Seven doctors in the state joined 384 nationwide in earning more than $100,000; Most earned substantially less.
Since the database became available in recent days, officials at the University of Maryland School of Medicine and elsewhere say they are reviewing information to see if new guidelines are warranted.
The university's conflict-of-interest policy, just 18 months old, seeks to address speaking fees at industry events that aren't certified as continuing medical education. Doctors are allowed to participate if they get approval from their department chairs, but they can't read speeches or put their names on journal articles written by the industry. Their own talks must not be considered promotional. And drug company pay must be "fair market value."
"We're still learning how well the policy is working," said Dr. Nancy Lowitt, Maryland's associate dean for faculty affairs and professional development, who helped develop the policy. "What we need to do now is be aware of the data coming out and respond more to what we're learning. There's still risk, and we have to be aware of it and respectful of it."
Lowitt said she believes doctors regularly turn down paid speaking invitations, more often since the policy became effective. And she said chairs take their oversight role "very seriously." Still, at least two dozen university doctors accepted money, according to the database.
Of the seven doctors in Maryland who accepted six-figure payouts, five did not respond to efforts to contact them, couldn't be reached or declined to comment.
Dr. Robert DiBianco, a Rockville cardiologist who earned $142,436 from GlaxoSmithKline and Pfizer during the time period, said he declines to speak if products are not backed by proper studies or if companies want him to use their slides and talking points. He says money doesn't influence him when he does speak — recently about GlaxoSmithKline's Lovaza, an FDA-approved drug made with omega-3 fish oil to reduce triglyceride levels.
"People are worried that if the physician is being paid they will lean toward that drug," said DiBianco of Cardiovascular Consultants. "But I don't think physicians are influenced that much by that."
