Physician groups provided mixed reaction to an investigative report from journalism group ProPublica and its media partners indicating that more than 17,000 doctors and other healthcare professionals accepted nearly $258 million from seven major drug companies in 2009 and 2010.
Of those medical professionals compensated for speaking engagements and presentations about drug benefits and applications, 400 raked in more than $100,000 in 2009 and 2010, with two physicians topping $300,000 in payments, ProPublica found. The report notes, however, that "receiving payments isn't necessarily wrong, but it does raise ethical issues."
Leaders from groups such as the American Medical Association (AMA) and American College of Physicians (ACP) acknowledged that while payments do occur--and are completely legal—what is depicted in the report is not an accurate portrayal of how most healthcare professionals, even those that have formal relationships with a pharmaceutical company or other supplier, practice medicine.
While AMA declined to comment on the report specifically, it noted that it has clear ethical guidelines stating that accepting cash from industry—drug, device and equipment companies—is not acceptable, and that any gifts a physician receives should be of minimal value.
In a statement to HealthLeaders from Board Chairman Ardis Hoven, M.D., the AMA emphasized "prescribing practices should be consistent with the latest scientific information and based on the physicians' best medical judgment." The organization supports a registry that discloses financial relationships between physicians and industry.
The AMA does not claim to discourage pharmaceutical-physician relationships, per se, saying that they can have social and educational value, but that any collaboration should be "transparent and in the best interests of patients."
Further investigation by the report's authors revealed that many of physicians, nurses, and pharmacists receiving payments from the pharmaceutical industry had questionable backgrounds, including documented cases of medical and professional misconduct. Studying licensing records in 18 states, the report revealed sanctions against 250 speakers, including some of the highest paid.
ACP acknowledges that conflicts of interest can arise when physicians are compensated for speaking or writing about a specific product. Organization president Fred Ralston, Jr., M.D., FACP, said these relationships have the potential to influence a physician's attitudes and practices.
Specifically addressing formal medical education scenarios, Ralston told HealthLeaders that much of the onus resides on conference organizers to be alert to conflicts of interest and "develop and enforce explicit policies that maintain complete control of program planning, content and delivery."
"Backgrounds have not always been thoroughly vetted and hopefully this information will help those offering educational content develop processes to keep this from happening in the future," he said.
Noted in the study and accompanying article published by ProPublica is that payout findings only covered seven pharmaceutical companies—including giants AstraZeneca, Eli Lilly, Merck and Pfizer—that voluntarily made physician payment information public.
These relationships are expected to come under greater scrutiny as the more than 70 drug companies operating in the United States are forced to release physician payment information by March 2013 in accordance with healthcare reform mandates.