NEAL CONAN, host: Most of us take our doctor's prescription for a cholesterol drug as an independent judgment by an expert. But what if you knew that your doctor had been paid by the drug company to sing the praises of that particular medication? An investigative report by ProPublica probes the relationship between doctors, pharmaceutical companies and the manufacturers of medical devices, and finds that some doctors make hundreds of thousands of dollars as consultants or for speeches at medical conferences. Under the new health care law, companies will have to disclose such payments by 2013. There is, though, no requirement that doctors do so.
So we'd like to hear from doctors. Should you have to tell your patients about outside income from drug companies or device makers? Call us: 800-989-8255. Email: email@example.com. Tracy Weber of ProPublica joins us now from our bureau in New York. Thanks very much for coming in.
TRACY WEBER: Thanks for inviting me.
CONAN: And we should also disclose NPR News is a partner with ProPublica in this investigative series. But I wanted to ask you. - you note in your story the close relationships with drug or device makers and doctors can lead to new and better treatment and doctors who are also better informed about new products.
WEBER: That's true. And we've talked to many, many of the physicians that are receiving payments for speaking and consulting on behalf of pharmaceutical companies. And they stress that they feel they're importing - they're participating in an important educational roll and teaching doctors, especially in rural areas, about new treatments and medications.
CONAN: And so there are benefits that derive here, but you also obviously feel there could be a conflict of interest.
WEBER: Yes. You know, well, we know that in fact if a physician is giving a speech on behalf of a pharmaceutical company and is also prescribing those drugs for a patient, it provides an important, you know, talking point, like is this the best drug for me? Some newer brand name drugs are both more expensive and perhaps more risky than more established drugs. There's generic drugs. Is the drug you're getting the best drug for you?
CONAN: And this also extends to device manufacturers - hip replacements, for example, or stents.
Right. You know, recently the Spine Journal did something extraordinary. They devoted an entire issue to repudiate - sorry, excuse me - talking about the research of several spine experts that were supporting the widespread use of a Medtronic product. It's a bone growth product used in spinal fusions. And the articles in the magazines challenge the researchers and said, you know, they overstated the benefits of the product, InFuse, and ignored its risks. And these researchers were receiving financial relationships with the company, Medtronic.
And the suggestion, at least as I read it in your story, was not necessarily of corruption but of - well, there may have been inadvertent twisting of the - or interpretation of the facts.
WEBER: Right. And the things to think about are, one, you know, there's been a lot of whistleblower lawsuit settlements in recent years. And if you look at those settlements, drug companies have paid out millions of dollars, hundreds of millions of dollars, in some case billions of dollars, to settle allegations that they gave kickbacks to physicians to prescribe their drugs or that they were improperly influencing drugs to prescribe medications for off-label uses. So that is a little bit of a behind-the-scenes peek that there could be problems involved in the prescribing practices.
But also, studies have shown that even small tchotchkes and dinners and such have an opportunity to influence physicians to maybe feel kindly towards a certain product or to, you know, have some sort of a bias that they might not be - they themselves be aware of. As a result, many top medical, academic medical centers have told their physicians we don't want you to be speaking on behalf of these companies. We don't - we want you to be very careful in your relationships with the drug companies.
CONAN: And there are, of course, doctors who don't do it at all anyway. But you did cite the case of one particular doctor in Santa Monica, who since 2009 earned about half a million dollars or more giving promotional talks and consulting for four different companies, according to the data that you found. This guy's an anesthesiologist who's apparently not a leader in his profession and indeed in some respects misrepresented himself.
WEBER: What was interesting is when we decided to put together this database and to sort of take a look at who did the pharmaceutical companies pick as their favorite speakers - and we initially thought these are gonna be the most qualified people, these are gonna be the leaders in their field; they're charged with, you know, educating their fellow physicians about medications. But when we went to examine the backgrounds of some of the physicians who are receiving the most amount of money from drug companies, we found that some of them had no academic credentials. They weren't associated with an academic medical center.
They didn't have a lot of research, and they might not even be known by the other leading experts in their field. But a lot of times they're maybe being chosen because they can convince other doctors to prescribe the drug or maybe they're very effective speakers. We tried the - the doctor in Santa Monica, Dr. Gerald Sacks, we tried to call him on several occasions to see exactly what he was doing for, you know, the money that he was getting from the pharmaceutical companies, but he would not respond to us.
CONAN: Let's get some doctors on the line. If you're a physician, should you, do you think, disclose any relationship, any outside money you make from pharmacies, pharmaceutical companies, or from device manufacturers? 800-989-8255. Email: firstname.lastname@example.org. Mohammed(ph) is on the line from Livonia in Michigan.
MOHAMMED: Hi. I am a big fan of your show. But anyway, my thing is that I have always, you know, I have spoken to different pharmaceutical companies about different products, like antibiotics and so forth, because I am an urgent care physician, and I do have a good understanding of the disease process. I'm an active practicing (technical difficulties) And my belief is that - is, you know, when you know better about new products, the products can sometimes have a low side effect and a better safety profile.
MOHAMED: So there are pros to knowing about a good product. But when I spoke to different physicians, and I did speak to my colleagues, and I was paid, of course, by the pharmaceutical company, I always talked(ph) clinical relevant matters. I would always discuss the disease process. I would discuss how it would affect, but not promote the product itself. But of course, when the other doctors come to the dinner or the program, they would know that it is sponsored by the pharmaceutical company that is hosting that event. And I thought that doing so, I was educating the doctors on the appropriate use of antibiotics rather than not. So it is all not, you know, in a negative connotation. And I do understand there were some real bad apples that went on to say about, you know, the spine, you know, processes and the spine diseases that was up in there.
CONAN: We understand that there's - there's no corruption involved here, but should you be, you know, should there be a requirement, an ethical requirement to disclose that to your patients?
MOHAMMED: Absolutely. I'm actually on the board of Michigan State Medical Society, and we all believe that doctors should have an ethical responsibility to disclose that if they are speaking. So on my own resume, I do have a, you know, I have voluntarily disclosed that I am - I do speak for the companies, and my product that I prescribe, you know, is not based on the judgment of what the company is, you know, giving or recommending it, but it's what is best for my patients.
CONAN: OK. Mohammed...
MOHAMMED: I do agree with that.
CONAN: Thanks very much for the call. We appreciate it. We're talking with Tracy Weber of ProPublica about an investigative piece that she - and NPR News has also been involved with this - has done about what the doctor ordered. It was published, this story in particular, in the Los Angeles Times on September 8.
You're listening to TALK OF THE NATION from NPR News.
And let's get Eric(ph) with us. Eric with us from Lafayette in California.
ERIC: Hi. Thank you for taking my call. I had a - wanted to point out a publication that was from Money magazine just this past month, just relevant to this point, and also touching on a related issue in financial services, that when we disclose our conflict of interest as doctors, it actually doesn't actually help reduce bias in the prescribing behavior or the patients' choices. And so I feel like we sometimes fool ourselves a little bit as physicians that when we, for example, accept a grant from a pharmaceutical company and then disclose that in a talk, that that will reduce our bias. And in fact, evidence was that it actually does not.
So, you know, what I recommend to doctors is that if you have any sort of, you know, stock or any equity, relationship with a company, that you really should divest yourself of that. Even if you have no other relationship with a company, you need to divest yourself of equities in pharmaceutical healthcare, and furthermore that we really need to create a structure of funding for research in this country where companies create a consortium of funds under the NIH that fund peer-based studies which really give better sort of results than the sort of drug company-based studies, which compare their drug against a placebo but not a competitor.
CONAN: Eric, thanks very much for the call. And Tracy Weber, I wanted to ask you. Have you approached the AMA? Is there an ethical guideline on this?
WEBER: There are several ethical guidelines, even by the pharmaceutical industry themselves about, you know, even down to meals about what should be acceptable and what should be accepted. You know, there's - we were very careful to say this is not against any laws to speak and consult in this way, but that it is something that patients should have the right to know, and it should be a topic of conversation.
What the last gentleman said about, you know, disclosing it alone does not alleviate a conflict, I think that's probably true. But a lot of doctors that we spoke to did not want to disclose it and did not want that information known and did not like the idea that we have a database out there with all of this information.
CONAN: Let's get Neil on the line. Neil with us from Los Angeles.
NEIL: Yes. I think your guest, as ingenuous as she is, is making a tempest out of teapot. I'm going to be speaking in China and India at the end of the month, and it's costing me money to do it, because when I take two weeks out of my office, I'm not making income, but I'm still paying overhead.
And regarding the use of off-label drugs, just about every drug given to a child under the age of five is off-label because no company wants - or university wants to sponsor research where they do clinical testing on five-year-olds. So the - your guest is just disclosing (unintelligible) the obvious. Everyone knows these people are hired by the company. It's fatally obvious.
CONAN: Well, Tracy Weber, response?
WEBER: You know, the federal government has gone after many pharmaceutical companies because it's against the law for them to market their drugs for off-label uses because the FDA itself has not approved the safety of it, and this is not just for kids under five. You know, some of these suits involved, you know, approaching child psychologists for anti, you know, anti-psychotic drugs that were, you know, not remotely approved for use in those and who have very serious side effects. And, you know, the FDA is trying to ensure that if a drug is prescribed, the drug companies themselves are not marketing it for use that has not been tested.
NEIL: I challenge your host. She's factually incorrect. The Viagra was discovered as an off-label use.
NEIL: Wellbutrin stops smokers. That was off-label.
CONAN: And very quickly, Tracy Weber...
NEIL: Your guest is losing credibility.
WEBER: I'm not saying that doctors themselves cannot make an individual decision to prescribe a drug for an off-label use that they themselves feel is safe. Doctors are allowed to prescribe whatever they want to whomever they want. But what I'm saying is drug companies themselves are not allowed to market products for that purpose.
CONAN: Tracy Weber, an investigative reporter with ProPublica. We'll provide a link to our investigative series with ProPublica, Dollars for Docs, as well as the op-ed Tracy Weber co-authored with Charles Ornstein in the LA Times. Just go to npr.org, and click on TALK OF THE NATION.
Tomorrow, Michael Moore will join us.
I'm Neal Conan. It's TALK OF THE NATION from NPR News.
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