Monday, July 23, 2018
Health

Numbers show link between drug company payments and how doctors write prescriptions

A larger share of doctors in Florida have accepted freebies or payments from pharmaceutical and medical device companies than in all but seven other states, according to a new analysis by ProPublica.

The analysis looked at doctors in five common medical specialties who had 1,000 or more claims to Medicare in 2014. In Florida, 85 percent of them had received free meals or travel, gifts, or compensation for speaking or consulting.

The national average was 74 percent. In five states — Maine, Massachusetts, Minnesota, Wisconsin and Vermont — it was less than 50 percent.

The figure matters because physicians who received payments from the medical industry prescribed a higher percentage of brand-name drugs than those who didn't, ProPublica found. The larger the payment, the more brand-name medication they tended to prescribe. And for patients who might do just as well with a generic drug, that translates to higher costs.

The analysis should raise some questions for patients in Florida, said Laura Brennaman, the policy and research director for the consumer group Florida CHAIN.

"I don't think I've ever met a physician or nurse practitioner who was overtly swayed by gifts or speaking fees," Brennaman said. "But the opportunity to earn extra income can certainly make someone pay more attention to the benefits of a particular drug, which can influence what he or she prescribes."

DOLLARS FOR DOCS: Has your doctor received drug company money? Use this search tool created by ProPublica to see.

ProPublica, based in New York City, describes itself as "an independent, non-profit newsroom that produces investigative journalism in the public interest."

Its analysis looked at about 150,000 doctors in five specialties: cardiovascular disease, family medicine, internal medicine, ophthalmology and psychiatry. More than 9,400 Florida doctors were included.

Overall, the analysis found that doctors who received any type of compensation from the industry — even meals alone — were at least two times as likely to prescribe brand-name drugs than those who didn't. Those who received more than $5,000 from companies had the highest brand-name prescribing rates.

One psychiatrist, Dr. Ilan Melnick, of Coral Gables, received nearly $361,186 from drug companies in 2014, records show. More than a quarter of the drugs he prescribed that year were brand name — a higher-than-usual share for psychiatrists, according to the analysis.

Another psychiatrist, Dr. Kenneth Pages in Tampa, was paid $211,927 by pharmaceutical companies in 2014. His brand-name prescribing rate was nearly 28 percent, ProPublica found.

Neither doctor returned calls from the Tampa Bay Times, which was provided an advance copy of ProPublica's data.

Not all doctors who accepted big payments fit the pattern. Dr. Warren Scherer, a South Tampa ophthalmologist, received about $474,449 in licensing fees or royalties from Texas-based Galderma Laboratories, federal records show. But he prescribed brand-name drugs as often as other ophthalmologists, according to the analysis.

Scherer did not return calls from the Times.

Dr. David W. Parke II, chief executive of the American Academy of Ophthalmology, suggested in an interview with ProPublica that many payments made to ophthalmologists don't relate to drugs they prescribe in Medicare Part D, and instead may be related to drugs administered in doctors' offices or devices and implants used in eye surgery. As a result, he said, it may be unfair to presume that industry payments are associated with prescribing in Part D.

Still, he said, the analysis points to areas that specialty societies may want to look at. "In some cases, there are very appropriate and clinically valid reasons" for doctors who are outliers in their prescribing, he said. "For others, education may very easily result in prescribing change leading to substantive savings for patients, employers and society."

In Florida, six-figure payments to doctors were far from the norm. The average payment was about $1,495, according to the analysis. About half of the doctors received meals alone.

Jay Wolfson, professor of public health, medicine and pharmacy at the University of South Florida's Morsani College of Medicine, said he understood why doctors with ties to the industry would prescribe a larger share of brand-name drugs.

Like consumers, some doctors have brand loyalty, he said.

"There are also a number of physicians who legitimately believe generics are not always as effective in meeting the needs of the patient," he added. "A lot of patients say when they go on the generic, (the drugs) don't work."

But Wolfson didn't downplay the industry's profit motive.

"The pharmaceutical industry is one of the largest and most influential businesses in America," he said. "Part of their business is marketing, not just to physicians but to patients directly."

Tim Stapleton, chief executive officer of the Florida Medical Association, which represents doctors statewide, said private companies play an important role in educating physicians about what drugs and devices are on the market. What's more, he said, the industry makes it convenient for doctors to learn about new products.

"Physicians, for the most part, want to do the right things for their patients," Stapleton said. "Whether they receive a meal or a fee from a company for giving a speech, I don't think that influences their decisions about what's right for their patients."

Stapleton couldn't say for sure why the share of physicians accepting payments in Florida was larger than in other states. But he said drug makers might reach out to more doctors in Florida because the state has a large Medicare population.

Some doctors, including Dr. John Gerald Canto of the Watson Clinic in Lakeland, see value in participating in industry-sponsored conferences. Canto received nearly $200,000 in speaking fees, and for travel, lodging and meals, federal records show. He was flagged in the analysis as being a "very high" prescriber of brand-name drugs.

"Our physicians utilize these educational forums in an effort to share the wisdom and expertise they have accumulated from a life of service in the medical field," his practice said in a statement. "These events also accommodate a free exchange of ideas between colleagues, and the possibilities of the next great breakthrough in medical research or treatment."

But other physicians are skeptical.

Dr. Owen Linder, an internist who practices in Safety Harbor and was included in the analysis, said he avoids interaction with the industry. He won't even take meetings with representatives or accept free samples, he said.

"I put my independence of judgment before dollars," he said.

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

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