It happens countless times a week in Oklahoma: a patient visits the doctor's office and leaves with a prescription.
But if the patient knew the doctor had received money from the pharmaceutical company for giving promotional talks about that drug or for researching the drug, would it make a difference?
Drug companies have handed out about $6.3 million to doctors across the state, according to The Oklahoman's analysis of information from national data compiled by the nonprofit investigative journalism group ProPublica.
Oklahoma City doctors make up the majority of those receiving money, with drug companies paying them about $4.8 million in the past three years. These include more than $10,000 for a series of speeches given by a doctor specializing in pain medicine and psychiatry, more than $225,000 to a sleep specialist and more than $740,000 to a research institute. Other payments were as little as $1.
Some drug companies recently began disclosing payments to doctors, for speeches, research, travel, meals and consulting. In order to address conflicts of interest created by drug marketing, all pharmaceutical companies will be required to disclose payments to doctors in 2013 so patients can look it up on government websites.
This comes against the backdrop of physicians both overprescribing drugs and finessing, if not actually concealing, negative research data to make a drug sound better than it really is, said medical ethicist Howard Brody.
He said the poster child in that category would be Vioxx, an arthritis and painkilling drug that became the industry's biggest drug recall in 2004. Researchers concluded it was responsible for up to 140,000 cases of heart disease and as many as 56,000 deaths during five years of aggressive marketing.
Merck & Co. recently agreed to pay $950 million and plead guilty to a criminal misdemeanor charge to settle allegations that it deceived the government about the drug's safety and illegally promoted the drug.
Conflict of interest concerns also result from drug companies paying doctors, said Brody, a medical doctor, author and director of the Institute for the Medical Humanities, University of Texas Medical Branch in Galveston.
“If the physician is going to be a true professional and not a hired gun, that physician is going to have to be independent. One has to prioritize what is good for the patient above ‘Will I, the doctor, make more money or will the drug company I work for make more money?' ” Brody said.
But Oklahoma City psychiatrist and pain specialist Dr. Siavash Nael, who received about $10,000 in drug company money for 10 speeches and about $13,000 to cover research project costs in 2010 and 2011, said the FDA restrictions are so strict that anonymous physicians are planted in the room to ensure lecturing doctors don't push a specific drug to other physicians in attendance.
“I'm not doing anything illegal or unethical,” Nael said. “I'm doing it for my own curiosity. I'm a teacher. I teach physicians, my colleagues, patients. If they put the information on a government website I don't worry about that. I think that's a very good idea.”
Brody said it is legitimate for a drug company to pay a doctor to conduct research as long as the payment covers precisely the costs of actually doing the research project.
But when physicians take money to do promotional talks, he said they become part of the company sales force and lose any status as independent scientists. When other doctors attending a speech ask about serious side effects, he suggested the paid doctor's answer may be biased.
“If they really want to keep getting that nice paycheck from the drug company ... better to soft pedal and say, ‘Oh the side effects aren't that bad,'” Brody said.
Nael said while that was true 10 years ago, the FDA has clamped down and will sanction both doctors and drug companies.
“We cannot be biased. We cannot soft pedal. We have to tell what is in the side effect profile,” he said.
A recent Consumer Reports survey found 72 percent of consumers polled indicated they think drug companies have too much influence on the drugs prescribed by doctors. Eighty-one percent said they are concerned about rewards drugmakers give doctors who write a lot of prescriptions for a company's drugs.
Jonathan Schwartz, a sleep and lung specialist who is also medical director of Integris' sleep disorders center, has received about $225,000 from Cephalon and Astra Zeneca from 2009 to 2011. But the money was donated directly to charity at his insistence.
“There are a lot of very good physicians who give talks for companies and they're not bad people because they get paid. You'd rather have qualified doctors with both research and clinical experience giving these talks,” said Schwartz.
ProPublica: Payments to Oklahoma Health Care Practitioners