Doctors and Their Speaking Fees

Would you keep using a doctor who collected $300,000 or even $300 in speaking fees from drug companies for saying a good word about their products?  That's the question the non-profit, investigative journalism outfit ProPublica is inviting thousands of patients to ponder. ProPublica, which is gaining a reputation for dissecting the innards of the medical system, brought forth a big spread a couple weeks ago along with some databases that let consumers in on dirty little secrets about their doctors--they may be on the payroll of the very companies whose drugs they prescribe.

One database lists 43 doctors who each earned more than $200,000 by giving speeches about a company's drugs The list includes 11 endocrinologists, which is not surprising given the uptick in diabetes and the fierce competition among pharmaceutical companies to push their diabetes drugs onto the public as fast as they can.

The second database lists 384 health care providers who received $100,000 or more in speaking fees in 2009 and early 2010.'  It appears that many psychiatrists, immunologists and pain doctors made the list.' Those medical specialties are also are juicy targets for drug companies hot new products.  The ProPublica site also lets readers type in the name of their physicians to see if they are on the lists. The databases currently offer information about only seven drug companies that have signed settlement agreements with the Department of Justice, and ProPublica makes that clear.  In 2013, there will be information on another 70 companies, and then we will have a pretty large picture of the huge sums spent to connect doctors to drugs.  Not that those who have studied the health system don't already know this.

What does all this mean for patients who may be in the dark about their doctors links to big Pharma?  The database is consumer friendly in the sense you can quickly find out if your doc is on the list. This is designed to trigger a conversation, says Charles Ornstein, one of the reporters on the project. It's about creating a conversation and asking questions.'  If your doctor won't have that conversation, are you comfortable with that doctor?

That, of course, touches on trust, an essential ingredient in the healing process. I know I would not shop for a new ophthalmologist even if he were paid $1 million by a drug company. My eye doctor has prevented nerve damage in my eyes despite elevated ocular pressures that could have caused blindness long ago. I trust him. Others whose outcomes are not so good might wonder if their trust is misplaced and question the treatments they've been getting. So trust, it seems, is also a function of personal experience which may even trump apparent conflicts of interest.

This also suggests that a larger conversation than just between patient and doctor is needed. We are already having conversations with our physicians about which drugs to take. Every night commercials on the evening news tell viewers that we should talk to our doctors about this drug or that, and we've learned that most of the time if we ask for a drug, we get it.

Choosing a doctor and building a trusting relationship is not simple. ProPublica's report and database raise serious questions about how just how much more responsibility we want to heap on patients for policing a corrupt medical marketplace.

Patients expect their doctor to prescribe the best and least costly drug for their conditions, not drugs that the doc is paid to promote. But now patients will have three steps to take in order to get that assurance: first, they can do some research on the drug and try to make a decision to take a drug based on the evidence. Second, they can research the ProPublica database to learn if their doctor is one of the high-rollers on the Pharma gravy train. And lastly if so, will they decide to stay with that doctor or begin the process all over again to find a new one?'  Do consumers want to do all that, and it is fair to ask that they should?

It seems to me that the value of ProPublica's databases is that disclosures might make a difference to employers who decide what insurance most Americans can have and to insurers that decide which doctors and hospitals consumers can use. After all, insurance companies are the gatekeepers to their networks, and employers often insist that certain doctors and hospitals are included.  ProPublica found that many of the doctors who received the most money were not necessarily the top practitioners in their fields. Some were not even board certified in their specialties. Others had been sanctioned by state medical boards or received warning letters from the FDA. They had done medical research, but had not bothered to obtain required consent forms for patients taking part in clinical trials.

So why do employers and insurers still include them in their networks, subjecting their workers and members to perhaps questionable medical care?  That's the question consumers should be asking those who make their insurance possible.'  If bad doctors are in the networks, then consumers aren't getting the very best product, are they?  If employers and insurers are troubled by the practices revealed by ProPublica's investigation (and they should be), then the links between doctors and drug companies could be severed in a New York minute.