Pharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released Tuesday. Other doctors made millions of dollars in royalties from products they helped develop.
The data sheds new light on the often murky financial ties between physicians and the health care industry. From August to December 2013, drug and device companies made 4.4 million payments to more than half a million health care professionals and teaching hospitals — adding up to about $3.5 billion.
The lucrative arrangements are just some of the findings of the online database, which provides one of the most detailed looks at the payments health care professionals receive from drug and medical device companies. The website also allows consumers to find information about their own doctors to determine whether they might have conflicts of interest.
The site, required by the recent health care law, is part of a broader push for transparency. Proponents say such disclosures are an important tool to help limit drug and device makers’ influence on doctors.
But the website is being questioned by the industry, which says that technical problems and data inaccuracies limit its value. For example, about 40 percent of the records do not tie back to a specific professional or teaching hospital, accounting for 64 percent of the overall payments.
Under the new requirements, all manufacturers of drugs, medical devices and medical supplies that have at least one product covered by Medicare or Medicaid must report payments or gifts they make to doctors and teaching hospitals. This can be as seemingly trivial as a bag of bagels — all payments above $10 are included — or as lofty as a research grant. It also includes meals, travel expenses and speakers’ fees. Group-purchasing organizations, which serve as middlemen between health care providers and manufacturers, also must disclose doctors’ ownership and investment interests in their companies.
The data is likely to raise questions about doctors’ financial interests. Several studies and reports, including one by The New York Times, have shown that doctors with relationships to industry are more likely to prescribe expensive and potentially inappropriate drugs.
“When you look at why do drug companies and device companies make gifts and offer consulting payments and honoraria to physicians, the main goal is to influence prescribing practices,” said Dr. Michael Carome, the director of Public Citizen’s Health Research Group. “The interest of those companies is to improve their financial bottom line, and not necessarily represent the best interest of patients.”
While some relationships may leave doctors open to scrutiny, other ties are important for innovation. Drug and device makers say they regularly consult with doctors to help them decide where the need is the greatest, and doctors conduct clinical trials that help get products approved.
Research, for example, accounted for nearly $1.5 billion of payments during the reporting period. Companies spent an additional $302 million on royalties and licenses, money that is paid to doctors and teaching hospitals for their role in developing companies’ products.
Royalties created lucrative relationships for doctors, particularly in fields that are highly dependent on medical devices. Dr. Steven S. Burkhart, a San Antonio orthopedic surgeon who has written a textbook for surgeons called “A Cowboy’s Companion,” received more than $7 million in royalties, travel expenses and speaking engagements, mostly from Arthrex, which makes supplies for orthopedic surgeries, during the reporting period. He did not return a call for comment.
Other orthopedic surgeons were also among the highest-paid doctors. Dr. Chitranja Ranawat, a Manhattan orthopedic surgeon, received nearly $4 million in payments from DePuy Synthes, the orthopedic unit of Johnson & Johnson.
Sometimes a large royalty payment contributed to the bulk of a company’s reported spending. Genentech, the United States division of the Swiss pharmaceutical company Roche, reported $210.2 million in payments during the last five months of 2013, according to a company spokeswoman. Company officials said a large chunk of that total — $122.5 million — were royalty payments that went to the City of Hope, a California cancer hospital, for sales of several products, including the drugs Herceptin, Rituxan and Avastin.
“We have very close relationships with physicians who use our devices in the field, and those physicians bring back valuable ideas and help us develop new improvements,” said Christopher L. White, general counsel of AdvaMed, an industry trade group for device makers.
The website comes with significant caveats, in part because it is rather clunky. To look up an individual doctor, visitors to the home page had to click to another page, open a database and then scroll through an unwieldy series of data fields to view basic payment information.
The data is also incomplete. Besides the unidentified payments, companies were permitted to delay the release of information about research payments for products that haven’t been approved, or for new uses of existing products. The Centers for Medicare and Medicaid Services, which is overseeing the release, said about 190,000 research payments during the August-to-December 2013 period were not made public for this reason.
When the website went live, one large payment to a doctor, a Boston neurologist, turned out to be an error. The data showed that Dr. Reisa Sperling, an Alzheimer’s researcher at Harvard Medical School, received a payment from the drug company Boehringer Ingelheim totaling more than $155,000 for travel expenses in September of 2013. But Dr. Sperling said she only did a one-day consulting assignment for the company in Boston and was paid no more than $5,000.
A spokeswoman for Boehringer Ingelheim confirmed that the amount was incorrect.
Only about 26,000 health care professionals registered to check their information beforehand, out of about 546,000 in the database, officials said. The disclosure rules apply not just to medical doctors but also to dentists, chiropractors, podiatrists and optometrists who are legally authorized to practice.
Dr. Raed Dweik, a Cleveland Clinic lung specialist, said he was surprised to see that the drug maker Boehringer Ingelheim had reported that he had received a lunch worth about $50 during a presentation at the clinic. Dr. Dweik, who is chairman of the clinic’s conflict of interest committee, said he had spoken at the event but deliberately skipped the lunch. He said he believed the company simply divided the number of event participants by the cost of the meal and did not check who had attended the lunch. “I’m very sensitive about this,” Dr. Dweik said, adding that other drug companies had also previously marked him down for lunches he did not eat. “I make it clear ahead of time that I’m not doing it.”
Dr. Dweik said he disputed the payment with the federal government, and it does not appear in the database. His personal experience, he said, led him to warn other physicians at the Cleveland Clinic to scrutinize their records.
“I think the concept itself is really good,” he said.
However, “the problem with this website is one has no context,” he added. “You don’t know if this relationship is legitimate or not, and the bigger problem is the inaccuracies.”