Dr. Jon W. Draud, is the medical director of psychiatric and addiction medicine at two Tennessee hospitals. It is likely that he is well paid for his administrative and medical expertise but according to ProPublica an investigative Journalism group the 47-year-old Draud has earned more than $1 million in the last four years for delivering promotional talks and consulting for seven drug companies and he’s not alone. Hundreds, perhaps thousands of physicians all over the country are also on the payroll of drug companies.
Look at these headlines:
Colorado doctors take big speaking fees from drug companies, data show
Posted: 03/26/2013 12:01:00 AM MDT
Colorado doctors who teach at major hospitals and universities continued to pocket hundreds of thousands of dollars in speaking fees from drug companies in 2012, sidestepping the institutions’ new restrictions on the lucrative payments.
Many private physicians also accepted speaking fees from pharmaceutical firms despite a spotlight on the practice, justifying their payouts as educational contacts with their peer
I-Team: Nevada Doctors Accept Millions from Drug Companies
Posted: Nov 18, 2013 4:01 PM EST Updated: Nov 19, 2013 3:10 PM EST
By George Knapp, Chief Investigative Reporter –
By Matt Adams, Chief Photojournalist
There has long been mystery surrounding how much, and to whom, drug companies give money.
Now, ProPublica has put together all of these disclosures that have been appearing recently on the Web. The resulting project, called Dollars for Docs reveals that about $258 million worth of compensation from seven companies went to health care providers in 2009 and 2010.
The team of investigative journalists found that 17,700 providers received such payments. Most of the money went to physicians, but nurses and pharmacists were also included, ProPublica said. The reasons for this money included speaking, consulting, business travel and meals.
So, what’s wrong with a physician getting paid to give speeches? Well, for the most part nothing unless the payment causes the physician to prescribe one drug or device over another because of it. There is nothing illegal about the practice but, is it ethical? What it boils down to is this. Does the physician always do what’s best for the patient or what’s best for his or her benefactor? An example: If Bristol-Meyers Squibb makes a high blood pressure medication that costs $25 a tablet and Abbot Labs makes one that sells for $2 each and both medications do the same thing does the physician prescribe the $2 pill or the more expensive one from the company that pays him an extra $100,000 a year to speak on their behalf? That’s the point of our blog today and we are going to return to it shortly but first some background.
According to MedPage Today http://tinyurl.com/n22k6dz The average debt facing graduating medical students is about $156,000. The Wall Street Journal worst case scenario for med school tuition debt is a whopping $550,000 tab run up by a family practitioner http://tinyurl.com/m5gcov6 That huge debt is the result of her deferring loan payments while she completed her residency, default charges and relentlessly compounding interest rates. Among the charges: a single $53,870 fee for when her loan was turned over to a collection agency.
While the debt appears to be outrageous it is made a little easier to handle when you consider the earning power of physicians. .A Time Magazine survey of 24, 216 physicians across 25 categories showed doctors’ earnings ranged from about $156,000 a year for pediatricians to about $315,000 for radiologists and orthopedic surgeons. The highest earners — orthopedic surgeons and radiologists — were followed by cardiologists who earned $314,000 and anesthesiologists who made $309,000 http://tinyurl.com/7jl8v6a. But remember, these are averages. Some Orthopedic surgeons earn over $625,000 a year, some neurosurgeons earn nearly as much while many pediatricians earn over $200,000. http://tinyurl.com/78lkdtg
The lowest earning doctors are family physicians and pediatricians and in both professions .there is a shortage that is getting worse. Witness the increasing use of Physicians assistants and Nurse Practitioners who can now perform some of the functions traditionally handled only by licensed physicians.
It is bad enough that you begin a career a quarter of a million dollars in debt but now add on malpractice insurance and we are looking at some seriously large payments.
It is estimated that your physician spends 10 cents on malpractice insurance from every dollar you pay for health care, according to Diana Furchtgott-Roth, a senior fellow at the Manhattan Institute. http://tinyurl.com/mhk6p3n Furchgott-Roth notes that premiums vary from $20,000 annually in low-cost states to $200,000 annually in high-cost states. According to a survey published November 2011 in “Modern Medicine,” family and general practitioners paid premiums of $12,100, and pediatricians’ premiums averaged $11,800. OB-GYNs paid an average of $46,400, and plastic surgeons reported median premiums averaging $30,000.
A 2010 survey by the “Medical Liability Monitor” compared premiums for three specialties in various areas of the country. Internists in Dade County, Fla., paid $48,245 annually in 2010, while general surgeons paid $192,982. In comparison, internists in the lowest-cost areas of California paid only $3,200 and general surgeons had the lowest premiums in Minnesota at $11,306 annually. OB-GYN premiums varied from a low of $13,400 in the lowest-cost areas of California to a high of $204,864 in the counties of Nassau and Suffolk in New York.
The new physician will not be able to earn much money during his five years of residency training either. The average salary for a surgical resident is about $56,000 per year, which will force him to defer paying the principal on his loans while the interest keeps on accruing that’s how the physician in the earlier Wall Street Journal story piled up over a half million dollars in debt.
So now that we’ve established that it costs a lot to become a physician we piled on and added the cost of malpractice insurance. The combination of student loans and insurance payments becomes for some, an unbearable burden even with a good salary. That leaves us with the question, how do you pay all that debt and still have something left to live on? Well, the answer is simple and physicians don’t have to look too far to find some extra income.
Enter center stage — Big Pharma. This is where the huge pharmaceutical companies can be the answer to many young physicians’ prayers. Once they have MD after their name and maybe a few other medical credentials their opinions become worth a lot of money. If Bob Aronson endorses a medication it is pretty meaningless but if Dr. Bob Aronson endorses it people take notice and if you add Dr. Bob Aronson from (name any famous clinic or hospital) the credibility is even higher.
Doctors are still among the most trusted people in America. A December 2012 Gallup poll ranked Physicians third on the list just behind nurses and pharmacists http://tinyurl.com/cz7orar When Doctors speak, people listen and more importantly, they believe what they hear. That believability, sincerity, and credibility, coupled with the Marcus Welby or Grey’s Anatomy image of super compassionate service makes doctors the ideal spokespersons for almost any company.
Most news stories today that address the issue focus on the big pharmaceutical companies like Bristol-Meyers Squibb, Eli Lilly and Abbot Labs and they do spend a lot of physician endorsements but so do the little pharma companies, those with but one product for which they are trying to get FDA approval. They spend hundreds of thousands of dollars of investor’s money to get physician endorsements. I know because I worked as a communications consultant to many of them myself and travelled the country working with the docs on just how to phrase their endorsements.
Often a drug company will pay first class airfare to fly several physicians in from all over the country for a meeting. Each doc gets a limo from the airport to the hotel, a very nice room, good meals a handsome stipend and professional help on how to endorse the company’s product. If the issue is big enough and the physician is important enough the spouse might be invited as well and the trip could take three or four days and include several rounds of golf at exclusive clubs and perhaps a short meeting every day aboard a yacht .that is on a week-long cruise..
Often when a physician speaks to a gathering it is from a script prepared by the pharmaceutical company. They get paid extremely well for doing nothing more than reading a speech prepared that was handed to them. Physicians justify the practice by pointing out that the FDA and other agencies require specific language when speaking about specific drugs and being as the company has already fine-tuned the words and had them approved it makes sense to use their script.
Dollars for Docs is a site that keeps track of what Pharmaceutical companies pay to physicians, state by state. You can look up your doc to find out if he or she is getting any money from the companies listed http://projects.propublica.org/docdollars/
Physician endorsements of pharmaceutical products are important because they can help:
- Gain approval from a regulatory agency for the use or expanded use of their drug or product.
- Ratchet back the noise when there is a crisis. For example, if a journalist finds a study that suggests your drug is unsafe or someone files a law suit claiming extensive damages or death it is reassuring to the public and to juries to hear a well-known physician say we shouldn’t worry, the drug is safe.
- It’s just good advertising to have a doc endorse you. “3 out of 4 Doctors recommend brand X.. Here’s what Dr. Smith from the renowned xyz institute has to say about it, …….”.
The Pro Publica site has made quite a splash. Journalists all over the country have used it to gain information about local physicians. On March 10 of last year, Susan Abram, Staff Writer for the Los Angeles Daily news wrote a story based on research from Pro Publica that outlined the situation in California. http://tinyurl.com/kjwrebp
“Hundreds of physicians, psychiatrists, and medical school faculty members across California are on the payroll of major drug companies, earning tens of thousands of dollars for speaking to other medical professionals at events held by industry leaders that make drugs such as Advair, Cymbalta, Viagra and Zoloft.
From 2009 to 2012, California doctors who participated were paid $242 million – the highest in the nation – by major drug companies for research, speaking, consulting, trips and meals, according to a new database released Monday by ProPublica, an independent, nonprofit news organization.
The disclosures have been listed on the websites of some drug companies for several years, but a federal mandate will require it for companies by 2014.”
While the practice of speaking is not illegal, it raises the question of conflict of interest: Is the drug being given to you because you need it, or because the doctor writing out the prescription is paid by Big Pharma? There really isn’t any way to tell.
So in the final analysis, patients need to be far more vigilant and inquisitive about prescribed medications. While clinical trials of drugs are usually quite thorough before the Food and Drug Administration (FDA) approves them, their full effect may not be known for years. Even with large clinical trials with thousands of patients involved it is sometimes impossible to determine exactly what a drug will do to or for any given person because we are all very different from one another.
It is easy to understand that a physician who is deeply in debt wants to pay off the loans and live a more stress free life by endorsing certain medications. I might do the same but they also have to exercise some caution with new high profile drugs that claim to perform miracles. Let me name just three and you’ll then better understand that Big Pharma’s influence is real and it works for them but may not be in your best interest.
- Upon release everyone thought drugs like Fosamax the anti-osteoporosis drug (a biphosponate like Boniva and Actonel), was a Godsend but the FDA now says these drugs may in fact cause harm. In 2012 the FDA issued a report that said after years of use the drugs may in rare cases actually lead to weaker bones in certain women, contributing to “rare but serious adverse events,” including unusual femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.” The agency’s analysis, which found little if any benefit from the drugs after three to five years of use, may prompt doctors around the country to rethink how they prescribe them.
2. Then there’s Lipitor which was the best-selling drug in history. Reports indicate that in 14 years the drug generated about 126 billion dollars for pharmaceutical giant Pfizer. Lipitor is a statin a class of drugs developed to block the enzyme in your liver that is responsible for making cholesterol. It has Since been found that statin users run the risk of experiencing severe muscle pain and damage which can lead to serious kidney problems.
The danger with Lipitor in particular is that the standard dosage is far stronger than many patients need. One physician wrote, “The Lipitor dosage guidelines do not distinguish between patients with or without heart disease. They do not distinguish between patients requiring large reductions and those needing small reductions. The recommended initial dose of Lipitor, 10 mg, is so powerful that doctors can treat many patients with the same dose and not have to bother matching the dose to individual patients.”
- And finally, Paxil the SSRI antidepressant that was the preferred method of treating Post Traumatic Stress Syndrome (PTSS) among Iraq war veterans. In 2007 the BBC did a story about a study that showed adolescents were six times as likely to become suicidal on the drug. In 2005, the FDA revealed birth defects associated with Paxil including heart problems, seizures, feeding problems, vomiting, low blood sugar and a host of other symptoms. Then it was revealed that some patients had extreme difficulty when they tried to stop taking Paxil According to a report in the British Medical Journal, in case after case, patients coming off the drug experienced nightmares, dizziness, burning and itching of the skin, agitation, sweating and nausea. And for many of those patients, the only way to treat the side effects was to begin taking Paxil again! http://hsionline.com/2006/02/06/the-dangers-of-paxil/#sthash.B9BKt990.dpuf
All of these drugs seemed legitimate, effective and relatively safe at first. A good number of physicians got on the Fosamax, Lipitor and Paxil bandwagons and were paid handsome sums for their endorsements. In retrospect it is obvious that many of the claims were premature and that the drugs probably endangered the people who were taking them.
To be purposely repetitious I will again offer this admonition. Patients have to become far more knowledgeable about medical treatments and prescription drugs and we have to ask more questions. When a physician recommends drug X for arthritis we need to ask if there’s a generic. We also need to question physicians about whether the drug or treatment is really necessary. And remember — sometimes it is important to get a second opinion. A good, honest physician will support that decision.
Bob Aronson is a 2007 heart transplant recipient, the founder and primary author of the blogs on this site and the founder of Facebook’s over 3,000 member Organ Transplant Initiative group.
Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients. He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy.
Bob is a former journalist, Governor’s Communication Director and international communications consultant.