Top-prescribing docs collect cash from drugmakers

Doctors who prescribe certain brands the most also have financial ties to the companies that make them, a ProPublica investigation found. Coincidence? Experts think not.

Using Medicare payment data, ProPublica and NPR looked at physicians who prescribed the most heavily promoted drugs of 2010 and 2011. Then they checked to see whether those doctors had financial relationships with the companies promoting those drugs. Many of them did.

In fact, for some heavily promoted brands, most of the top prescribers did. At least 17 of the 20 doctors who prescribed the blood pressure drug Bystolic the most often collected fees and meals from Forest Laboratories ($FRX), ProPublica found--a total of more than $300,000. Nine of the top 10 prescribers of the Alzheimer's drug Exelon collected from Novartis ($NVS). Eight of the top 10 Nucynta prescribers were paid by the painkiller's maker, Johnson & Johnson ($JNJ). And so on.

ProPublica can compile these numbers because of fears that pharma payments sway doctors to prescribe expensive brands over cheaper generics that are just as effective. After a series of scandals linking pharma-paid physicians with unethical behavior, lawmakers pushed for disclosure of those payments. Meanwhile, some drugmakers started posting the payments online. Some were forced to by Justice Department marketing settlements; others volunteered. Disclosure is now mandated by sunshine provisions in the Affordable Care Act. And now, we know that drugmakers paid doctors more than $1 billion last year--and that's only the 12 leading companies that actually disclose the data right now.

ProPublica's new numbers appear to bear out those fears. In Bystolic's case, Forest paid speaking fees ranging from $1,250 to $85,750 to 17 of the 20 top prescribers. Seven of them also received at least $1,000 worth of meals. The doctors themselves cited a variety of reasons for their frequent use of Bystolic--none of them related to money--but top cardiologists told ProPublica that those reasons are specious. "I don't see any purpose for Bystolic whatsoever," cardiologist and Scripps Health official Eric Topol told ProPublica. "I have no idea how you could come up with a storyline for use of that drug."

In surveys, doctors say they're not influenced by relationships with pharma. Drugmakers also say they don't pick speakers based on their prescribing habits. The companies say they're simply educating doctors--and using physicians to educate other doctors--about new drugs. Forest, for instance, told ProPublica that paid talks and the like "enable healthcare professionals to stay abreast of the latest treatment options."

Meanwhile, a laundry list of drugmakers have paid hundreds of millions--even billions--in fines for marketing their drugs for unapproved uses and using kickbacks, including free trips and rebates, to boost prescribing. And a recent study found that pharma reps often fail to mention a drug's side effects to doctors--even serious side effects.

Recent surveys of patients and patient groups have given the pharma industry low marks, reputation-wise. The industry is too secretive and lacks integrity, the patients said. Headlines about payments persuading doctors to prescribe expensive drugs don't help. So, is it a coincidence that these top prescribers also collected from drugmakers? Let us know what you think.

- read the ProPublica analysis