March 24, 2013

Drugmakers cut marketing payments to Maine doctors

Pharmaceutical firms reduce fees to physicians for speaking engagements amid wider disclosure, but increase money paid for research.

By Eric Russell
Staff Writer

Drug companies have long enlisted doctors to serve as de facto spokespeople for specific products, and have paid them handsomely to do so.

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In 2009 and 2010, drugmakers paid Dr. Jeffrey Barkin, above, $114,225 for speaking engagements. He says he didn’t write more prescriptions for drugs made by the firms that paid him.

Gordon Chibroski/Staff Photographer

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Here's a look at some of the most commonly known drugs associated with leading pharmaceutical companies:

Eli Lilly -- Prozac (depression), Cialis (erectile dysfunction), Cymbalta (anxiety).

Pfizer -- Celebrex (pain, inflammation), Lipitor (cholesterol), Viagra (erectile dysfunction).

Merck -- Claritin (allergies), Levitra (erectile dysfunction), Singulair (allergies).

GlaxoSmithKline -- Avandia (diabetes), Paxil (depression), Advair (asthma).


However, an increase in disclosures by some drug companies in recent years of the amount they pay doctors – disclosures that will be mandatory by next year – appears to be reducing the amount of money those companies are giving doctors in Maine.

From 2010 to 2012, the amount of money paid by drug companies to Maine doctors for speaking engagements dropped by 60 percent, according to data compiled by ProPublica, an investigative journalism website. Money paid to doctors in Maine for research, usually clinical drug trials, increased by 40 percent from 2011 to 2012.

ProPublica launched its Dollars for Docs initiative in 2010 to track the money drug companies spent to test and market their products. The database was recently updated to include disclosures for 2012, including hundreds from Maine.

The list is not comprehensive because not all drug companies are required to disclose the information yet, but it does offer a glimpse into the financial relationships and incentives between pharmaceutical companies and doctors.

Supporters say those relationships are critical for drug companies, to help them generate industry support for new products, but critics say doctors who take that money run the risk of becoming salespeople for those companies, not educators. Although speaking engagements are legal, they also raise ethical questions about whether physicians who take payments to speak about those products are more likely to prescribe them.

Sharon Treat, a Democratic state representative from Hallowell and executive director of the National Legislative Association on Prescription Drug Prices, said she thinks more disclosure about the financial relationship between drug companies and doctors has changed the way doctors behave.

"Some of these relationships certainly look questionable, but disclosing the information lets the public decide," she said. "Patients should be able to ask their provider whether they are being paid a fair amount of money to talk about benefits of a drug and then write prescriptions for that drug."

The health care professionals interviewed for this story did not say what drugs they spoke about or put through clinical trials.

Dr. Jeffrey Barkin, a Portland psychiatrist and president of the Maine Association of Psychiatric Physicians, received the second highest total amount of money for speaking engagements: $63,375 from drugmaker Eli Lilly in 2009; another $31,950 from the same company in 2010; and $18,900 from drugmaker AstraZeneca in 2010.

In an interview with the Press Herald, Barkin said his speaking engagements were never specifically tied to certain drugs. Rather, his talks were about educating other physicians on appropriate diagnoses for psychiatric disorders and about the overlap of physical disease with psychiatric disease and how that can sometimes lead to fragmented care.

Barkin said he has not received any payments from drug companies since 2010, prior to his current employment, and said his feelings about the relationship between doctors and drug companies have evolved.

He said while there are benefits to having doctors, particularly specialists, speaking to other doctors about a particular drug or disease, especially in rural areas, he believes that the cozy relationships often drive up the cost of medications.

Still, even while he was being paid by drug companies to speak, he said he never felt his speaking engagements were a quid pro quo arrangement. "I wasn't writing more prescriptions for those drugs," he said.

Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said in an email response that a number of factors have affected drug companies' interactions with physicians over the past years, but she did not elaborate on whether there has been an appreciable decrease in the number of paid speaking engagements.

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