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Yahoo
18-05-2025
- Health
- Yahoo
Nearly 60% of doctors take money from Big Pharma. Is your doctor one?
Joan Doyle trusts her doctors. Between her husband's epilepsy and diabetes, her daughter's Down syndrome and her own car accident years ago, the 65-year-old Sharonville resident and her family have relied on a whole host of doctors to guide them through new diagnoses and prescriptions. So when she searched her family's doctors in Open Payments, a public database that shows which doctors have received money from Big Pharma, Doyle was curious about what she'd find. 'Certainly none of my doctors are on this list,' she remembered thinking before searching the database. She was surprised. 'Every single one of them,' Doyle said. 'Everybody from our dentist to our family doctor to all of our ologists.' The Enquirer verified that all 12 of the doctors Doyle searched accepted payments or in-kind forms of compensation from pharma or medical device companies between 2017 and 2023. The total sum varied widely, from less than $300 for her OB-GYN to more than $150,000 for her husband's oncologist. Doyle searched her doctors' payments after The Enquirer asked readers to use the database and share what they found. What she discovered about her family's doctors is true for millions of American families. Payments like these are pervasive: A 2024 analysis found that more than half of doctors in the U.S. accepted a payment from a pharmaceutical or medical device company over the past decade. These companies compensate doctors in a number of ways, ranging from a single expensed meal to hundreds of thousands of dollars in royalties for doctors who invent medical devices. Others are paid thousands of dollars in speaker fees, to help pharma companies advertise a new treatment. A small number of doctors, including a handful in Cincinnati, have earned millions through their relationships with drug and device companies. The Enquirer analyzed the data to determine the 10 doctors and 10 nurses and physician assistants who received the biggest payouts from industry sources. Most don't earn millions of dollars – in 2023, the median total industry payment per doctor was $147 in Ohio and $182 in Kentucky – but research shows that when a doctor was bought a single meal of less than $20 by a drug company, they were up to twice as likely to prescribe the medication the company was marketing. This kind of direct-to-physician marketing is legal, as long as there's no evidence of direct kickbacks to physicians for prescribing certain treatments. Physicians and other medical professionals who accept those payments say they are improving patient care by getting the word out about promising drugs and technological advances. When The Enquirer reached out to Cincinnati doctors who earned the most, those who responded said their work on behalf of the companies benefited their colleagues and the patients they treat. But researchers and ethicists are concerned about the amount of money involved and the potential for that money to influence physicians. Doyle shares those concerns. Though she's decided to stick with her doctors, she said she was 'deflated' by what she found. 'How affected are they?' Doyle wondered. 'And by that, how affected am I?' Anyone can search their doctor's payments from industry due to a federal law called the Physician Payments Sunshine Act, which requires drug and medical device companies to disclose payments they made to health care providers. Dr. Charles Rosen, an orthopedic surgeon and professor at University of California, Irvine Medical Center, began lobbying for the Sunshine Act back in 2006, four years before the bill passed. As the cofounder of the Association for Medical Ethics, a volunteer-run organization for doctors who advocate for transparency in medicine, Rosen testified before the US Congress in 2008 on the conflicts of interest created by industry paying surgeons. Rosen felt compelled to push for more transparency in the medical industry when a new artificial lumbar disc, a device that replaces a damaged disc in the lower spine, hit the market in 2004. The artificial disc, manufactured by Johnson & Johnson subsidiary DePuy, was the first of its kind in the United States. 'I wanted to see if it was a new device that I could use in my surgeries,' Rosen remembered. When he looked into the device's FDA clinical trial, he was shocked. 'The data was terrible,' said Rosen, who later discovered that almost every author of the study earned royalties from the disc replacement or were salaried consultants for the company. 'I just thought it was bad medicine.' Rosen ended up treating dozens of patients who suffered agonizing pain from the failed disc replacements. 'That's when I started saying, well, I would like to know, and I think patients would like to know, if the doctor that's writing a prescription for a medicine for them is being paid by the company that makes the medicine.' The Enquirer analyzed all payments unrelated to research that companies made to doctors who worked in the Cincinnati area between 2017 and 2023, the most recent year data was available, and talked to the doctors who received some of the highest payments. Our analysis of the dataset, which contained nearly 750,000 individual transactions detailing practitioners' trips, meals, gifts, speaker and consultant fees, found that doctors, nurses and other medical practitioners in Cincinnati received $136 million in payments during the past seven years. The top category of payment – nearly $38 million – was non-consulting services, in which practitioners served as speakers or faculty for a company, outside of a continuing education setting. Paying physicians to speak to other physicians is a strategy that works for companies, according to Brandon David Lewis Marshall, professor of epidemiology at Brown University, who's researched opioid makers' payments to doctors. 'Physicians are more likely to listen to another doctor than direct from a pharma rep,' said Marshall. These doctors will often give talks over dinner, a practice that is legal but has sometimes led to trouble. In 2023, a Cleveland neurologist pleaded guilty to accepting kickbacks in exchange for writing prescriptions – and federal prosecutors said he was incentivized, in part, by being paid to speak to other doctors over "dinner at a high-end restaurant." The second largest category of payments was consulting, where doctors, nurses and physician assistants were paid a total of $36 million for serving as company consultants, followed by $19 million in royalty and licensing fees paid to doctors who invented medical devices. Companies spent $17 million on meals for doctors and other prescribers. While a company buying a doctor a meal every now and then may seem innocuous, it proved influential during the opioid crisis, according to Marshall. His research found that the more doctors were given free meals by opioid manufacturers, the more likely they were to prescribe the opioid being marketed – a finding replicated across studies of other marketed drugs, said Genevieve Kanter, an economist and professor at the University of Southern California who researches industry influence in medicine. 'Unambiguously, it does increase the prescribing of the promoted drug,' she said. The Enquirer compiled a list of the 10 Cincinnati doctors and nonphysician practitioners who've received the most industry payments since 2017. Those who received more than $1 million wield considerable influence in their respective fields, holding patents, leading departments at universities and editing medical journals. Three of the top 10 are orthopedic surgeons, one of whom operated on Joe Burrow's wrist in 2023. Five are inventors of successful medical technology, ranging from an artificial elbow to a stomach stapler used for weight loss surgery, that's earned them hundreds of thousands of dollars in royalties. Cincinnati's most highly paid medical professional in industry payments is Jack Hahn, who invented three dental implant systems over his 58-year career as a dentist. 'I was basically the first to come up with a concept of the tapered implant that looked like a root of a tooth,' said Hahn, who's now retired. Hahn said he drew an early design of a prototype on a napkin at Sugar 'N Spice Diner in Bond Hill – he's earned nearly $4 million since, mostly from royalties. Hahn said he could have earned more money if he owned his patent, as opposed to signing a five-year contract with the company that now owns his invention. 'I was not a good businessman,' he said. Rosen, the orthopedic surgeon from UC Irvine, said there's nothing wrong with receiving payment for your invention, as long as research shows it works for patients and payments are disclosed to the public. 'If you invent a product that's brilliant, and it's independently reviewed, and it works great, then you're entitled to get royalties," he said. "That's the American way.' Among those who received the most money from industry, Hahn's story is familiar: These are medical professionals who were experts or invented something that changed patients' lives. They were paid, they say, to share that expertise. The second most highly paid physician on the list is Dr. Henry Nasrallah, a psychiatrist who has received $3.2 million in industry payments since 2017. Formerly the department chair of psychiatry at Ohio State University, Nasrallah is now an emeritus professor at the University of Cincinnati. Over 70% of Nasrallah's payments come from serving as a speaker for pharmaceutical companies. Those payments included 739 meals over seven years, an average of 106 per year – two meals per week – at $66 per meal. Nasrallah's most lucrative relationship is with Janssen Pharmaceuticals, a Johnson & Johnson subsidiary. The company paid him more than $718,000 over seven years, more than any other doctor in the country. Nasrallah declined The Enquirer's request for an interview and provided an emailed statement instead. He said his goal is to educate other doctors about effective medications. 'That's why I agreed to speak to community clinicians about the new antipsychotics and antidepressants,' he said. 'Thus, I made time to travel around the country and lecture about the newly approved drugs.' Nasrallah said he's not beholden to any company and has spoken on behalf of companies with competing medications. 'I am impartial and focus on the FDA-based data,' he said. That's a common view among doctors who receive payments, said Kanter, the USC economist, citing a 2001 survey of medical residents that found that most respondents said industry promotions did not influence their own prescribing. 'Physicians view themselves as unbiased,' Kanter said. Other top doctors on the list included UC Health orthopedic surgeons Dr. Michael Archdeacon and Dr. H. Claude Sagi each made over $1 million by receiving royalties and consulting fees from Stryker, a Michigan-based medical equipment manufacturer. While neither doctor responded to requests for an interview, the company's website shows Archdeacon performing a demo of its new pelvic implant system at The Diplomat Beach Resort Hollywood, a four-star hotel in Hollywood, Florida, last June. 'This is our baby,' Archdeacon announced during the demo. 'We think it's gonna change pelvic surgery.' Archdeacon's conflict management plan, obtained by The Enquirer through a records request, showed that he recused himself of "all negotiations, discussions and interactions" between Stryker and UC Health or the University of Cincinnati College of Medicine. In an emailed response to The Enquirer's questions, a Stryker spokesperson said that payments to physicians for events like these are 'not marketing,' but instead, 'education on the safe and effective use of our products.' Rosen disagreed. 'It has nothing to do with education,' he said. 'It's just marketing.' Archdeacon isn't alone. Cincinnati Eye Institute ophthalmologist Robert Osher took a $6,000 trip to Vienna for a 'company sponsored educational symposium' in 2023. The expense was covered by Hoya, an optical technology manufacturer. Doyle said she understands how her doctors and others might find free dinners, trips and other perks appealing. But she's now asking questions about how much influence those events might have on their decisions. 'How does that work?' she wondered aloud. Nonphysician practitioners also emphasized the educational value of speaking engagements and trainings that they're paid to do by pharma companies. 'It's my responsibility for about 230+ providers to educate them on what's new,' said Leigh Ann Pansch, a nurse practitioner at DOCS Dermatology. 'I have a lot of relationships with industry to help make that happen.' Karen Whitney, Cincinnati's second most highly paid physician assistant in industry payments, works full-time as a cosmetic injector and part-time as a trainer for Botox manufacturer Allergan. Whitney discloses her status as an Allergan trainer to her patients, she said, because it distinguishes her 'as one of the experts.' 'I'm just so proud to be part of an educational program that is, in my mind, so ethical,' said Whitney. 'It's not marketing, in my opinion.' George Knight, a nurse practitioner, echoed Whitney's thoughts. 'I'm considered an expert in dementia. I do educational programs, for webinars, practitioners, physicians," he said. 'I'm not just taking money from pharma companies to write prescriptions. That's totally not what's happening.' Joan Doyle says she won't stop going to her doctors just because she found them in the Open Payments database, though she's now more interested in looking up the names of new providers. She doesn't necessarily think that her doctors receiving meals, trips, or other payments from industry has compromised their care. 'On the other hand,' she said, 'I wouldn't really know.' Data scientist Kevin Gong contributed to data analysis. This article originally appeared on Cincinnati Enquirer: Nearly 60% of doctors take money from Big Pharma. Is your doctor one?
Yahoo
18-05-2025
- Health
- Yahoo
Concerned that your doctor's being paid off? What to do
Every year, pharma and medical device companies spend billions paying doctors in speaker fees, meals, gifts and trips. Research shows that payments like these are pervasive, with more than half of doctors in the U.S. accepting an industry payment over the past decade. If you're worried that these payments are affecting your doctor's medical advice, what can you do? Some doctors will tell you about their industry payments. Dr. Jonathan Thompson, Cincinnati's third highest paid doctor in industry payments, issues a conflict of interest disclosure form to his patients, according to records obtained by The Enquirer, that allows them to opt out of using equipment developed by Thompson's company in their surgery. If you have a serious ethical concern about your doctor that you'd like to discuss with someone else, you can contact your hospital's compliance and business ethics department. (Each hospital has its own conflict of interest policy, with some academic hospitals and private practices limiting what physicians can receive from companies, and others going as far as to ban drug reps entirely.) And if you're worried about your doctor improperly prescribing or dispensing drugs, the State Medical Board of Ohio handles those complaints on its website, For anyone who's concerned about getting the most accurate medical advice possible, it's always good to seek out a second opinion, said Genevieve Kanter, an economist from USC who researches conflict of interest in medicine. This is especially important for expensive treatments and serious diagnoses. Dr. Charles Rosen, an orthopedic surgeon from UC Irvine, recommends that patients wait between three to five years before trying out new treatments. That way, you'll have access to more data on long-term complications. When reading research on a medical device or drug, he recommends seeking out publications like The Spine Journal, which require authors of studies to disclose any industry payment higher than $100. And for studies in other journals, use the Open Payments database to see if the authors have been paid by the manufacturer. This article originally appeared on Cincinnati Enquirer: Concerned that your doctor's being paid off? What to do
