Drugmakers Pay Millions to Idaho Physicians
From Idaho Statesman (Boise) (September 15, 2011)
Sept. 15--They dine out courtesy of drug companies. A Boise psychiatrist ate $607 worth of meals paid for by Pfizer last year.
They speak and get paid by drug companies, too. A Sun Valley psychiatrist earned $102,900 in the first half of 2011 to talk about Cephalon drugs.
Idaho medical providers have received $2.56 million from the companies in the past three years for speaking, eating during presentations, conducting research, travel and consulting, according to investigative news outlet ProPublica, which has gathered and catalogued the payments in a database.
The database at ProPublica.org lists drug companies' payments to more than 1,000 Idaho doctors from 12 companies. Most occurred in 2010 and the first half of this year. Idaho accounts for about 0.3 percent of the national three-year total, $761.3 million.
In April, the Statesman's weekly Business Insider magazine drew upon earlier information in the database to report that drug companies had paid Idaho doctors about $1.3 million in 2009 and 2010 to talk about their drugs. Disclosures since then show what has happened in 2011, and they detail payments the drug companies made for meals for doctors and drug research -- expenses not included in the previous report.
DISCLOSURES TO BE REQUIRED
All drug companies must disclose their payments publicly starting in 2013 under the federal health reform law passed last year. Some are getting a head start because of pressure or lawsuits.
Most of the Idaho doctors who show up in the records got free meals. Typically, they listen as fellow physicians paid by the drug companies discuss how the medication works, what its merits and downsides are, and what its effects are.
But a large chunk of the money went to medical research that doctors say benefits patients.
One question is whether the money influences doctors' prescription choices. ProPublica dug through lawsuits last year and found that multiple drug companies had been accused by whistleblowers and federal lawyers of using speaker fees to reward those who prescribe the companies' drugs and to pay speakers accused of misconduct.
But the Idaho Board of Medicine says it knows of no reports of problems in Idaho. And Idaho doctors say the money doesn't influence which drugs they prescribe.
GETTING PAID TO TALK
William Patrick Knibbe, a rheumatologist in Boise, is one of the speakers that drug companies paid. Knibbe told the Statesman that he has given presentations for "nearly every company that has released a drug for rheumatoid arthritis."
But he's been a doctor for 30 years, knows the pros and cons of various drugs, and has a reputation of objectivity to uphold, he said. The drug companies may "try to exert some influence, but ... I don't believe it has any influence at all on my prescribing habits."
Pfizer and Eli Lilly reported $37,810 in payments to Knibbe in the past three years, mostly for speaking engagements. The payments are reimbursements for time away from the clinic, he said.
"It's admittedly a fine line to walk," he said. "I wouldn't be able to meet the physicians in the region and be able to promote good practices for rheumatology regionwide without the support of the drug companies. I can't do that on my own."
GETTING PAID FOR RESEARCH
Knibbe and other physicians said the research money from drug companies helps their patients.
Drugmakers are in the business of creating new pills and potions. But before they hit the shelves, somebody has to make sure they work. Drug companies have paid hundreds of thousands for Idaho doctors and their business affiliates to run those tests in the past few years. Idaho accounted for at least $681,960 of pharmaceutical research spending in 2010 and the first half of 2011.
Doctors don't necessarily receive the research dollars; they're often funneled right into the drug trials.
Child and adolescent psychiatrist Alan Unis of Coeur d'Alene said he frequently does drug research.
"The degree of assessment that those kids undergo (as test subjects) is more than is typically offered," and the drugs are paid for by the company, he said.
Unis said he doesn't think about drug company payments when he's treating his patients, who are children and teens with serious psychiatric illnesses such as schizophrenia and bipolar disorder.
"I'll use any tool I can get my hands on that is going to help a kid recover," he said.
Unis hasn't done a speaking gig for a year and a half. Not because he's worried about criticism -- he said he's for transparency in the industry -- but because there aren't enough new drugs for him to talk about.
Knibbe is on the speaker list for a couple of drug companies now. He's been pulling out of the speaking circuit, though, he said, to devote more time to his specialty, juvenile arthritis.
Knibbe said drug companies are also providing grants for medical education.
"We write (proposals) all year long to the pharmaceutical companies for independent medical education grants, so we can put on an annual course," he said.
One of the drug-trial participants was Sonora Clinical Research in Boise. Emergency and pediatric doctor William Jonakin was the lead on $71,235 of research for Pfizer last year.
Selma Luedtke, a co-owner of Sonora, declined to say what kind of research was done and how the payment was divvied up between Sonora and Jonakin, citing confidentiality.
The Food and Drug Administration has a set of rules meant to protect against bias in drug trials based on financial interest. Luedtke said regulations on the trials are "very strict."
The American Medical Association has a set of ethical guidelines for doctors taking gifts. The FDA sets rules for drug trials. And the Idaho Board of Medicine can take away licenses if a doctor violates those rules.
Idaho law is largely silent on the drug company payment issue. The law says doctors can't take kickbacks.
"We can enforce the law, but ethics are a little more gray," said Mary Leonard, associate director of the Idaho Board of Medicine.
The board looks to the American Medical Association for ethical questions, Leonard said.
The AMA says doctors should not put their own financial interests ahead of their patients' welfare.
Audrey Dutton: 377-6448
(c)2011 The Idaho Statesman (Boise, Idaho)
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Posted: September 2011