July 10, 2008

How Much Did Drug Companies Pay Your Doctor Last Year?

Vermont is a small state. It's largest city would be called a "Town" if it was found in any other state.

It has few hospitals and none of the huge regional medical centers found in neighboring states like Massachusetts or Connecticut. What it does have is a law that forces drug companies to reveal--in carefully cloaked terms--how much they paid to the 100 anonymous doctors who received the most money from them. The identities of these doctors are kept secret. All we learn is their specialty.

Even so, this year's report finds that drug companies paid an average of $56,944 to eleven Vermont psychiatrists. And according to the Rutland Herald--a fact that has not been reported in many news wire versions of this story--two Vermont cardiologists split over $300,000.

You would be a good candidate for psychiatric care yourself if you didn't wonder what those doctors were doing in return for that money.

For the first time this past year the Vermont law also specified that the drug companies must reveal the top ten drugs they were marketing, and to no one's surprise, half of the top ten drugs that are marketed with drug company money are used to treat psychiatric disorders--specifically depression and ADHD.

I have not been able to find the entire report online, but my guess is that the rest of the drugs that were being marketed heavily were the very expensive cholesterol drugs: Crestor, Zetia, and Vytorin. That would explain the payments to cardiologists.

Here are the questions you should be asking yourself on hearing this.

1. If drug companies are paying this much to doctors to promote drugs in a little out-of-the-way state like Vermont with a tiny population and no major medical center, what are they paying doctors in places like New York, Boston, Los Angeles and [insert your city name here]?

2. How likely is it that the figures released here were correct? The State of Vermont has a very small state government and lacks the resources it would take to audit this kind of report.

3. How much do drug companies pay your doctor to motivate them to prescribe their biggest profit makers? Did the drug reps take your doctor to a nice dinner, send them on a cruise where they put in 1/2 an hour listening to a drug presentation and then vacationed at drug company expense? Did the drug company enroll your doctor's patients into an aftermarketing "study" where the doctor was payed hundreds or thousands of dollars per patient to "enroll" each patient--which meant prescribing a drug that was paid for by the patient or the patient's insurance company?

Finally, if your doctor put you on a new, possibly dangerous and definitely expensive drug like $145/month Januvia or Janumet shortly after you were diagnosed with diabetes instead of $8/month Metformin--which is the drug that current practice recommendations say you should have been started on, you might want to ask how much payment they received last year from Merck.

If your doctor did not tell you that you can buy R insulin for $23 a month rather than analog insulin at $89 a month, you might want to know what they received from Novo-Nordisk, Adventis, or Lilly.

Finally ask yourself how unbiased you would be in your recommendations if someone was paying your $58,000 a year for, ostensibly nothing and that someone just happened to have a product out there that you could prescribe for your patients--one that cost ten times or more what competing equally effective products could do.

Pretty scary, eh?
Update June 12, 2008:

The New York Times ran an article today that has more detail about the drug company payoffs received by psychiatrists around the country and how several of them lied about the amount when asked to disclose.

A key phrase in the article leapt out to me and points to yet another cause of the childhood obesity epidemic:

"An analysis of Minnesota data by The New York Times last year found that on average, psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs appear to have written three times as many prescriptions to children for the drugs as psychiatrists who received less money or none. The drugs are not approved for most uses in children, who appear to be especially susceptible to the side effects, including rapid weight gain." [emphasis mine].

It's worth noting that these psychiatric drugs have been shown, in adults, to cause not only rapid weight gain but diabetes.

Here's the whole article which I recommend you read:

Psychiatric Group Faces Scrutiny over Drug Company Ties


The Old Man and His Dog said...

Just had this discussion with my fiance' last night after watching an old episode of ER where the unethical Dr., receiving money from the pharmaceutical company, prescribed a drug known to cause kidney damage to a patient that received a kidney transplant. She lost the kidney that her father donated to her, then her father committed suicide so that they could use his last kidney for his daughter.

We determined that each of us is ultimately responsible for our own health now. We are now our own formally uneducated Dr's. Not like in the old days when you actually went to a Dr. because you understood that they knew more than you and you could actually trust them to do what is best for you. A shame this is no longer true. Now most Dr's are just in the "business" to make as much money as possible.

Very sad state of affairs. Even more disturbing for those that aren't able to do the kind of research required to make an knowledgeable decision as to what treatments they will or will not accept.

How many have to suffer, die and/or go broke before this changes?

The Old Man and His Dog said...

Another article about Januvia I saw today.


Arun.N.M. said...

Great Post. Situation in India is almost the same. I try to be ethical in my prescription practise as far as possible but I know many a time Pharma Company pressures and gifts make me falter. What do you feel is the way out of this bad and ugly situation?

Emily said...


The report is now online here:

-Emily from VT

Anonymous said...

here are the top 10 drugs by spending:

Strattera, ADHD, Eli Lilly

Metadate CD, ADHD, UCB

Januvia, Type 2 Diabetes, Merck
Lexapro, Depression, Forest Laboratories

Cymbalta, Depression, Eli Lilly
Lantus, Diabetes, Aventis Pharmaceuticals

Seroquel, Antipsychotic, AstraZeneca

Namenda, Alzheimer's, Forest Pharmaceuticals

Vytorin/Zetia, Cholesterol, Merck/Schering-Plough
Benicar, Hypertension, Daiichi Sankyo