Dollars for Doctors: Who Owns Your Physician?

Paul D. ThackerInvestigator

Project On Government Oversight

Industry payments to physicians

Industry funded ghostwriting

In 2008, health insurance cost around $5000 for an individual and $18,000 for a family of four.

It is health that is real wealth and not pieces of gold and silver.—Mohandas Gandhi

A wise man should consider that health is the greatest of human blessings.—Hippocrates

Why Is Our Health Important?

Senate Finance Committee has jurisdiction over tax, trade, social security, and medicare and medicaid.

Medicare and Medicaid are now a larger portion of the federal budget than the Pentagon.

The pharmaceutical industry’s largest customer is the U.S. federal government, which pays for about 1/3 of drugs sold in the United States

Pharmaceuticals account for about 15% of healthcare expenditures, in both government programs and the private sector

Who Cares?

Indirect Costs

Vioxx: up to 140,000 excess heart attacks.

Avandia: about 83,000 excess heart attacks.

In 2004, Medicare reimbursed hospitals $27,820 of a national charge of $45,076 for acute myocardial infarction.

Medicare: $3.89 billion

Total: $6.31 billion

Medicare: $2.31 billion

Total: $3.74 billion

Who Do You Think You Are?!

The power to oversee or investigate is implied rather than enumerated in the Constitution .

The Supreme Court has affirmed the power of Congress to investigate.

Statutory Authority can be found in several whistleblower protection laws going back to the 1912.

PHARMA

DOCTORS

UNIVERSITIES

HOSPITALSCME

PROFESSIONAL SOCIETIES

Pharma was an industry in which it was almost too easy to be successful. It was a licence to print money. In a way, that is how it lost its way.

News Meeting — August 9, 2011 02:38 PM

Pay to Play JournalismWhy is the Karzai government funding reporters’ trips to Afghanistan?

By The Editors

Justice Clarence Thomas Caught with Ghostwritten Opinion

By Adam LiptakSeptember 21, 2011, 4:23 PM ET

A growing legal scandal engulfed the Capitol when allegations surfaced that attorneys for Goldman Sachs ghostwrote a legal opinion for Justice Clarence Thomas in a matter heard last fall by the Supreme Court involving shareholders suing the company’s top executives for fraudulently hiding financial losses in early 2008.

Drafts of documents and emails obtained by The New York Times show that Goldman attorneys apparently wrote entire passages and tinkered with sentences in the opinion summary, to slant language in favor of Goldman executives and against shareholders.

Contacted at his home last night, Justice Thomas refused comment as did other members of the Supreme Court.

Justice Thomas Ghostwriting Talking Points

These accusations are blatantly false and inaccurate.

I had to edit and rewrite the draft several times to produce the final opinion.

I scrutinized every page and rewrote and edited as I deemed necessary. The final product reflects this process.

The work and conclusions of the opinion are mine.

I stand by the opinion.

Comments on J-Blog

I do not do commercials. I remain professionally insulted to think that my reporting is unduly biased by government relationships.

There is absolutely no shame in being paid well for having good ideas. I have followed every rule and practice to the highest ethical standard.

I am sure my colleagues have been troubled by the attacks on them in the press but they have not been singled out. The personal attacks against me must be answered because I want you, my colleagues and friends, to know the facts. I remain proud of my efforts to report on current events in Afghanistan.

In the end, readers are well-served when government representatives work with journalists to make sure the facts are reported properly.

Physicians, Judges, Journalists….

Held in high social regard and have unique knowledge not normally accessible by the general public.

Expected to make decisions based on a set of objective facts and precedent.

Require constant learning to stay abreast of changes.

Should avoid bias.

Make decisions that can dramatically effect the lives of many people.

Industry Payment to Physicians

Psychiatrists, Children and Drug Industry’s Role

By GARDINER HARRIS, BENEDICT CAREY and JANET ROBERTSPublished: May 10, 2007

When Anya Bailey developed an eating disorder after her 12th birthday, her mother took her to a psychiatrist at the University of Minnesota who prescribed a powerful antipsychotic drug called Risperdal.

Lawmaker Calls for Registry of Drug Firms Paying Doctors By GARDINER HARRISPublished: August 4, 2007WASHINGTON, Aug. 3 —

Mr. Grassley said that he had asked how much the child psychiatrist, Dr. Melissa DelBello at the University of Cincinnati, made from AstraZeneca, the London-based drug giant that manufactures the antipsychotic Seroquel.

Dr. DelBello’s studies of Seroquel in children have helped to fuel the widespread pediatric use of antipsychotic medicines. Those studies were inconclusive, but she has described them as demonstrating that Seroquel is effective in some children.

Asked in a past newspaper interview how much she was paid by AstraZeneca to help market Seroquel, she had said, “Trust me, I don’t make very much.” Mr. Grassley said this week that her disclosure forms at the University of Cincinnati show she received $100,000 from AstraZeneca in 2003 and $80,000 in 2004. Dr. DelBello consults for seven other drug makers as well. She did not respond to requests for comment this week.

Richard Puff, a university spokesman, said he did not know how much Dr. DelBello made in combined payments from all eight drug makers. Asked if the institution did anything to verify its professors’ financial disclosures, he replied, “We do trust our faculty when they’re making these

disclosures.”

Physician Payments Sunshine ActRequire Disclosure on a Publicly Available Database

NIH Rules on Disclosure

Defines Significant Financial Interest as $10,000 in payment or 5% ownership.

University discloses a COI to NIH.

University confirms management of COI.

It is difficult to get a man to understand something, when his salary depends upon his not understanding it!“

— Upton Sinclair

For where your treasure is, there will your heart be also.

— Luke 12:34

šar- i-iš šá šá-ri-i i-dab-bu-bu dum-qí-šú / šar-mi meš-ru-ú il-la-ku i-da-a-šú ḫSolemnly they speak in favour of a rich man, “He is a king,” they say, “riches go at his side.”

The Babylonian Theodicy, lines 281-282, in W.G. Lambert, Babylonian Wisdom Literature

Physician Payments Sunshine Act passed as part of Healthcare Reform

NIH announced new rules for disclosing financial interest.

Universities’ Lobby Pushed Obama to Keep Conflicts From Public2011-09-02 04:01:00.9 GMT

By Alex Wayne and Drew Armstrong (Bloomberg) -- The lobby for Harvard University andother research institutions drove the Obama administration to weaken draft rules for scientists to disclose potential conflicts of interest, according to U.S. records and watchdog groups.    The standards, introduced by the National Institutes ofHealth on Aug. 23, give schools the option to conceal when government-funded scientists get financial compensation from drugmakers and other companies, said Sheldon Krimsky, a professor at Tufts University School of Medicine in Boston and author of “Science in the Private Interest.”

Industry Funded Medical Ghostwriting

Ghostwriting in Medical Literature

Minority Staff Report

111th Congress

United States Senate Committee on FinanceSen. Charles E. Grassley, Ranking Member

June 24, 2010

Despite acknowledgment of medical writers for “editorial assistance,” the role of pharmaceutical companies in medical publications remains veiled or undisclosed

Some medical schools explicitly prohibit ghostwriting in their policies

Detection of ghostwriting by medical schools is limited

Strengthening journal authorship policies appears to have limited effect on ghostwriting and disclosure of industry financing of medical articles

• Editor-in-chief of a medical specialty journal contacted the Committee and said that his journal handles articles that it suspects were ghostwritten by questioning or editing the articles.

• At least one third of the papers submitted to his journal were written by science writers hired by an agency and paid for by a pharmaceutical company.

• In some cases, it was clear that the academic expert had limited input in the writing of the article.

• He was also concerned that medical literature “has become inundated with repetitive promotional articles.”