Drug companies pay doctors millions each year to promote products to their peers over meals at pricey restaurants.
The drugmakers have found that doctors are more likely to prescribe a new medication if they've heard about it from a colleague instead of a sales rep.
So who are some of the doctors telling other doctors what drugs to prescribe? Patients might want to know.
Drug companies say they choose "leading clinicians" for paid speaking engagements. Among these speakers, according to Florida public records:
• Two Tampa surgeons involved in a botched robotic procedure that killed a Plant High School teacher.
• A St. Petersburg doctor who was put on probation by a local hospital and received a warning letter from the U.S. Food and Drug Administration after he broke several FDA rules while running a drug study.
• A surgeon in Jacksonville who mistakenly removed brain tissue during sinus surgery, leaving the patient paralyzed, blind and brain-damaged.
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Under pressure from the public, as well as government settlement agreements, last year several drug companies began publishing the names of doctors who pitch products to colleagues at informal lunches and dinners. Eli Lilly reported spending $22 million on 3,400 speaker-physicians during the first nine months of 2009. These doctors "serve as a credible voice in bringing information to their peers," according to the Lilly Web site.
Though the events are billed as casual conversations, the physicians are supposed to adhere strictly to a company-approved script, except during question-and-answer sessions.
While there are hundreds of Florida doctors with no disciplinary records speaking for drug companies, several who have been paid speakers for Lilly and GlaxoSmithKline have drawn sanctions from state regulators.
Dr. Adriane Fugh-Berman is a physician and associate professor at Georgetown University who heads a group critical of the pharmaceutical industry's marketing tactics. She said while drug companies might overlook malpractice lawsuits when vetting potential speakers, they should take it more seriously when a doctor has been disciplined by a state medical board because such actions are so rare.
A report by Public Citizen, a Washington, D.C., watchdog group, found that in 2008, the nationwide rate of serious actions by states' boards was the lowest in nine years, at 2.92 per 1,000 doctors. Florida was among the lowest in the country, with just 2.35 actions per 1,000 physicians.
Lilly declined to comment on how it reviews speakers. A Glaxo spokeswoman said speakers must certify that they have not been excluded, debarred, suspended from practice or convicted of a criminal offense.
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Drs. Tod Fusia and Mark Swierzewski are partners in a busy urology practice in Tampa. Glaxo reported paying Fusia $500 in the second quarter of 2009.
Swierzewski, who also has a regular advice segment on Bubba the Love Sponge's radio show, was paid $4,175 by Lilly.
Neither physician returned calls seeking comment.
Swierzewski was disciplined in 2004 by the Florida Board of Medicine and New York state, where he also holds a license, for "failing to keep legible medical records." Regulators found that Swierzewski had prescribed two drugs for unapproved uses without doing appropriate lab tests or considering possible side effects. The patient, who was complaining of low testosterone levels, was being treated for abnormally large breasts, a side effect of the testosterone replacement medicine.
Fusia was the primary surgeon and Swierzewski his assistant during an operation in October 2002 that resulted in the death of Al Greenway, a Plant High School teacher. Greenway, 53, had a cancerous kidney. Using what was then a relatively new robotic system to remove the kidney, Fusia mistakenly cut the largest artery in the abdominal cavity and a vein that runs parallel to it. A third surgeon was called in to repair the error, but Greenway died the next day, blood seeping from his nose, ears and mouth.
Fusia and Swierzewski's insurer paid a $1 million settlement for medical malpractice in the Greenway case.
Fusia received a letter of concern from the Florida Board, had to pay a $10,000 fine, plus about $6,000 in costs, perform 100 hours of community service and take courses in medical ethics.
Fusia's insurer also paid $745,000 to settle a claim after another patient died due to complications while having a kidney stone removed. A third malpractice lawsuit settled in 2007 for $100,000 when a patient being operated on for prostate cancer suffered injuries that led to permanent damage.
Tampa's David G. Eaton was attorney for the families in the latter two lawsuits against Fusia.
"Having been sued for two deaths should definitely keep you from speaking for drug companies, or at least they should have to disclose some biographical data," he said.
Referring to doctors being paid as drug company speakers, Eaton said, "It's the business of medicine and I'm not sure that makes for the best patient care. It certainly doesn't lead to objectivity with drug companies."
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Dr. Jeffrey Ronald Levenson is an HIV specialist in St. Petersburg who has spoken for years on behalf of drug companies. Glaxo reported paying Levenson $1,500 in the second quarter of 2009.
In 2000, insurers for Levenson and several other physicians paid $250,000 to settle a lawsuit resulting from claims they failed to recognize and respond to deterioration of a patient who died. Also in 2000, the FDA took Levenson to task for failing to properly supervise the clinical trial of a new antibiotic. In 2007, Levenson was put on probation by Palms of Pasadena hospital for an undisclosed reason.
Speaking on Levenson's behalf, Amy Eland, his assistant office manager, said the hospital action resulted from a paperwork issue that did not affect his privileges, though he no longer practices at Palms. The hospital declined to comment on the probation. Eland said late paperwork was also responsible for the FDA's warning letter to Levenson and that he no longer conducts clinical trials. The malpractice settlement involved a patient who was severely ill when he was first seen by Levenson, Eland said.
"I'm sure the drug companies make sure physicians representing their companies are qualified and appropriate," said Eland, who said Levenson gives pharma-sponsored speeches every few months. "He just talks about medicines if he's used them in his practice and seen good outcomes."
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Elsewhere in Florida, speaker-doctors include Dr. Charles C. Greene of Jacksonville. Greene, who did not respond to requests for comment, was paid $4,500 by Glaxo in the second quarter of 2009.
Greene was disciplined by the state medical board and his insurer paid $500,000 to settle a lawsuit stemming from errors made during a sinus operation in 2002 that resulted in brain damage. According to the board's investigation, Greene failed to pursue nonsurgical courses of treatment before the surgery, then performed a more extensive procedure than the patient had consented to.
Greene paid a $10,000 fine, $9,000 in costs and was ordered to perform 150 hours of community service. He also received a letter of concern from the board.
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Fugh-Berman, the Georgetown University physician, said drug companies often rely on sales reps to select speakers who have high-profile practices and persuasive speaking styles. One bonus, she said, is that the speakers' prescriptions of the featured drugs often increase more than the attendees'.
Dr. David Lubin of Tampa has attended numerous dinner meetings. He defends their usefulness, saying he often comes away with "good basic information," rather than drug-specific data. He's heard both Fusia and Swierzewski, the Tampa urologists.
"They've very dynamic guys and people like to hear them," Lubin, a family practice doctor, said. "Just because someone has been disciplined doesn't mean they're necessarily a bad doctor."
Under public pressure, the drug industry has pared back some of the marketing freebies, from pens to free trips, that doctors once took for granted. But dinner talks remain common.
Fugh-Berman said that regardless of the speaker's competence as a medical professional, physicians should consider it unethical to speak for drug companies. She noted that several major medical universities and related practices now ban their doctors from acting as drug company speakers.
"I just want all promotional talks to go away," she said.
Kris Hundley can be reached at firstname.lastname@example.org or (727)892-2996.