by Charles Ornstein, Tracy Weber and Dan Nguyen
September 7, 2011
Eight pharmaceutical companies, including the nation's three
largest, doled out more than $220 million last year to promotional
speakers for their products, according to a ProPublica analysis of
For the first time, all these companies have reported a full year of
payments, allowing for head-to-head comparisons of how much they
spent on physicians to help push their pills. Some appear to be
Firms with the highest U.S. sales last year didn't spend the most on
physician marketers. Industry leader Pfizer, with sales of $26.2
billion, spent $34.4 million on speakers, ranking third among the
Eli Lilly and Co. spent the most on speakers, $61.5 million,
even though its sales were about half of Pfizer's.
"We continue to believe in the
benefits and value that educational programs led by physicians
provide to patient care," Lilly spokesman J. Scott MacGregor
said in an email.
The data provide a preview of
what the public can expect to see in 2013,
when all drug and medical-device companies - potentially hundreds -
must report such figures to the federal government.
2010 U.S. Sales
Johnson & Johnson
Until 2009, pharmaceutical company payments to health professionals
were closely held trade secrets.
But several companies began reporting
the information publicly under pressure from lawmakers or as a
condition of settling federal whistle-blower lawsuits.
In October, ProPublica published a database called
Dollars for Docs that included
information from those companies. It allows the public to search for
individual physicians to see whether they've been on pharma's
Today, ProPublica is updating that tool to include payments made to
health professionals by 12 companies.
Eight of those published data for all of
Johnson & Johnson
In addition to the payments made to
speakers, some of the companies also disclosed how much they've
spent on consulting, travel, meals and research.
In all, payments to doctors and other health-care providers in
ProPublica's database total more than $760 million and cover reports
from drug companies between 2009 and the second quarter of 2011.
Some Docs Pull
The new data offer a glimpse of how the firms have adapted their
strategies over time, both to changes in the marketplace and to
increased scrutiny of their sales techniques.
Many experts predict physicians will back away from working for the
companies once their names and pay are publicly revealed. It's too
early to know if this is true, but ProPublica's analysis shows that
the payouts to dozens of doctors and other health professionals took
a steep dive last year.
Pulmonologist Veena Antony, for example, was paid at least
$88,000 to give promotional talks for GlaxoSmithKline in 2009.
But last year, the Birmingham, Ala.,
doctor gave them up out of concern that patients might think her
advice was tainted.
"You don't even want the appearance
that I might be influenced by anything that a company gave," she
Cancer specialist Nam Dang was a
regular on Cephalon's speaking circuit, pulling in $131,250 in 2009.
But those promotional gigs stopped, he
said, after he took a job at the University of Florida in
Gainesville, which bans such talks. In 2010, he received $10,000 for
consulting for Cephalon and Pfizer.
Nurse practitioner Terri Warren, who runs a Portland, Ore., health
clinic, earned at least $113,000 from Glaxo in 2009, mostly talking
about its herpes drug Valtrex. In 2010, that dropped to $300 after
the drug went off patent and Glaxo no longer had a financial
incentive to promote it.
"It's a business decision, clearly,"
said Warren, who felt her talks helped educate other health
professionals about treating a taboo illness.
"My money [from Glaxo] went into
keeping this little clinic alive, and now we have to figure out
some other way to do that."
Another group of physicians has ramped
up speaking engagements and consulting.
Buffalo hematologist Zale Bernstein earned $49,250 from Cephalon in
The following year, his pay jumped to
$177,800 (plus an additional $35,500 for travel). Bernstein did not
return calls for comment.
Pain specialist Gerald M. Sacks spoke and consulted for four
companies in the database and was among the highest paid. The Santa
Monica, Calif., doctor earned $270,825 from Pfizer, Johnson &
Johnson, Lilly and Cephalon in 2010, up from $225,575 in 2009. Those
figures do not include travel costs and meals.
Over 18 months, Pfizer alone paid Sacks $318,250 for speaking. He
did not return repeated calls for comment.
Pfizer's new disclosure also revealed an unusual recipient. Its
top-paid physician consultant last year, Dr. Christiana Goh Bardon,
runs a hedge fund in Boston that bets on the rise and fall of
She was paid nearly $308,000 to,
"provide input on our
BioTherapeutics business development plan," Pfizer spokeswoman
Kristen Neese wrote in an email.
Bardon, who started her hedge fund after
her Pfizer contract ended, was required to sign a confidentiality
agreement and not allowed to invest in Pfizer or any of the biotech
companies that Pfizer was looking at acquiring or partnering with
for projects, Neese said.
Bardon said in a voice-mail message that she does not currently
practice as a physician and her work was based on her business
Change Their Strategies
Some companies apparently have used fewer physician speakers and
consultants since they began posting their data publicly.
Cephalon, a relatively small Pennsylvania company that specializes
in pain, cancer and central nervous system drugs, paid physicians
nearly $9.3 million in 2009 for speaking and consulting.
That figure dropped to $5 million last
"There wasn't one big thing that
happened that shifted the focus," said spokeswoman Jenifer
Rather, the company's marketing
strategies for its brands changed.
AstraZeneca cut its spending on speakers from roughly $22.8 million
in the first half of 2010 to about $9.2 million in the second half.
The company's U.S. compliance officer, Marie Martino, said
AstraZeneca typically holds most of its speaker events in the
beginning of each year. But she acknowledged that the company's
spending on promotional talks has been decreasing.
"We're in a period now where we
don't have a lot of new indications [approved uses] or new
products that have been introduced in recent months, and that
really is the fundamental explanation for what you're seeing,"
AstraZeneca, like other companies, is
also replacing some in-person speaking events with teleconferences,
webcasts and video conferences.
Glaxo's spending on speakers also slowed in 2010, averaging about
$13.2 million per quarter in 2010, down 15 percent from the last
three quarters of 2009. (Glaxo did not report data in the first
quarter of 2009.)
Company spokeswoman Mary Anne Rhyne said the company is working to
reduce its speaker rolls by 50 percent.
"We feel it is a better use of
resources to use fewer speakers more often. This cuts down on
training costs as well as lessens the number of contracts
needed," she wrote in an email.
And Lilly's speaker payments dropped 10
percent from 2009 to 2010, which spokesman MacGregor said was likely
"normal year-to-year fluctuation."
ProPublica's early analysis of the data
is limited because so few companies report their spending and even
then, disclose different information.
Lilly, for example, reports every health
professional it pays to speak, while Pfizer includes only those who
"It's really unclear how much money
is being spent in any one of these areas," said Vincent
DeChellis, a principal at NHHS Healthcare Consulting, which has
studied the data.
"As you get more and more companies
participating and submitting this information, you're going to
get an initial look" at what may be a multibillion-dollar
When Massachusetts required drug and
device companies to
report payments to doctors in that
state last year, 286 companies did so.
Scrutiny of speaker programs has prompted changes.
reported last year that some
drug-company speakers had been sanctioned by their state medical
boards, the firms pledged to
toughen their screening procedures
and exclude physicians with disciplinary records.
Separately, ProPublica found that
universities were not enforcing
their own policies barring physicians from giving promotional
speeches. In response, a number of schools said they would begin
using the payment rosters to check
Pharma's trade group said the focus of most companies right now is
ensuring the accuracy of data that will be publicly released in
2013. But this transparency also must be put into context for
patients, said Diane Bieri, executive vice president and general
counsel for the Pharmaceutical Research and Manufacturers of
Doctors help develop new medicines, advise companies on marketing
and help educate their peers about appropriate uses of new drugs,
"If the only information that's
available is that company A paid doctor B $75,000 for a
consulting arrangement," she said, "that's typically not enough
information to really educate the patient about what was
involved in that relationship."