There are lots of reasons why your doctor might switch your prescription to a Lilly drug.
One of them might be found in a new online database that lists how much Eli Lilly & Co. paid physicians for their expertise during the first quarter of 2009.
For the first time, Floridians can see if their doctors juggled patient appointments with speaking gigs for the maker of popular drugs like Cymbalta, Zyprexa and Cialis.
Drug companies spend billions on marketing to doctors because it works: Targeted doctors prescribe more of the company's products.
Lilly was forced to disclose its physician pay data, which it calls a "faculty registry," as part of a $1.4-billion settlement with the federal government earlier this year.
Lilly spread $22-million among 3,400 health care providers nationwide during the first three months of the year.
In the Tampa Bay area alone, the company spent more than $350,000 on about four dozen doctors. And that's just one drugmaker's expenditures. Though others have promised to follow suit and disclose their physician compensation numbers, none have yet done so.
Pay to sway
According to Pharmedout.org, a group that tracks drug industry marketing, pharmaceutical companies will spend as much as $100,000 a year on a physician considered to be particularly influential. Most favored are specialists like psychiatrists, cardiologists and internists, who are apt to prescribe a brand-name drug that the family physician will simply renew, rather than switch to a cheaper generic.
The drugmaker's payoff for each dollar paid to physicians: more than $12 in additional prescription sales, according to Pharm Exec, an industry publication.
Lilly's top earner in the Tampa Bay area was Dr. Maria-Carmen Wilson, a neurologist who is director of Tampa General Hospital's Headache & Pain Center and a professor at USF College of Medicine. She also is director of USF's headache medicine fellowship program, co-director of the division of pain medicine and associate director of both the neurology residency program and pain medicine fellowship program. Her annual salary from USF is $195,410.95.
Despite her busy schedule at the university, Wilson found time to moonlight for Lilly, which paid her $54,400 in the first quarter. That put Wilson, 53, among the company's most highly compensated doctors nationwide. In Florida, Wilson ranked second only to Miami internist Manuel Suarez-Barcelo, who received $65,100 from Lilly.
The most frequent assignment for Lilly's paid physician-representatives: talk to fellow doctors about the drugmaker's products over dinners and "lunch-and-learns." Despite the informal, conversational nature of these peer-to-peer sessions, the physician-speakers are supposed to strictly adhere to a company-approved script. "The speaker's presentation is carefully regulated and provided by Lilly alone," the company says in its online registry.
Nationwide, Lilly paid doctors for an average of six speaking engagements during the first quarter, at an average of $1,000 per activity. The company says compensation varied based on the expertise of the speaker.
In the Tampa Bay area, the lowest payment was $600, which went to a Clearwater nurse for a couple of patient education sessions. Reimbursement for chatting over a meal with fellow doctors varied widely. Dr. Mark Cavitt, a psychiatrist on staff at All Children's Hospital in St. Petersburg, received $4,800 for a single speaking engagement; Dr. Amado Suarez, a psychiatrist in private practice in Brandon, gave three talks for the same amount. Neither psychiatrist returned calls seeking comment.
A salary boost
Wilson, the Tampa neurologist, made her extra money speaking to colleagues 27 times during the quarter, or more than twice a week, at about $2,000 an appearance. She told Health News Florida, an online news service, that the topic of her talks was Lilly's Cymbalta, an antidepressant approved for fibromyalgia and peripheral neuropathy in diabetics.
Wilson did not return calls requesting comment.
Although Wilson is required by USF to get prior approval for all outside activities, she did not report her Lilly work until earlier this month. Wilson reported that she sometimes gave three talks — at breakfast, lunch and dinner — each day over a two-day meeting. All engagements were during evening hours or while on annual leave, she said.
Wilson told Health News Florida she reached Lilly's annual cap on payments of $75,000 a year in May, boosting her university salary by about 38 percent.
It's not the first time Wilson has neglected to keep USF informed of her extracurricular work. A story in the St. Petersburg Times in April noted that Wilson failed to tell the university of free trips she took to Scotland in 2002 and Spain in 2004 on behalf of drugmaker AstraZeneca.
Wilson told HealthNews Florida that her activities with drug companies promote USF. However, she said she would forgo the outside work if the university asked.
"But then the university doesn't get known and we don't get invited to do clinical trials," Wilson said. "We would also lose good faculty," who supplement their pay with drug company work.
Dr. John Curran, associate vice president for academic and faculty affairs at USF College of Medicine, said he approved Wilson's Lilly activities retroactively last week.
"She is meeting her other duties and assignments including patient care and teaching," he said.
But Curran, a USF physician and faculty member for more than 30 years, questions whether the benefits of such speaking engagements outweigh potential for a conflict of interest.
"The benefits to USF are very limited, other than marketing the physician as an expert, which can build referrals," he said. "But I have some concern that the amount of activity and compensation can indeed influence the physician's judgment, despite the physician not believing that's the case. The public has serious concerns as to whether this is influencing the physician's use of high-priced drugs, particularly in neurology and cardiology."
The only other paid USF faculty member among Lilly's most highly compensated speakers was Dr. Brian Keefe. Keefe is an assistant professor and residency training director in the Department of Psychiatry and medical director of USF Psychiatric Services at Tampa General.
He received $15,300 from Lilly in the first quarter; his annual salary from USF is $189,282.98.
(Keefe and Wilson are state employees, so their salaries are public information.)
Keefe told USF officials he was unaware the Lilly work had to be reported to USF since it was done on vacation time but said he would comply with the requirement.
USF's Curran said, "It's a slow process to change a culture, to go from hiding things to making them transparent. But it creates peer pressure when it's readily accessible information."
Other universities are starting to take a harder line on faculty's participation in speakers' bureaus. Doctors affiliated with Stanford and Harvard are prohibited from being paid speakers for drug companies. At Duke University's medical school, the practice is discouraged and limited to four days a month.
The side effects
Lilly touted its new online database as "one more step toward increasing transparency." It announced its intentions to voluntarily disclose the information in September. The federal settlement five months later, over the off-label marketing of Lilly's popular antipsychotic Zyprexa, made the move mandatory.
Several states, including Minnesota and Vermont, require drug companies to disclose physician gifts valued at as little as $25. Sen. Charles Grassley, meanwhile, has proposed a federal law that would make drugmakers' payments to doctors public to patients.
Lilly said its speakers "serve as a credible voice in bringing information to their peers." But Dr. Adriane Fugh-Berman of Georgetown University said the impact is often biggest on the speaker, who ends up prescribing more of the sponsor's drugs than any of the attendees.
"In these cases where you have a small group of physicians in a nice restaurant, it's just an excuse for the drug company to give the doctor $1,000," said Fugh-Berman. She heads the Pharmedout.org project ,which advocates unbiased drug education for physicians. "We had one drug company insider tell us they go after doctors who are a little insecure because they'd be really grateful for the friendship and the opportunity to become a speaker."
Wilson, a native of Spain who has written a book in Spanish on headaches, said in April that her prescribing habits were not influenced by drugmakers' marketing efforts.
"My prescribing never changes because once a month a drug rep brings in a tray of sandwiches," she said, referring to a tactic drug sales reps use to snag precious time with physicians. "Whether a drug is appropriate or not for a patient is for me to say."
Times researcher Caryn Baird contributed to this report. Kris Hundley can be reached at firstname.lastname@example.org or (727)892-2996.