Category Archives: Conflicts of interest

Pharmaceutical industry influence starts with the doctor’s prescribing pen #ahcj13

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Tracey Drury

About Tracey Drury

Tracey Drury is a reporter at Buffalo Business First. She is attending Health Journalism 2013 on an AHCJ-New York Health Journalism Fellowship, which is supported by the New York State Health Foundation.

Can a doctor’s prescription be bought for a tuna sandwich?

Whether it’s a tuna sandwich, steak dinner or a four-figure payment, there’s always the possibility of influence. And that’s how conflicts of interest begin in the medical field.

That was the message this morning from reporters Peter Whoriskey of The Washington Post and John Fauber of the Milwaukee Journal Sentinel during their panel on reporting on medical and financial conflicts of interest during AHCJ’s Health Journalism 2013 in Boston.

“Their job is to sell as much product as they can and maximize profits,” Fauber said of the pharmaceutical companies. “One of the ways they do that is by creating financial relationships with various stakeholders, which can be doctors, medical societies or medical schools. While this may be good for the bottom line of the drug companies, it may not work out for the patients.”

Fauber advised journalists to be on the watch for several things: promotional speaking gigs by physicians; participation in continuing medical education (CME) events; financial relationships between medical journal editors and drug companies; and royalties that come back to hospitals and physicians.

“It struck me very quickly that all the cynicism the media brings to politicians or companies, anybody, is held in abeyance for doctors and anybody that wants to heal you,” Fauber said. Continue reading →

Using data to track doctors’ referrals, relationships #ahcj13

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Jason Hidalgo

About Jason Hidalgo

Jason Hidalgo is a business reporter at the Reno (Nev.) Gazette-Journal. He is attending Health Journalism 2013 on an AHCJ-Healthier Beat Fellowship, which is supported by the Leona M. & Harry B. Helmsley Charitable Trust.

Fred Trotter

Photo by Pia ChristensenFred Trotter.

Going online is usually a great way to waste time or — for adventurous social media users — get in trouble.

For resourceful journalists, however, the Internet is a treasure trove of information that can be invaluable for reporting. These include providing access to open-source tools such as DocGraphs, which can provide crucial data that may not easily be available anywhere else.

A crowdfunded project from open source developer Not Only Dev, DocGraphs aims to shed light on the relationships between various medical providers, and make that information more accessible to the public. Examples include which doctors and medical centers a specific doctor refers patients to or which laboratories a physician group tends to use. Continue reading →

Panel will discuss newly released 990 data on hospitals #ahcj13

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About Karl Stark

Karl Stark, vice president of AHCJ's board of directors, is the assistant managing editor, health and science, at The Philadelphia Inquirer.

AHCJ has just released a new trove of information from GuideStar on the finances of nonprofit U.S. hospitals. This information – from tax years 2009 and 2010 – contains carefully selected highlights from the hospital’s IRS 990 forms, which nonprofits must file to maintain their mostly tax-free status.

Reporters can use this AHCJ spreadsheet to get:

  • detailed salary info on top executives
  • the institution’s charity care and community benefit numbers
  • a hospital’s lobbying expenses
  • and the business relationships of board members, among other things.

This data will be discussed at the Health Journalism 2013 session, “Diving into documents: Using 990s and more to cover hospital finances,” on Sunday at 10:40 am. Howard Rivenson, senior lecturer on health management, Harvard School of Public Health, will join me to help demystify hospital finances.

The newest material from 2010 is here and here are last year’s data.

Even in treatment guidelines, pharma conflicts abound

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

As part of the ongoing Milwaukee Journal Sentinel and MedPage Today series “Side Effects” John Fauber and Ellen Gabler “examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the United States” and unearthed yet another tactic by which “pharmaceutical companies, with billions in sales at stake, exert a powerful but often unrecognized influence over the practice of American medicine.”

Issued by leading medical associations and government institutions, treatment guidelines are supposed to be based on rigorous science. But the committees that write them have been dominated by doctors who have worked as paid speakers, consultants or advisers for companies selling the recommended drugs.

In their investigation, the duo found:

  • Nine guidelines were written by panels where more than 80 percent of doctors had financial ties to drug companies.
  • Four panels did not require members to disclose any conflicts of interest. Of the 16 that did, 66 percent of doctors on the panels had ties to drug companies.
  • Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing. Medical experts have raised such questions about guidelines for anemia, chronic pain and asthma.

For extensive anecdotes and examples, dig into the full piece.

Investigation: Medtronic paid millions to surgeons; ghostwrote papers

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Over at the Milwaukee Journal Sentinel and MedPage Today, John Fauber updates Side Effects, his long-running investigation into conflicts of interest, with coverage of a Senate inquiry which Fauber’s work helped inspire.

The Senate investigation, led by the familiar bipartisan duo of Max Baucus and Chuck Grassley (2,315-page PDF | press release), involved the review of about 5,000 pages of documents from medical device maker Medtronic (a frequent subject of Fauber’s reporting) over the course of 16 months.

Fauber, who is uniquely qualified to do so, summarized the report’s key findings:

Medtronic marketing employees were secretly involved in drafting and editing favorable medical journal articles about the company’s lucrative back surgery product while the company paid millions to the surgeons whose names lent weight to the studies, documents from a U.S. Senate investigation reveal.

The company’s undisclosed manipulation of information about its genetically engineered spine surgery product, Infuse, included overstating its benefits and downplaying concerns about serious complications.

Over the course of 15 years, Medtronic paid $210 million to a group of 13 doctors and two corporations linked to doctors, including more than $34 million to University of Wisconsin orthopedic surgeon Thomas Zdeblick, who co-authored a series of papers about the product.

Reporter tracks top prescribers’ ties to drugs they prescribe

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

A while back, Sen. Charles Grassley wrote to state health officials, asking for lists of top Medicaid prescribers of certain drugs. When her state released its, Lisa Chedekel of the Connecticut Health Investigative Team took it and ran with it, using all manner of public data to assemble a portrait of Connecticut’s prolific prescribers and the conflicts of interest that may drive them.

Speaking of conflicts of interest, Chedekel found that 43 of the 108 high prescribers (some broke into the top 10 for multiple drugs) earned money, meals or other benefits from the very companies whose drugs they were subscribing in such large quantities. She profiles a number of these physicians, but my personal favorite is one whose records show a curious correlation:

Dr. Kathleen Degen of Norwich was not among the top prescribers of Eli Lilly’s Zyprexa in 2008, but was the seventh-highest prescriber in 2009 (with 255 prescriptions), when Eli Lilly paid her $24,950 in speaking fees. Her prescribing fell off slightly in 2010, and she received $5,291 from Eli Lilly for speaking and travel. She disappeared from the high prescriber list in 2011 and received just $16 in meals from Eli Lilly, records show.

To better understand the problems that could arise from situations like these, Chedekel talked with academics, as well as a number of physicians named in the story. She also took a look at the drugs themselves, many of which Grassley had selected due to their controversial nature. The piece is a blueprint for reporting state-by-state on similar lists. The story also aired on Fox Connecticut.

‘Top Doctors’ rankings lack standards, oversight

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

It’s going to surprise exactly nobody that the organizations that help sell plaques to physicians might just be in it for the money, but I still have to tip my hat to ABC News for investigating the living daylights out of several such outfits.

The typical business model seems to be “shamelessly flatter any doctor whose contact information you can get your hands on, then refer them to your affiliated plaque salesman. Profit, rinse, repeat.” Nevertheless some doctors and consumers seem to take them seriously, with hospitals pushing their doctors to get listed, and physicians trumpeting their listings on websites and in press releases. Following their lead, ABC treated the listings just as seriously, going so far as to match them with databases of disciplined doctors. They found plenty of matches, including a few examples that were downright spectacular.

Dr. Conrad Murray, convicted of manslaughter for administering a lethal overdose of the anesthetic propofol to Michael Jackson in 2009, is still listed as a “Top Cardiologist,” according to the Consumers’ Research Council of America.

A “Top Pediatrician” according to the Consumers’ Research Council of America is also a convicted serial child rapist charged with the molestation of 103 children. Dr. Earl Bradley is currently serving 14 life sentences in addition to a 160-year prison term, yet he remains on the Consumers’ Research Council of America “Top Pediatrician” list.

Beyond the headline-grabbing details, the reporters go to great lengths to explain the company’s business models and their screening procedures, or lack thereof. My personal favorite was a website, TopDocs.com, whose CEO says he has enticed “a couple of hundred” doctors to pay from $1,500 to $10,000 for a listing, not including the $1,600 annual fee. Yet, the ABC crew writes, “In reference to the actual name ‘TopDocs.com,’ (the CEO) told ABC News, ‘We are not inferring in any way that the doctors in the site are top doctors.’”

U. Iowa hospitals share patient data with fundraising organization

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Des Moines Register‘s Clark Kauffman opens his investigative report with a simple observation: “University of Iowa Hospitals is giving patient names and specific patient-treatment information to a fundraising organization that solicits donations through written appeals signed by physicians.” Then he backs it up.

Kauffman reports that while universities deny that the practice is questionable, “Patient advocates … say the fundraising seeks to take financial advantage of patients who feel indebted to their doctors for their medical treatment.”

“If people actually knew this sort of thing was going on, there would be a significant number of them disturbed by it,” said Dr. Michael Carome of Public Citizen, a national advocacy group with 80,000 members. “The fundamental practice is exploitative … and in my view there is no way to make this work in a way that would be ethical.”

Hospital spokesman Tom Moore said the fundraising campaign is legal and “completely ethical.” He said the university looked at “best practices” among its peers, and its fundraising practices are in line with those of other hospitals.

Kauffman found that, apparently, these “best practices” include sharing patient contact information, insurance status and appointment schedules with donors without their consent. It also includes routinely seeking patient permission to disclose more specific medical information. And the information flows the other way too, with doctors being notified if one of their upcoming patients is a major donor. Kauffman’s piece describes a fascinating hidden economy.

Experts with ties to drugmakers promoted prescribing opiates to older patients

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Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

Should older adults use powerful narcotics for ongoing pain relief?

This is a much-debated topic in geriatric circles. Last week, it burst into the public sphere with an article in the Milwaukee Journal Sentinel and MedPage Today by John Fauber and Ellen Gabler.

Their story focuses on a 2009 recommendation by the American Geriatrics Society that physicians consider prescribing opiates more often to seniors with moderate to severe pain.

Potential conflicts of interest may have compromised the Geriatric Society’s guidelines, Fauber and Gabler discovered. Five of 10 panel members who prepared the report had financial ties with opiate drugmakers and a sixth member began serving as a speaker for a drug company in the following year.

In another disturbing finding, Fauber and Gabler reveal that a pain guide endorsed by the Geriatrics Society and funded by an opioid drugmaker highlighted benefits of narcotics while downplaying risks – the potential for addiction, cognitive problems, overdosing, falls and fractures, and the enhancement rather than diminishment of pain.

“None of these side effects was included” in the document; instead, it claimed that “opiods allow people with chronic pain to get back to work, run and play sports,” they write.

The Geriatrics Society told the reporters that it stands behind the guide and is “deeply concerned that public policy may create barriers that will limit older adults’ access to pain medicine.”

In a sidebar, Fauber and Gabler examine a related issue in this controversy: the contention that alternatives to opioids – common over-the-counter drugs such as Aleve, Advil and Motrin – can have more deleterious health effects than narcotics. Continue reading →

Esophageal cancer screening could lead to runaway health costs

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Reuters’ Frederik Joelving reports that a new, easier method of taking biopsies to detect esophogeal cancer, called TSA, has opened a up a whole new profit center for folks pushing cancer screening, despite the fact that, as Joelving writes, “there is no research showing that routine screening for esophageal cancer lowers the risk of dying from the disease. Specialist medical groups recommend against it, as does the American Cancer Society.”

Joelving’s report focuses on one physician, Dr. Jonathan Aviv, who has peddled the screening with particular vigor, recommending it for anyone over age 50. Here he is with talk show host Dr. Mehmet Oz:

Folks in the know are not nearly as impressed as the TV doctor.

While the cost of TNE is lower on a per-patient basis than traditional endoscopy, critics say testing millions of people would needlessly add billions of dollars to the already bloated U.S. national health bill and lead to lifelong follow-up testing for many people who would never get the disease.

“You are going to end up hurting a lot of people, and it’s not clear to me you’re going to help very many,” says Dr. Otis Brawley, chief medical officer of the American Cancer Society and author of “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.” “The simple, ‘Let’s find it early, let’s not pay any attention to the potential for harm’ – that same thought process is what started prostate cancer screening.”

Joelving even goes so far as to compare the test’s business potential to PSA, the well-known antigen screening for prostate cancer that costs the American health system at least $3 billion a year, and which one of its discoverers described as resulting in “a hugely expensive public health disaster.”

And, speaking of conflicts of interest, Joelving found Aviv has plenty.

At different times over the past decade, he was a paid consultant to three companies that make or sell TNE scopes and related equipment: Minneapolis-based Medtronic Inc, Pentax — now known as KayPentax, based in Montvale, New Jersey – and Vision-Sciences Inc, of Orangeburg, New York. Aviv says he is no longer a paid consultant to any of the companies, though he owns several thousand shares in Vision-Sciences and uses its equipment. The company’s systems cost between $30,000 and $60,000.

Watch the AHCJ Health Reform Core Topic pages for an upcoming feature by Joelving about how he reported this story. For more about screenings and comparative effectiveness research, see our recent article by Rochelle Sharp.