Psychiatrists Get The
Most Gifts By Drug Companies
As some US states begin to require that drug companies disclose
their payments to doctors for lectures and other services, a pattern
has emerged: psychiatrists earn more money from drug makers than
doctors in any other specialty.
How this money may be influencing psychiatrists and other doctors
has become one of the most contentious issues in health care.
For instance, the more psychiatrists have earned from drug makers,
the more they have prescribed a new class of powerful medicines
known as atypical antipsychotics to children, for whom the drugs
are especially risky and mostly unapproved.
Vermont officials disclosed that drug company payments to psychiatrists
in the state more than doubled last year, to an average of $45,692
each from $20,835 in 2005. Antipsychotic medicines are among the
largest expenses for the state's Medicaid program.
Over all last year, drug makers spent $2.25 million on marketing
payments, fees and travel expenses to Vermont doctors, hospitals
and universities, a 2.3 percent increase over the prior year,
the state said.
The number most likely represents a small fraction of drug makers'
total marketing expenditures to doctors since it does not include
the costs of free drug samples or the salaries of sales representatives
and their staff members. According to their income statements,
drug makers generally spend twice as much to market drugs as they
do to research them.
"For the fourth year in a row, our analysis shows that there
is a great deal of money being spent in our small state on marketing
pharmaceutical products," said William H. Sorrell, the Vermont
Endocrinologists received the second largest amount, according
to the Vermont analysis, earning an average of $33,730. Since
the state identified the specialties of only the top 100 earners,
these averages represent the money earned by only some of the
state's specialists. There were 11 psychiatrists and 5 endocrinologists
in that top group of 100.
As in Vermont, psychiatrists earned on aggregate the most in
Minnesota, with payments ranging from $51 to $689,000. A New York
Times reporter found that psychiatrists who took the most money
from makers of antipsychotic drugs tended to prescribe the drugs
to children the most often.
These and other stories have helped to fuel a growing interest
among state and federal officials to document and restrict payments
to doctors from drug makers. At a gathering last month at Columbia
Law School in New York, state attorneys general from across the
country discussed ways to get similar data for their states.
And today, the Senate Special Committee on Aging, which is led
by Senator Herb Kohl, Democrat of Wisconsin, will hold the first
of a series of hearings on the issue, which could lead to legislative
proposals to restrict and require disclosure of payments and gifts
to doctors from drug companies nationwide.
Several lawmakers on Capitol Hill have expressed interest in
such legislation, including Senator Charles E. Grassley, Republican
of Iowa. "A federal law requiring public disclosure of payments
to doctors could be very effective if it was carefully monitored
and consistently applied," Mr. Grassley said.
Efforts to require disclosure of payments to doctors began almost
by happenstance in 1993, when The Minnesota Legislature passed
a law that restricts drug companies from giving doctors gifts
valued at more than $100 in any given year. The legislation also
required companies to report and make public any consulting fees
paid to doctors.
Lee Greenfield, a former state representative in Minnesota and
one of the law's authors, said it passed with little fanfare or
debate after legislators heard stories about doctors accepting
gifts of great value from drug makers.
"Why do we want them bribing doctors to use what may not be the
best or most cost-effective drug for the patient purely to get
some hand-held TV, we all asked," Mr. Greenfield said.
Still, compliance with the law has been spotty. Some companies
never responded to the board's requests for disclosures. Others
did so fitfully. A few sent letters saying they did not collect
that information and thus could not provide it.
Minnesota officials never cracked down. Such reports were put
in file drawers and largely forgotten until this past year, said
Cody Wiberg, executive director of the Minnesota Board of Pharmacy.
Mr. Wiberg said he planned this year to pursue companies that
fail to report.
Besides Vermont and Maine, more than a dozen other states have
or are now considering similar legislation, said Sharon Anglin
Treat, executive director of the National Legislative Association
on Prescription Drug Prices.
Officials in Maine and Vermont said they would try to compare
reports of payments to doctors with Medicaid records to explore
how marketing practices might influence prescribing by doctors
in ways that increased costs to taxpayers.
"What we want to be able to do is overlay the prescribing information
that we have with the drug detailing information," said Jude Walsh,
special assistant to the governor of Maine, John E. Baldacci.
"If we see that doctors in a certain southern county in the state
are prescribing a lot of a drug and getting a lot of detailing
for that drug, that could lead to some record reviews to see what's