By the fall of 2014, every company will be required to list every payment it makes to a medical professional, and what each payment is for.
Scores of Chicago-area doctors added tens of thousands of dollars to their incomes last year by making speeches for drug companies, according to an investigation by NBC Chicago and ProPublica.org.
One local doctor was paid more than $160,000 last year alone -- over and above his regular income -- just to speak and promote the products of three drug companies.
It’s a practice that has long been in the shadows, even though it is all perfectly legal: Drug companies hand out hundreds of millions of dollars’ worth of free meals, travel, gifts, and lucrative speaking fees to physicians to promote the same drugs and medical devices that those doctors may prescribe to their patients.
"You would like to think, as a patient, that when you go to a doctor, that doctor is prescribing the safest, most effective and least-expensive drug," said Dr. Sidney Wolfe, the Director of the Health Research Group of Public Citizen, a consumer-advocacy organization based in Washington, D.C. “That may just not be the case when this doctor has taken a bunch of money from drug companies.”
The potential for conflicts of interest has spurred Congress to demand that all drug companies must make these payments public. By the fall of 2014, every company will be required to list every payment it makes to a medical professional, and what each payment is for. Fifteen companies -- about half -- have already started posting their payments online.
ProPublica, an online investigative website and partner of NBC5 Investigates, has sorted and crunched these already-posted payments into a tool that anyone can use to see if his or her own doctor receives money from drug companies.
Many of these payments are for research or consulting fees, as a pharmaceutical company develops a new medication, for example, or employs a physician to conduct research trials or provide consulting services.
But NBC Chicago and ProPublica examined another type of payment made to doctors: Speaking fees. That’s an area which critics single out as having major potential for conflicts of interest, with money paid purely to promote an already-existing drug.
At least seventy Chicago-area doctors collected $10,000 or more from drug companies in 2012 in speaking fees, over and above their regular incomes, NBC5 Investigates has found. Topping the list is Dr. Israel Rubinstein, a pulmonologist at Jesse Brown Veterans Administration Hospital in Chicago, who was paid $160,425 last year to make speeches for three separate drug companies. Since 2009, Dr. Rubinstein’s speaking income has totaled $318,838. Dr. Rubinstein did not return calls to talk about his speaking fees.
"Physicians are authorized to engage in non-government speaking engagements, [which] cannot conflict with their position at VA," a spokesman for Jesse Brown VA Hospital said in a statement. "Israel Rubinstein, MD, has requested and received permission for a number of outside activities.”
"The doctors who take this money don’t think that the money has any influence on what they say," said Wolfe. "Doctors will tell you, ‘I think it has an effect on other doctors, but not on me.'"
The bias is often subconscious, said Dr. Daniel Sulmasy, a bioethicist and professor of medicine at the University of Chicago.
"There are good data showing that even small gifts that are given to physicians actually do influence their prescribing habits," he explained. “The patient can legitimately ask the question, to what extent is that doctor really acting in their best interest, or is that doctor acting because they’re basically being paid to promote the drug?”
To that point, the second-highest-earning local doctor is retired and no longer directly treating patients. Dr. Nicholas J. Gross is a pulmonologist and professor emeritus at Loyola University School of Medicine. He earned $97,650 in 2012 speaking on behalf of Forest Laboratories. He told NBC5 Investigates in a phone conversation that he researches a medication as thoroughly as possible before agreeing to speak about it.
"I could never promote a drug I didn’t believe in," he said.
But Dr. Gross sees the potential for an appearance, at least, of a conflict of interest for doctors who are currently treating patients.
"I understand it is a risky position for some people," he said.
The third highest-earning physician for speaking fees in the Chicago area during 2012 is Dr. Rohit Romesh Arora, a cardiologist at the Captain James A. Lovell Federal Health Care Center in North Chicago. He also teaches at The Chicago Medical School in North Chicago. NBC5 Investigates was not able to reach Dr. Arora for comment, and messages left at The Chicago Medical School and the Lovell Health Care Center went unanswered.
Drs. Sulmasy and Wolfe agree that every patient should ask his or her doctors about any payments from drug companies. The ProPublica search tool allows anyone to print out a list of payments, so that a patient can take them to their next doctor’s appointment.
But Dr. Sulmasy warns that the data is complex, and that it can be difficult for patients to sort out valid research payments from speaking fees.
"They find out their physician is getting money from fifty different companies, and they’re trying to make sense of what it all means," he said. "I think it’s going to be very confusing and, in the end, not very helpful."
But Wolfe said the choice may be a simple one.
"I think that more and more patients are going to realize that if they have a choice of going to two doctors … and the only difference between them is that one of them got $20,000 [from a drug company] and the other them got none, which are they going to choose?" Wolfe offered.
That’s all the more reason, he says, to arm patients with this information, in order to get those answers.
"Every time your doctor writes a prescription, you might just say, ‘Can you just stop for a minute and tell me whether that prescription is influenced by the lunches or the speaking fees you get?’ And I think the more that’s done, the more self-conscious doctors will become about accepting this money," he said.
|ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest. | ProPublica.org|