PhRMA to Dollars for Docs: What’s Cash Got to Do With It?

Sep 15th, 2011 | By

The irrepressible ProPublica has been at it again, cross-checking, compiling and organizing the flow of cash from drug companies to doctors. Among the 12 drug companies which have revealed data (most of whom have been forced to do in the context of legal settlements) we are now up to $760 million in payments from 2009 to the first part of 2011.

But PhRMA’s pushing back, saying, essentially, “What’s cash got to do with it?” Kate Connors, a media liaison for PhRMA, argues in the blog that the public is not getting the full picture:

“Over the coming days and even weeks, there will be attention in the press to a database and series of articles called “Dollars for Docs,” which claims to promote transparency by compiling already-public information about company payments to physicians. Unfortunately, it does so without any context, clearly to raise questions about the propriety of these interactions.”

Connors links to another article that provides the context she believes is missing:

“Why do biopharmaceutical companies engage with healthcare professionals? Biopharmaceutical research companies are deeply committed to the discovery and development of innovative new medicines. However, it is also important that those medicines, once approved by the FDA, reach the patients who need them.

Companies work with physicians and other providers in a variety of ways, including consulting and research, programs in which physicians provide information to their colleagues through peer speaker programs, and meetings in which company representatives distribute FDA-approved information and clinical data.”

In other words, there’s nothing nefarious about the $760 million. It’s all about developing new medicines and disseminating this crucial information to doctors and the public.

If this is were actually true, I would have no problem with it. If I were a diabetic, for example, I would want companies to hire the smartest doctors and researchers to provide advice on how to create better diabetes drugs. And I would want these same experts to go to my primary care doctor’s office to discuss the data showing that the newly developed drugs are better than the old ones. These are the noble activities that PhRMA is claiming the $760 million buys.

The problem is that drug companies have resisted revealing any evidence that advisory boards and speakers bureaus actually work this way. If they really wanted to gain the public’s trust, they would provide evidence with the same level of specificity as ProPublica’s financial disclosures. For example, if advisory boards are such wonderful boons to medical science, they could post the agendas and minutes of these meetings—with proprietary information redacted.

But, to my knowledge, they have never done it. The closest I’ve found to such an agenda is this proposal for a 1993 Paxil Advisory Meeting that was supposed to have featured Dr. Charles Nemeroff. (Nobody seems to know if this meeting ever happened—another perplexing lack of transparency from PhRMA).

If you read the detailed agenda, it doesn’t look remotely like a scientific meeting to develop better treatments—it simply looks like a marketing summit.

For example, here’s the first part of the agenda:

This was not about teaching doctors about how to use best treatments for patients. It was about developing advertisement copy to convince doctors to prescribe more Paxil, when other equivalent medications (at that time, Prozac and Zoloft) already existed.

Granted, this was in 1993, and the tenor of such meetings may have changed since then—but maybe they haven’t. Unfortunately, PhRMA and their member companies have not seen fit to follow through with the “context transparency” that they are demanding of ProPublica.

Until they do, their defense of their $760 million in payments to doctors rings hollow.

So I’ll lay down the gauntlet for PhRMA. If you want to regain the goodwill of doctors and patients, post the following—I’m happy to put it on my website if it speeds things up for you.

For each pharma-funded advisory meeting or speaking engagement, post the following (with appropriate redactions as needed to hide trade secrets):

• The location of the meeting
• Meeting costs, including payments to key opinion leaders for travel, room, meals, and consulting or speaking services
• Meeting agendas
• Meeting minutes
• For “educational talks” to other health care providers, transcripts of the talks as well as the slides and handouts

PhRMA: It’s time for you to show us the money…behind the money.

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