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

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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).


Scott MacGregor, communications director for Lilly USA, the domestic arm of Eli Lilly, said that employing experts to lead educational forums is a critical part of drug development. He said payments are largely market-driven, depending on the development stage of a particular drug.

The database includes 927 total disclosures in Maine from 2009 to 2012. In some cases, the disclosures were payments made by drug companies to medical practices. In others, the payments were made directly to physicians.

The payments are split into several categories. The most common payment, for travel and meals, represents about 60 percent of disclosures, and it is given when a drug company pays physicians to listen to a presentation about a product. Sometimes, physicians will travel for the presentation; other times, drug company representatives will visit a doctor's office or practice and buy lunch or dinner. Those disclosures are typically smaller amounts, in the $500 to $1,000 range.

Gordon Smith, executive director of the Maine Medical Association, said companies used to reward doctors with perks, such as all-expense paid golf trips as a sort of quid pro quo. Those days are gone, he said, largely because the American Medical Association updated its code of ethics and because of the increasing number of disclosures by the companies.

Among the findings in the database:

In 2012, 10 drug companies paid a total of $181,960 to 26 Maine doctors for 44 speaking engagements. The average payout was $4,135, but the range of payments varied from $19,500 down to $291. In 2011, the number of speaking engagements was nearly the same, but the total payout was twice as much, $362,174. In 2010, companies spent $472,110 on 62 speaking engagements.

Eli Lilly has spent the most money in Maine by far on speaking engagements between 2009 and 2012, paying $571,572 for 37 appearances. GlaxoSmithKline paid for 50 speaking engagements in Maine during that time and spent $256,262.

Companies spent $788,755 on clinical research in Maine in 2012, an increase from $450,390 in 2011. Merck spent the most, followed closely by Pfizer.

One doctor, Dr. Stephan Babirak, a Scarborough endocrinologist, received $184,669, the highest total amount paid to a single doctor, for nine speaking engagements between 2009 and 2012. Babirak did not return several calls for comment left over several days.

Dr. Robert Weiss, an Auburn cardiologist, received $407,498, the highest total amount for research funds between 2009 and 2012.

Weiss, a nationally respected cardiologist, said he was often asked by drug companies to speak about a specific drug or course of treatment. In most cases, he said, he agreed to the request because he had free rein to talk about both the benefits and drawbacks of the drugs.

But now, he said, drug companies have changed those procedures so that before doctors can talk to their peers about a specific drug, they must first review slides provided by the company and talk to the company's medical officers. Weiss said his recent experiences have been even worse than that, with drug companies' marketing departments presenting speakers with a script that they are not allowed to deviate from.

"That doesn't seem respectable," he said.

Weiss said there will always be doctors willing to speak for a paycheck, even if it means their name shows up in a database tracking doctors who receive drug company payments.

On the research side, Maine doctors received significantly more money from drug companies in 2012 than they did in 2011, although some of that is dependent on the production of new drugs.

Weiss said some of his colleagues have stopped taking clinical research funds because of the increased scrutiny brought on by disclosure, but said he's proud of his research.

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