Reporting Recipe: Dollars for Docs
With more data on relationships between doctors and drug companies soon to be released, here are some ways journalists can use this information.
by Charles Ornstein ProPublica, March 28, 2014, 11:57 a.m.
This year promises to bring an unprecedented expansion in publicly accessible data on the relationships between doctors and pharmaceutical companies. In September, the federal government plans to release details on payments made by drug and medical device companies to all U.S. doctors from August to December 2013, as required by a provision of the Affordable Care Act.
ProPublica has been tracking this issue closely for years and has assembled Dollars for Docs, our comprehensive database of payments made by 15 companies that currently report the information to the public. Earlier this month, we updated the database to include payments through the end of 2012; it now reflects about $2.5 billion in payments overall.
Using the database, this week we published a story about 1,300 researchers who have personal or promotional ties to the drug companies that fund their clinical trials.
We thought this would be a good time to take a step back and explore the types of stories journalists can write now and in the future using payment data.
We’ve made our Dollars for Docs easy to search and customize by state, year, drug company and type of relationship, so that’s a good place to start. Of course, it’s important to note that data on payments is just the first step. Talking to physicians and patients is important to understand details about how the relationships work, how they may affect patients and how they may be changing.
- Who are the highest-paid speakers/consultants in your area? ProPublica has looked at data for several years and found that some doctors make hundreds of thousands of dollars a year working with pharmaceutical companies. That is in addition to what they earn from their day jobs. What do they do and why do they do it? What are their qualifications? An example of what we found: The million-dollar doctor.
- Who’s in/who’s out? Dollars for Docs includes data for some companies dating back to 2009. That presents a chance to look at changes over time: which doctors have started accepting funds from a company, which continue to accept funds and which no longer do so—and why.
- Are the top-paid doctors in your area actually “experts”? When we first looked at the data, we found that many of those who made the most money weren’t experts in a traditional sense. They didn’t work at academic medical centers. They didn’t have research publications. They weren’t leaders in their specialty societies. Some didn’t even have board certification, meaning they didn’t have special credentials in their fields. And some had been disciplined by their medical boards.
- What are the rules at your local medical schools—and are faculty members following them? Many academic medical centers and teaching hospitals have put in place policies prohibiting faculty from serving on pharma speakers bureaus, believing doctors should not serve as company pitchmen. But we found that some faculty did so anyway. What’s going on in your area? Are schools/hospitals adopting restrictive policies, and more importantly, are faculty members following the rules?
- How much do drug company dinners cost? Some doctors, we’ve found, receive hundreds and even thousands of dollars’ worth of meals each year from a single drug company. How much do folks in your area get? How often do you have to get company meals to add up to thousands a year?
- Do big prescribers of brand-name drugs in Medicare Part D have financial relationships with the makers of those drugs? We found that for many highly advertised drugs, the top prescribers also received speaking money from the maker. Is this the case in your state?
- Do doctors have overlapping relationships with a company? We looked at how many doctors received research money from a company, as well as speaking or consulting payments. What type of unique conflicts of interest does this pose?
Why You (and Your Audience) Should Care
- Patients trust their doctors to prescribe the right drugs for them and not be influenced by financial interests.
- More than a dozen drug companies have been required to disclose payments to physicians as a condition of settling lawsuits alleging improper marketing and/or kickbacks to physicians.
- All companies (pharma and medical device) will be required to disclose payments to doctors this fall under the Physician Payment Sunshine Act. A story now about these relationships could help prepare the public—and the medical community–for the huge amount of data that will be available later this year. More information on the Open Payments system can be found at go.cms.gov/openpayments.
- There are a number of basic questions patients can ask their physicians about financial relationships in a non-confrontational way.