Pharmaceutical company paid a dozen doctors with known disciplinary problems to promote its drug

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Researchers and experts in pharmaceutical industry ethics expressed concern that physicians who take money from drug companies don’t have patient care top of mind.

Twelve of the 500 doctors paid by a pharmaceutical company to promote its drug were disciplined by state medical boards, according to a CNN investigation.

The newspaper said that in many cases the physicians paid by Avanir Pharmaceuticals to speak or consult on the drug Nuedexta were previously suspended, fined, had their licenses revoked or were placed on probation for a range of offenses, including illegal prescribing practices or insurance fraud.

Nuedexta is used to treat a rare condition marked by sudden fits of laughing or crying. But sales of the drug jumped 400% in four years to reach $300 million in 2016. A CNN investigation earlier this year revealed that some of the sales increases were directly related to doctors who took payments from Avanir and prescribed Nuedexta to nursing home residents. The latest newspaper report finds that the company has paid doctors nearly $14 million to promote or consult on the drug.

But Avanir, a unit of Japan’s Otsuka Holdings, told CNN that the arrangements are ethical and it screens the physicians it works with and complies with all legal requirements to contract with doctors who can advance treatment options for people who suffer from central nervous system disorders. Still researchers and experts in pharmaceutical industry ethics expressed concern that physicians who take money from drug companies don’t have patient care at top of mind.

RELATED: 65% of patients see doctors who get paid by drug companies

A recent study found that 65% of patients in the United States have visited a doctor in the past year who received payments or gifts from pharmaceutical or medical device companies, but most have no idea about it. Genevieve Pham-Kanter, an assistant professor in Drexel University's Dornsife School of Public Health, who was the lead author of that study, said at the time that "patients should be aware of the incentives that their physicians face that may lead them to not always act in their patients' best interest. And the more informed patients are about their providers and options for care, the better decisions they can make."

Other research though shows many oncologists who take payments from drug companies never disclose their conflicts of interest when they mention the medicine on Twitter.

The CNN investigation is just the latest trouble for the pharmaceutical manufacturer. Late last month it told the Orange County Business Journal that it will lay off 73 employees (11% of its workforce in the U.S.) as part of a restructuring plan “to streamline our current approach to sales and better position Avanir to pursue its long-term mission.”