Conflict of interest   Swine flu vaccine

St. Louis doctors get $2.5 million from Pfizer, Lilly, Glaxo, Merck
By Evan Binns
http://stlouis.bizjournals.com/stlouis/stories/2010/04/26/story2.html?b=1272254400^3242391

April 23, 2010

Dr. Robert Belshe traveled throughout rural Missouri and Illinois last year to discuss flu vaccines during the H1N1 scare. Drug companies Merck & Co. Inc. and GlaxoSmithKline helped pick up the tab.

Belshe, head of Saint Louis University’s Center for Vaccine Development, spoke at more than 20 educational forums on behalf of the drug companies, and he was paid roughly $18,000 in speaker’s fees and travel expenses, according to the companies’ financial disclosures.

“Companies come to me because I have a deep background in vaccines and because of my training,” Belshe said. “And if I’m available, they compensate me for that.”

Belshe has lots of company. Dr. David Alpers, a gastroenterologist at Washington University School of Medicine, received $134,688 from GlaxoSmithKline in compensatory fees last year, according to company filings. Dr. David Weinstein, an OB/GYN at Missouri Baptist, was paid more than $103,000 — $31,000 from Glaxo-SmithKline and $72,500 from Eli Lilly and Co. — in fees, according to filings.

Those three doctors were among 186 health-care professionals, medical institutions and medical practices in St. Louis to receive compensation last year from Merck, GlaxoSmithKline, Eli Lilly and Pfizer Inc. Disclosures show the 186 entities received a combined $2.5 million for participating in continuing education on products, leading forums and for travel expenses.

The actual total for the year is likely much higher. Eli Lilly’s data covers only the first nine months of 2009, while England-based GlaxoSmithKline’s info covers the final nine months. Merck and Pfizer released data for only the final six months of 2009.

As drug manufacturers prepare to increase transparency as mandated by provisions of the health reform law, critics question whether this kind of compensation unduly influences the practice of medicine.

While drug manufacturers disclose some payments to health-care physicians, Eric Campbell, an associate professor at Mass General Hospital’s Institute for Health Policy, noted that the disclosures did not contain full-year data, were difficult to access and were unaudited.

As of right now, “there is no universal disclosure for what companies pay,” Campbell said. “And a couple of the companies are doing it for marketing off-label drugs.”

Both GlaxoSmithKline and Pfizer were required to disclose payments to health-care professionals to settle investigations into the alleged illegal promotion of drugs for off-label uses, or uses not approved by the FDA.

Belshe said speaking at forums sponsored by drug companies not only gave continuing education on new drugs to rural physicians, it also provided community feedback on the challenges of providing effective health care, such as vaccinating children in rural communities.

“(Universities) want to encourage faculty with very deep expertise to provide this type of education for community doctors, because you will get quality info with the least amount of bias possible,” Belshe said.

Mass General’s Campbell said compensatory payments to physicians for non-research services, such as speaking at forums or leading continuing education seminars on particular products, were “essentially marketing-related relationships.”

“I’m highly skeptical of calling anything of what drug companies do ‘educating.’ They sell drugs to satisfy a fiduciary duty to shareholders,” Campbell said. “The companies hide a lot of drug sales under the rubric of education, but the people employed on their behalf are not educators; they’re people selling drugs.”

A 2009 report published by the Institute of Medicine of the National Academies found that general practitioners involved in industry-sponsored studies increased their use of the trial sponsor’s drugs. The report was compiled by the institute’s committee on conflicts of interest in medical research, education and practice. “Some clinical trials in community practices may be ‘seeding’ trials that (drug) companies design to change prescribing habits rather than to gather scientifically useful information,” the report stated.

“The payments do what they’re supposed to do, which is make the doctors prescribe the company’s drugs,” Campbell said.

Despite criticism over payments to doctors, experts say that drug companies provide essential treatments and drugs, which ultimately benefit the population’s health.

“The reality is that big pharmaceutical companies do wonderful things with medicine, and new products are developed through these companies being good stewards but also effective business people,” said Dr. Robert Heaney, senior associate dean of Saint Louis University School of Medicine and assistant vice president for the university’s Medical Center. SLU received almost $12,000 from Pfizer for clinical research last year, according to the drug manufacturer’s filings.

For SLU, drug companies are major benefactors of ongoing research, according to Heaney. “Merck is the primary manufacturer of vaccines. How could you not talk to them and still be a good vaccine center?” Heaney said.

SLU enforces policies to limit the interactions of practicing physicians and medical students with drug companies to avoid undue influence. “We have to understand that (drug companies’) business ethics are not always compatible with a physician’s professional ethics,” Heaney said.

Washington University and its medical school, which collectively were paid more than $131,000 by Eli Lilly and Pfizer in 2009, said the money was part of about $61 million in funding for research from private sources. Joni Westerhouse, executive director for medical communications at Washington University School of Medicine, said the university also saw a “need to ensure that corporations’ research support and business-development activities do not unduly influence research and medical decision-making.”

“The school will continue to nurture academic-industry collaboration in medical discovery and scientific advancement, and continue to refine and update our policies to ensure the highest standards of ethical and professional behavior and research integrity,” she said. The university has a five-year, $25 million agreement with Pfizer to collaborate on biomedical research.

List of Drug Company Payouts
Top 5 earners for each drug company:

Merck & Co. Inc.*
Physician Payment
Dr. Janet McGill $12,525
Dr. Stephen Crespin $10,625
Dr. Lawrence Gelb $10,500
Dr. Mario Castro $10,375
Dr. Robert Belshe $10,325
*disclosure of payments to U.S. speakers for promotional (non-CME) medical education activities conducted from July 1 to Dec. 31, 2009.

Eli Lilly and Co.*
Physician Payment
St. Charles Psychiatric Associates $130,900
Dr. Azfar Malik $74,900
Dr. David Weinstein $72,500
Allied Behavioral Consultants Inc. $67,750
Northwest Psychiatric Associates $60,450
*disclosure of payments for leading advising and consultation fees, as well as reimbursement for educational programs, from Jan. 1 to Sept. 31, 2009

GlaxoSmithKline*
Physicians Payment
Dr. David Alpers $134,688
Dr. Bernard McGuire $46,000
Dr. Morey Blinder $40,400
Dr. Eric Lederman $32,650
Dr. David Weinstein $31,000
*disclosure of payments made from April 1 to Dec. 31, 2009.

Pfizer*
Physicians Payment
Washington University and Washington University Medical School $106,414
Dr. Marin Kollef $86,489
Dr. Jeffrey Gordon $75,108
Dr. Andrey Shaw $37,500
Dr. Carl Klutke $37,370
*disclosure of payments made from July 1 to Dec. 31, 2009.