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Speaking fees declining for pharmaceutical firms

The amount of money paid by pharmaceutical firms to physicians and other health professionals to speak about their products seems to be slowing, but a look at 12 companies that disclose those figures shows it still amounts to millions of dollars in Maryland.

A review of the payments reported by eight major pharmaceutical firms including Eli Lilly, AstraZeneca, GlaxoSmithKline, Merck, Pfizer and Novartis show that in 2010 in Maryland, doctors were paid more than $4 million in speaking fees. This compares to the first half of 2011, when reporting companies paid only $836,330 in speaking fees.

In addition to speaking fees, other payments were made for meals, research, consulting and travel. From 2009, the first year some companies disclosed the information, through 2011, individuals in Maryland received a total of 2.4 percent, or $18.6 million, of the nationwide $761.3 million in reported payments.

California received the highest amount of payments since 2009 at $89.4 million, followed by New York and Texas, with $60 million and $59.4 million, respectively. Maryland came in at 15th on the list.

The information about the pharmaceutical firm payments is part of a searchable database compiled by ProPublica, an online nonprofit investigative journalism organization that won the 2011 Pulitzer Prize for national reporting. The complete picture of the industry’s involvement is incomplete though as only 12 companies make public what they pay to physicians and other health care providers. Of those 12, a few started reporting in 2010 while others such as Allergan do not show what the money was paid for and only gives a range instead of a specific amount.

As scrutiny continues to intensify and health care reforms loom large in the coming years, more information about the pharmaceutical industry’s relationship with health care providers is expected to be revealed.

“It’s definitely been a big topic the past few years,” said Dr. Nancy Lowitt, associate dean for faculty affairs and professional development at the University of Maryland School of Medicine. “I think the industry wants to be as transparent as possible, and it’s going to become easier and easier over time for patients to find out all of this information.”

Controlling conflict

One of the driving forces behind getting industry payments made public is the fear of conflicts of interest. Some of the 12 companies disclosing the information did so as part of settlements in federal whistleblower lawsuits.

In the U.S. District Court for Maryland, in 2010, drug maker Alpharma Inc. agreed to pay $42.5 million to resolve False Claims Act allegations over its marketing of painkiller drug Kadian. The settlement centered on allegations that from 2000 to 2008, Alpharma paid health care providers to get them to promote or prescribe Kadian.

“Illegal marketing of pharmaceutical drugs jeopardizes the public’s confidence in our health care system,” Tony West, assistant attorney general for the Civil Division of the Department of Justice, said in a statement at the time of the settlement. “All consumers have the right to know that their health care provider’s judgment about drugs they should take has not been undermined by misinformation or kickbacks from pharmaceutical manufacturers.”

Gene M. Ransom III, CEO of MedChi, the state’s medical society, said that over the last few years there have been a lot of changes in how the profession deals with the pharmaceutical industry. He said that, for example, the American Medical Association has strict guidelines when it comes to dealing with industry interaction with pharmaceutical firms. He said that this is in addition to rules in place at individual practices, hospitals and universities.

“Physicians have generally been very good about following those rules,” Ransom said. “Back in the old days, they really didn’t have those kinds of rules, and things were quite different, but the profession has come a long way since then. The difference being spent to support physicians from then to now is absolutely amazing — it’s nothing like what it used to be.”

A look at the numbers provided by the companies that report shows that while speaking fees remained at, or above in many cases, the 2009 levels, the first half of this year shows a drastic drop in what is being paid out. GlaxoSmithKline, for instance, reported 91 payments in 2010 to Maryland professionals for speaking fees, amounting to $1.29 million. For the first half of 2011, the company reported 48 payments for $178,000.

Eli Lilly reported 73 payments totaling $1.73 million in 2010 compared to 43 payments for $271,365 in the first two quarters of 2011.

School policies

The state’s two medical schools have also implemented guidelines for how their faculty and researchers can interact with the industry. Part of the reason Maryland receives millions each year from the industry is due to the state being home to The Johns Hopkins University School of Medicine and the University of Maryland School of Medicine.

At the University of Maryland School of Medicine, Lowitt said that paid speaking engagements are prohibited as is membership in so-called industry speakers bureaus. The school also does not allow faculty or students to accept gifts or meals from the industry, and consulting relationships have to be pre-approved.

The Hopkins School of Medicine has had a conflict of interest policy since 1992. And the school adopted a policy on interaction with industry in 2009 that allows speaking engagements but requires that independent content must be ensured.

“We have a detailed, robust policy on conflict of interest and take the issue very seriously,” Julie Gottlieb, associate dean, policy coordination for Johns Hopkins University School of Medicine, wrote in an emailed response to questions.

The school also has a complete ban on gifts from the pharmaceutical industry under the interaction policy.

“Gifts, even small gifts, carry an implied expectation of reciprocity,” the policy reads. “Accepting a coffee mug or mouse pad from a pharmaceutical sales representative may not consciously affect one’s decision-making, but the interaction with the giver or the presence of the item in an office is likely to make one think positively of the donor or product and cloud one’s clinical judgment.”

Both schools were lauded the American Medical Student Association, which has released an annual “PharmFree Scorecard” since 2007. Hopkins and University of Maryland each earned an A grade in the scorecard for having conflict of interest policies that are clear and can be enforced.

Research funding

Another reason for the policies and concern over conflicts is because research funding to the schools amounts to millions each year. From the companies that reported payments, Maryland received $3.14 million in 2010 for research conducted at schools, hospitals and at private clinics and offices.

Gottlieb said that Hopkins faculty members are often sought by a wide range of organizations, including the private sector, to conduct research.  She said the school looks for potential financial conflicts of interest with research to ensure management or elimination of any potential for bias due to financial interests.

“External research support is critical for conducting studies that will advance innovation in biomedical research, move laboratory discoveries to the clinic, and improve healthcare delivery,” Gottlieb wrote. “Research must be done objectively and according to scientific norms.”

The University of Maryland also works with the industry on research projects that are monitored for any conflict.

“Some of the relationships with the industry are highly beneficial to the school,” Lowitt said. “But, we want to be sure always that those relationships don’t get in the way of what’s best for the patients and the school.”

Lowitt said research funded by the industry goes through the same processes and controls that a project funded by any other source, like the federal government, would. This entails a committee that reviews the project for anything that might raise a red flag.

As part of health care reform, the money paid out by pharmaceutical firms, medical device manufacturers and other companies will be mandatorily disclosed in 2013.

“I think a lot of companies are ready or getting ready for this to happen,” Lowitt said. “I think everyone is getting ready for it to change, and I think it’s a very good thing — the more information that’s made available the better.”