Drug money

A dozen UC Davis Medical Center doctors and many more in the greater Sacramento area received some $1.1 million from pharmaceutical companies in 2009 and the first half of 2010. Physicians and employers say the relationship is a necessity to marry scientific expertise to corporate innovation. But watchdogs, and even the federal government, are taking a close look at the uncertain relationship between medicine and business.

And by 2013, drug makers will be required to publicly disclose all payments to doctors. In the meantime, watchdog journalism group ProPublica created a national database of payments from seven drug companies to doctors between 2009 and 2010.

In Sacramento, 65 doctors received a form of payment for travel, heading forums, consulting and speaking. Many doctors received fees from multiple companies, and the amounts paid, by such companies as Eli Lilly and Company, Pfizer and GlaxoSmithKline, ranged from $100 to $78,000.

In Sacramento, the top five payees were Dr. Thomas Aoki ($168,250), Dr. Janak Mehtani, ($132,566), Dr. Michael Wise, ($83,990), Dr. Samuel Louie ($75,073) and Dr. Chinh Le ($62,303).

UC Davis Medical Center spokeswoman Carole Gan says the relationships “match expertise with the pharmaceutical and medical-device industries” and that regulations should not “squelch that process.”

And while many agree that doctors provide an important advisory role, critics say the close ties between the medical industry and physicians is a conflict of interest.

Chris Manz, chairman of the PharmFree campaign at the American Medical Student Association, said any relationship at odds with a doctor’s chief responsibility to improve a patient’s health is a problem. For instance, a patient may be encouraged to take a brand-name medication rather than an equally effective but cheaper generic.

Allan Coukell, a pharmacist and director of for Pew Prescription Project, added that gifts from medical companies—a tradition of freebies that includes pens, pill samples and even personalized stethoscopes—are also frowned upon.

At the UC Davis Medical Center, some of the more lucrative contracts on the Pro Publica database are for speaking. The amounts vary from $250 to $20,000—but one doctor received separate payments of $78,000 and $76,000 for talks.

“I get nothing personally from it, and all the money goes to the research [institute]—I try to keep it going every which way I can,” UC Davis’ Dr. Aoki said. “The talks are often the first way for physicians to learn about new research, and though the company provides [guidelines], all of the material has been peer-reviewed in medical journals.”

The UC Davis Medical Center is considered a model of ethical policies and transparency. In fact, as a response to an early effort by AMSA to create conflict-of-interest guidelines, the UC Davis developed its own policies in 2006. Since, the center served as a model for other UCs and, in AMSA’s latest conflict-of-interest score card, UC Davis received the highest grade, an A—although the school allows industry sales representatives on campus (some schools do not).

“We want to have clear oversight, and our doctors are required to fill out annual disclosure forms,” Gan said.

Even so, Manz urged particular caution when it comes to overseeing doctor-industry relationships. “There is an inherent conflict between a company’s financial incentive and the objective of education talks, which is to improve quality of care,” Manz told SN&R. In fact, he added, Harvard University has just banned its faculty from taking part in speaking bureaus.

So where does this leave the consumer or patient?

Pew’s Coukell advises individuals to stay informed. “Try to have a conversation with your physician and understand where the information is coming from,” he said. “Those that get paid by a company can become a part of the marketing for that company.”

Manz, a Duke University medical student, advised that physicians avoid relationships, including the acceptance of gifts and free meals, that “conflict with their primary obligation to provide the best care.”