Editorial: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?

By Steve S. Ryan, October, 2015

In 2014, the pharmaceutical and medical device industries paid out billions to doctors and teaching hospitals. What are they getting for their money? Are they paying for ‘influence’ at the expense of patients?

The EP’s Million Dollar Club

Drug and medical device makers reported payments to seventeen Cardiologists of at least $1 million each from August 2013 through 2014. The payments were for consulting, travel, royalties and other fees. The largest dollar recipients were those who developed a new interventional cardiology device and sold it to one of the big medical device companies.

Among the seventeen doctors are several Electrophysiologists (EPs):

Dr. Sanjiv Narayan	$10,990,510	Mostly from the sale of Topera to Abbott
Dr. Eric Prystowsky	$2,829,957	Mostly from the sale of Topera to Abbott
Dr. Benzy Padanilam	$1,018,500	Mostly from the sale of Topera to Abbott

$300 Million in Conflicts of Interest?

More routine activities can garner considerable medical industry payments for many thousands of additional cardiovascular healthcare professionals (who don’t invent a device or start a company). For example, Dr. Peter Kowey received $544,000.

Between August 2013 and December 2014, the medical industry paid $300 million to cardiologists and other related healthcare professionals for consulting, speaking and other various activities. Receiving a total of $299,050,686 were 31,379 doctors; 1,639 of those received over $50,000.

This doesn’t include larger sums paid to support healthcare research, or payments for ownership and investor interests.

And the Big Winner is…Anticoagulant Drugs

The new anticoagulants (NOACs) aimed at A-Fib patients for stroke prevention are among the top ten drugs promoted by the pharmaceutical industry. The number of payments to doctors linked to specific drugs are:

Eliquis	145,000 payments
Xarelto	124,000 payments
Pradaxa	74,000 payments

As a healthcare consumer, do these payments related to a certain NOAC concern you? They do me!

Reporting Payments to Physicians Now Required by Law

Do the pharmaceutical and medical device industries ‘influence’ doctors through large dollar payments (or other “transfers of value”)? We can only speculate.

In the U.S. under the Sunshine Act [part of the 2010 Patient Protection and Affordable Care Act (PPACA)], we can now research if a doctor has received such payments.

The Center for Medicare and Medicaid Services (part of the U.S. Department of Health and Human Services) is responsible for Open Payments—the federally run program that collects the information about these financial relationships and makes it available to consumers. The second year of Open Payments data is now available.

The Open Payments online database along with the ProPublica Dollars for Docs project make it possible to look up payment history for individual physicians, teaching hospitals and companies.

Note: It’s currently hard to isolate data about EPs, specifically, and the Open Payments data doesn’t include all disbursements such as industry payments to sponsors of Continuing Medical Education (CME) courses. (Almost all CME courses are paid for by the medical industry.) But it’s a beginning.

What This Means to Patients

Industry Money a Form of Recognition? Most doctors and U.S. teaching hospitals are not ashamed or embarrassed to receive industry money. For most it is a badge of honor and a recognition of their importance in the industry.

A variety of doctors and U.S. teaching hospitals accept medical industry money, for example, for promotional talks, research, to speak at conferences, consult, etc. It’s reasonable they be reimbursed for their time and effort.

Or is it a Form of Influence? Like death and taxes, medical conflicts of interest are inevitable.

How much does ‘Conflicts of Interest’ factor in to the choices, recommendations and purchases made by these doctors?

For example, Dr. Philip Sager who received $350,000 from the medical industry, has served several times as a member and the chair of the FDA’s Cardiovascular and Renal Advisory Committee. Another frequent FDA panel member is Dr. Sanjay Kaul who earned $250,000 during this same period.

I know of only one medical center in the US that prohibit these types of medical conflicts of interest: The Mayo Clinic.

Legislation to Prevent Conflicts of Interest? Currently, it isn’t possible in the US to legislate away medical conflicts of interest.

Even if we could pass conflicts of interest laws, the medical industry is very creative. They would find other ways to influence doctors.

There is Hope: Transparency and Disclosure. At the last heart-related conference I attended, every presenter’s first slide described their conflicts of interest. The same information was also listed in a brochure given to all the conference attendees. Some doctors even included approximate dollar amount terms such as “significant.”

Takeaway

As healthcare consumers in the US, the most we can hope for right now is transparency and disclosure. The Sunshine Law goes a long way in telling us if our prescribing doctor or the influential speaker at a conference has conflicts of interest.