Whenever the uncomfortable topic of pharmaceutical companies paying physicians arises, the industry is quick to counter with the same refrain: Those payments are necessary to help educate physicians.
There is an impressive dedication to this mantra. John J. Castellani, president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA) said it in the lead up to the first Open Payments data release, and then reemphasized the importance of “collaborations” a month later when the data was officially released.
It’s even featured on the association’s website:
“Doctors and other healthcare professionals with real-world clinical experience in specific therapeutic areas are uniquely qualified to educate and inform their peers about the medicines they prescribe.”
So uniquely qualified, in fact, that they carried a $2.6 billion price tag in 2015.
A new analysis released by ProPublica last week should add another layer of doubt to that premise. The report found that between August 2013 and December 2015, at least 2,300 doctors received payments from pharmaceutical companies despite a history of misconduct. And that was just in five states.
This despite PhRMA’s code that “company decisions regarding the selection of healthcare professionals are based on defined criteria such as medical expertise, reputation, knowledge and experiences in a particular therapeutic area, and communication skills.”
Not everyone is buying it.
“I think it’s crystal clear that their fiduciary duty is not to educate physicians and make public welfare better. It’s to sell a product,” Charles Rosen, M.D., the co-founder of the Association for Medical Ethics told ProPublica. “I think they’d pay the devil if no one knows and he sells a lot.”
I'd take it one step further: They might pay the devil even if everyone knows, given the fact that speaking fees have been roundly criticized for years. Either way Rosen’s point speaks to the pharmaceutical industry’s steadfast excuse that is quickly falling apart at the seams.
And it’s not just the number of instances in which pharma pays doctors with a checkered past, it’s the egregiousness with which they do it. ProPublica notes the case of Michael Reiss, M.D., a New Jersey physician who had his medical license suspended for three years in 2012 for hiding several million dollars from the IRS. Reiss was rewarded with $85,000 in consulting fees from Johnson & Johnson in 2015.
In 2014, the report notes that Miltiadis Leon, M.D., was paid $26,000 in speaking fees and travel expenses by AstraZeneca despite the fact that he was operating under a limited license dating back to 2006, after sexually harassing female patients and staff members.
Keep in mind, six years ago, both Johnson & Johnson and AstraZeneca promised to review the screening process of physician speakers after a previous ProPublica investigation uncovered many of the same concerns.
Then there’s Fernando Avila, M.D., who made a cool $60,000 from Insys in 2015 even after it was discovered that he improperly prescribed pain medication in 2009. Yesterday, the Illinois Attorney General filed a lawsuit against Insys for deceptively marketing and selling the company’s painkiller, Subsys, allegedly directing its efforts toward high prescribers. In that sense, it appears Avila and Insys were a perfect match.
Imagine this kind of lackadaisical oversight playing out in a different industry. What would happen to an elementary school teacher arrested for DUI, or a college professor accused of sexually harassing students? Can you imagine a scenario where they would retain a paycheck?
Furthermore, if we’re to take PhRMA at its word and buy into the idea that paying physicians is so critical to patient care and medication education, why are pharmaceutical manufacturers hiring such shockingly unqualified candidates to represent those interests, and then leaving it up to them to self-report misconduct?
We already know that allowing pharma to pay physicians becomes problematic rather quickly when speaking engagements transform into lavish dinners and trips, with little attention devoted to education. Undoubtedly this topic will come up again. Another study/expert/investigation will question the link between seemingly insignificant pharmaceutical payments and physician prescribing practices and the industry will predictably resort to its well-worn excuse.
Given the mounting evidence to the contrary, that line of reasoning will get a little bit harder to swallow each time.