Dollars for Doctors: The Drug-Money Juggernaut

Welcome to Pill Head nation

Welcome to Pill Head nation

The Ohio medical board concluded that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue.

Yet the finding, posted on the board’s public website, did not prevent Eli Lilly from using him as a promotional speaker. They paid him $85,450.

In 2001, the U.S. FDA ordered Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

Still, three leading drug makers paid him $224,163 over 18 months to lecture other physicians about their drugs.

In Georgia, a hospital decided to kick Doctor Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I’m a pervert. I honestly don’t know.”

None of that matters to Cephalon Pharmaceutical. They paid Taylor $194,050 in less than two years to lure doctors into prescribing their drugs.

Doctors Leak, McMillen and Taylor are part of the drug industry’s white-coat sales force – doctors paid to promote brand-name drugs to other doctors — and if they’re convincing enough, get even more physicians to prescribe them.

Drug companies say they hire the most-respected doctors in their fields to teach other doctors about the benefits and risks of their drugs.

But an investigation by ProPublica uncovered hundreds of physicians on company payrolls had been accused of professional misconduct; disciplined by state boards; or lacked credentials.

ProPublica created a comprehensive database that represents the most accessible accounting yet of payments to doctors. The database covers $257.8 million in payouts over a two-year period for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

The investigation revealed discipline against more than 250 doctors, including some of the highest paid. The misconduct included inappropriately prescribing drugs; providing poor care; having sex with patients. Some doctors had even lost their licenses.

More than 40 have received FDA warnings for research misconduct; have lost hospital privileges or been convicted of crimes. Considerably more misbehavior is suspected, but not yet revealed publicly.

In fact, five of the seven largest dug companies acknowledged they don’t check for doctor misbehavior before hiring them. Instead, they rely on self-reporting. Only Johnson & Johnson and Cephalon said they did do some level of background checks.

ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.

“They are representatives of our company,” said Dr. Jack Harris, vice president of Lilly’s U.S. medical division. “It would be very concerning that one of our speakers was someone who had these other things going on.”

For the pharmaceutical companies, one effective speaker may not only teach dozens of doctors how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.

Pharma companies like to say physician salesmen are chosen for their expertise. Glaxo, for example, says it selects “highly qualified experts in their field.”

But ProPublica found some top speakers are experts only because the drug companies say they are.

“It’s like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York.

“Nobody has heard of you before. Then, after you’ve been around the country speaking 100 times, people know your name and think, ‘This guy’s important.’ It creates an opinion leader who isn’t necessarily an expert.”

Las Vegas endocrinologist Firhaad Ismail, is an excellent example. He is the top earner in the database, making $303,558.  His lecture brochures list him as “Chief of Endocrinology” at a Las Vegas hospital.

Research reveals he is not a department chief of any hospital anywhere.

“Without question the public should care at this,” said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine, who has written about the drug industry’s influence on physicians. “You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor?”

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We sincerely thank ProPublica staff Charles Ornstein, Tracy Weber and Dan Nguyen, as well as Director of Research Lisa Schwartz and researcher Nicholas Kusnetz. Their terrific investigative reporting can be regularly found at:

http://www.propublica.org/investigations/

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