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Between 1997 and 2005, drug companies paid more than 5500 doctors, nurses, and other healthcare workers in the US state of Minnesota at least $57m (£30m; €43m) and another $40m to clinics, research centres, and other organisations, says an investigative report in the New York Times newspaper.
More than 20% of the state's licensed physicians received a median payment of $1000, and more than 100 received more than $100000 (www.nytimes.com/2007/03/21/us/21drug.html).
Doctors receive money typically in return for delivering lectures about drugs to other doctors, says the report. Some of the doctors receiving the most money sit on committees that prepare guidelines instructing doctors nationwide about when to use medicines.
But in dozens of interviews, most doctors said that such payments had no effect on their care of patients. Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said interactions between drug companies and doctors were beneficial. Patients were well served when technically trained pharmaceutical research company representatives worked with health professionals to make sure medications were used properly, he said.
However, the journalists Gardiner Harris and Janet Roberts, authors of the New York Times article, said, “Research shows that doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs.”
The authors admit that there is nothing illegal about doctors accepting money for giving marketing talks, but quote Professor Max H Bazerman of Harvard Business School, who said, “When honest human beings have a vested stake in seeing the world in a particular way, they're incapable of objectivity and independence. A doctor who represents a pharmaceutical company will tend to see the data in a slightly more positive light and as a result will overprescribe that company's drugs.”
Commenting on the New York Times report, a spokesman for Public Citizen, a public interest watchdog organisation, said, “In contrast to other professions such as education and law, the health care profession allows payments from the drug industry that involve cash, cash-value payments, or in-kind payments, such as meals or conference fees.
“To avoid conflict of interest, the American Medical Association recommends that gifts should be of educational value and not exceed $100. The pharmaceutical industry has similar guidelines . . . Five states and the District of Columbia require these payments to be reported. Of these, only two states—Vermont and Minnesota—currently make the data publicly available” (www.citizen.org/pressroom/print_release.cfm?ID=2399).
The New York Times study claimed that 10 doctors and one dentist in Minnesota received more than $500000, and because records are incomplete, the sums are underestimated. More than 250 Minnesota psychiatrists together earned $6.7m in drug company money—more than any other specialty. After psychiatrists, internists received the most money, followed by cardiologists, endocrinologists, and neurologists.
The newspaper claimed that in 2004, the year he was chosen as president elect of the National Kidney Foundation, Allan Collins received at least $25800, mostly in consulting and speaking fees, from Amgen, manufacturer of two expensive kidney treatment drugs (erythropoiesis stimulating agents Epogen and Aranesp), and that Amgen underwrote more than $1.9m worth of research and education programmes that Dr Collins led.
In an email to the newspaper, Dr Collins said that in 2004 he personally received less than $10000 from Amgen for educational presentations, while the $1.9m was paid to Minneapolis Medical Research Foundation, for which he is the senior researcher. Dr Collins wrote that he did not work for, or serve, the foundation's board of directors.
Daniel Coyne, a kidney specialist at Washington University, told the newspaper that the payments troubled him: “Amgen's funding for Dr Collins's MMRF is another huge financial connection to individuals at the National Kidney Foundation. The foundation's recent pro-industry anemia guidelines—and the revisions due next month—have to be viewed with great skepticism.”
Dr Coyne recently criticised guidelines written last year by the kidney foundation that encouraged doctors to use more of Amgen's drugs to treat anemia in kidney patients (Influence of industry on renal guideline development, Clin J Am Soc Nephrol 2007;2:3-7 doi: 10.2215/CJN.02170606; Practice recommendations based on low, very low, and missing evidence, Clin J Am Soc Nephrol 2007;2:11-12 doi: 10.2215/CJN.02980906). The Food and Drug Administration also recently issued an alert about the use of erythropoietin (BMJ 2007;334:495, 10 Mar, doi: 10.1136/bmj.39146.387789.DB).
The New York Times article included comments from a number of drug sales personnel who later left the industry, detailing effects on doctors of promotional activities. One of these was Kathleen Slattery-Moschkau, former sales representative for Bristol-Myers Squibb and Johnson & Johnson, who left the industry in 2002.
“The vast majority of the time that we did any sort of paid relationship with a physician, they increased the use of our drug,” she said. “I hate to say it out loud, but it all comes down to ways to manipulate the doctors.”