Some doctors in the Houston area were paid last year for activities such as consulting and travel by the same drug companies that fund their clinical research. Sixteen of them received more than $10,000 in combined compensation, according to an analysis done by the Houston Chronicle of recently released data.
The database by the Centers for Medicare and Medicaid Services, made public last week, details financial relationships drug companies have with doctors and teaching hospitals.
The data is part of a federal transparency initiative included in the 2010 Affordable Care Act. It covers only the last five months of 2013 and more than 40 percent of the records are unnamed because identities are being clarified or payments are in dispute.
For advocates of transparency, though, the release was an important development.
“The power of sunshine is going to make it easier and more necessary for stakeholders to examine the relationship between any given individual and industry,” said David Rothman, professor of social medicine at Columbia University Medical School and a frequent writer on research ethics.
Manufacturers of drugs, devices and supplies that provide at least one product covered by Medicare or Medicaid must report payments or gifts in excess of $10 that they make to doctors and teaching hospitals.
Prior to the release of the database, the only source of such payments came from ProPublica, a New York City-based news organization. Its database tracked payments disclosed by the companies themselves, mostly due to legal settlements. According to the new data, Texas doctors and teaching hospitals received more than $243 million during the final five months of 2013.
Critics like Rothman feel doctors are influenced, consciously or not, by accepting payments from drug companies.
Even a single dinner, Rothman said, can make a physician feel like he owes the company something in return.
“Drug companies are not dumb,” he said. “They don’t give this stuff out for the hell of it.”
Dr. Suzanne Bruce, who owns and runs a dermatology practice in the Houston area, says it is not that simple.
Bruce treats patients with acne or skin cancer and gives Botox treatments but is also paid by drug companies as a consultant and researcher. She is a former vice president of the Texas Dermatological Society and former president of the Houston Dermatological Society and has been in practice for close to 30 years.
The financial data showed Bruce conducted research for Allergan, a pharmaceutical company known for producing Botox. She also accepted $8,000 for consulting, and the company paid for trips to Toronto and San Diego. In total, Bruce was paid close to $72,000. She discloses on her practice’s web site that she works with drug companies in addition to her primary practice.
Being paid to conduct clinical trials as well as serving as a consultant on an advisory board of the same company does not qualify as an ethical violation to Bruce. Advancing medicine requires companies consult with experts in the field, she said.
“Because I get to use it (the product) before it’s released on the market, I’m more knowledgeable about it,” Bruce said. “Because I’m doing the research, I’m more on the cutting edge.”
She argues that this expertise is needed by pharmaceutical companies who otherwise would not know how the product is being used in the market.
Bruce feels placebo-controlled studies make it difficult to influence the results of a clinical trial to the benefit of a particular company. The controls make Bruce confident about the integrity of her relationship with Allergan.
“People can critique it,” she said. “I’m not losing sleep over it. I’m doing everything ethically and honestly.”
When a doctor works as part of a larger system like the University of Texas Health Science Center, M.D. Anderson Cancer Center or Baylor College of Medicine, there are policies designed to protect the hospital and the staff from unethical behavior.
The University of Texas applied the National Institutes of Health standard to all staff, saying anyone receiving more than $5,000 in payments in a 12-month period is considered to have a “significant financial interest” in the company.
Staff meeting that criteria have to submit disclosure statements and can be subject to a conflict of interest management plan. Those plans may require doctors be removed from research or have independent monitors assigned to their work.
“There is no doubt in my mind that awareness of potential conflicts has gone up dramatically,” said Dr. George Stancel, the university’s executive vice president for academic and research affairs.
Currently, about 45 staff members – out of several thousand employees – have conflict of interest management plans at UT.
Dr. Elizabeth Torres, president of the Harris County Medical Society, feels most doctors behave ethically, regardless of payments from drug companies.
Torres thinks that controls already in place cover most of the concerns people have about undue influence. For example, when doctors speak at conferences, they are required to disclose their conflicts of interest to the audience.
She does have concerns that doctors appearing in the data will seem guilty without context.
“Obviously, we want to be up-front with our patients,” Torres said. “But nobody wants to appear conflicted.”
The problem facing the medical community, according to doctors and critics alike, is how to find a balance between legitimate research and use of expert knowledge and the abuses that can come from financial ties.
Both Bruce and Rothman feel disclosures like the ones made last week will reduce the risk.
“I’m all for transparency,” Bruce said. “I’m in favor of the public knowing what’s going on.”
Rothman’s hope is that doctors taking smaller amounts of money would chose not to receive compensation in the future since it’s being publicly disclosed.
If that occurs, he said, “sunshine will have been worth it all.”
Name Payments Company
William Wierda $330,567.50 GlaxoSmithKline
Stephen Pflugfelder $227,503.18 GlaxoSmithKline
Charles Conrad $145,814.94 Actelion Pharmaceuticals U.S.
Suzanne Bruce $71,607.64 Allerga
Stephen Slade $36,835.15 Alcon
Robert Feldman $34,720.53 Alcon
Zeenat Safdar $34,332.06 Actelion Pharmaceuticals U.S.
Adaani Frost $22,224.91 Actelion Pharmaceuticals U.S.
Dale Halter $21,658.68 Takeda Pharmaceuticals U.S.A.
Susan Samson $21,358.99 Novartis Pharmaceuticals
Craig Pratt $18,845.96 Otsuka America Pharmaceutical
Michael Mcguire $18,283.13 Geistlich Pharma
Prashanth Sunkureddi $15,103.78 Takeda Pharmaceuticals U.S.A.
Abdulla Salahudeen $14,498.88 Otsuka America Pharmaceutical
Maureen Mayes $11,002.51 Actelion Pharmaceuticals U.S.Daria Lee $10,891.75 GlaxoSmithKline
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The post Drug companies paying Houston doctors for research and consulting, data shows – Houston Chronicle appeared first on Evan Vitale Consulting Blog.
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