There have long been concerns about the influence on doctors who receive payments from the pharma companies whose meds they prescribe, something doctors hotly deny. But it is not just doctors who are the beneficiaries of the billions of dollars spent each year by drugmakers. It is also the medical associations that create the guidelines that can influence which kinds of drugs are in favor at any given time.
An investigation into these financial ties by the Milwaukee Journal Sentinel and MedPage Today uses as an example the new-gen anticoagulants that have replaced warfarin as the standard of care, even though they came on the market with no antidote for the bleeding risks that they carry. New guidelines favoring their use have been issued by a number of organizations. Using federal Open Payments data, the news groups found that the companies that make the drug often contribute handsomely to the groups whose endorsements would be important, $40 million in three years.
Organizations in the U.S. and Europe that issued new guidelines received millions of dollars from companies like Pfizer ($PFE) and Bristol-Myers Squibb ($BMY), marketers of Eliquis; Boehringer Ingelheim, which sells Pradaxa; and Bayer and Johnson & Johnson ($JNJ), which co-market Xarelto. In one case, the guidelines redefined who should receive the anticoagulants to prevent stroke and heart attack, a move that instantly grew the potential pool to 4.7 million from 3.7 million Americans.
They found, for example, that The American Heart Association, which last year approved new guidelines for treating atrial fibrillation, was the beneficiary of more than $13 million in three years from anticoagulant makers. On top of that, the news groups report that from August 2013 through 2014, 9 members of guideline committees for different groups endorsing the use of the drugs, received a total of $400,000, an average of $44,440 each, for travel, food and other things.
A separate review of the documents by public investigative reporting group Pro Publica found that Pfizer and Bristol-Myers shelled out $8 million in payments to doctors on behalf of Eliquis during the last 5 months of 2013. That was the second-largest amount spent on a single drug, behind Novo Nordisk's ($NVO) diabetes remedy Victoza. Xarelto ranked sixth with $6.93 million, and Pradaxa 13th at $4.43 million.
Of course there are denials from the organizations and doctors alike that such payments convince them to favor or promote drugs they wouldn't have turned to anyway. But opponents of such payments argue that the kind of money being thrown around is certain to have an influence on medical practice that might not always be good for patients.
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| UCLA's Dr. Jerome Hoffman |
"It seems to be a poster child for everything that is wrong with how we create guidelines," Dr. Jerome Hoffman, an emergency medicine physician and emeritus professor of medicine at the University of California, Los Angeles, told the Journal. Hoffman writes about conflicts of interest in treatment guidelines.
Others would argue that the so-called Sunshine Act data, which was posted publicly last year, allows patients and others to see who gets payments and how much and so they can evaluate for themselves if they believe it has influenced doctors to push one med over another. Of course, that is a daunting task for anyone, given that it includes $3.5 billion in payments to 546,000 doctors and 1,360 research institutions over a 5-month period.
Critics also point out that the database also does not list payments to newer categories of healthcare professionals who are playing a growing role in the system, like nurse practitioners and physician assistants. According to IMS Health study, the two groups wrote 15% of all scripts nationwide during the first 5 months of the same year. Dr. Walid Gellad, co-director of the University of Pittsburgh's Center for Pharmaceutical Policy and Prescribing, told NPR: "If the purpose of the act is to shine a light on the relationship between industry and the healthcare sector, then you've left out an important component of that sector."
- read the Journal Sentinel/MedPage Today report