Data shines light on industry payments to researchers, medical experts

“I’ve got the expertise to talk about these new classes of medications in a way that very few people in the country can,” one physician says of consulting for drug makers.

Depoe Bay is the “Whale Watching Capital of the Oregon Coast.” But besides a resident pod of gray whales, the seaside town is also home to one of the nation’s top medical experts in managing diabetes.

Dr. Patrick Boyle, an endocrinologist, was a professor of medicine for 22 years at the University of New Mexico in Albuquerque, where he helped conduct landmark clinical trials in diabetes for the National Institutes of Health. 

Now, he’s semi-retired, but sees patients six days a month at the Samaritan Depoe Bay Clinic, in a town of 1,400 people that he describes as “medically underserved.”

When he’s not at the clinic, Boyle spends a fair amount of time traveling around Oregon speaking to groups of primary care physicians about the different options available for treating diabetes, a disease that affects 1 in 11 Americans.

For his consulting work, Boyle earned $58,000 in the last five months of 2013 from various drug manufacturers, including Takeda Pharmaceuticals, AstraZeneca Pharmaceuticals, Janssen Pharmaceuticals, Eli Lilly and Company, and Bristol-Myers Squibb.

He acknowledges the public perception of a conflict of interest – “I think society looks negatively upon this, like it’s just another way for rich doctors to make more money,” he said – but insists that he is sharing highly specialized knowledge with primary care providers, who write most of the prescriptions for diabetes drugs because of a nationwide shortage of endocrinologists.

“I’m one of 4,000 endocrinologists in the United States, I’m a former professor of medicine and I’ve got the expertise to talk about these new classes of medications in a way that very few people in the country can,” Boyle said.

“It’s not just speaking about what the drug company wants,” he said of the speaking engagements. “It’s about positioning the compound in our managed care world – where it fits, understanding why people have diabetes, why this class of medicines addresses that. I’m taking whatever advances in science exist, and using my experience to help people understand and put it in terms that they can put into practice.”

Boyle insists the payments do not influence the prescriptions he writes for his patients. And, he said, his work as a consultant is no secret.

“Most of my patients in fact know that I do this,” he said. “I tell them ahead of time. I don’t want them to think there’s impropriety.”

The payments that Boyle received in 2013 became public last fall in a database called Open Payments, created as a result of the Sunshine Act, part of the Affordable Care Act designed to increase transparency and accountability in the healthcare system.

The $58,000 Boyle received in 2013 ranks 10th for doctors in Oregon, and pales in comparison to the $178,000 that Dr. Mark Jewell, a plastic surgeon in Eugene, took in.

The Lund Report first reported on the payments database last October, finding that physicians and teaching hospitals in Oregon were paid $9.65 million from 348 pharmaceutical companies and device manufacturers. The database only covers payments made during the last five months of 2013.

Other Oregon doctors receiving payments, like Boyle, are well-known across the country.

Dr. Kiren Kresa Reahl, a neurologist specializing in multiple sclerosis and Parkinson's disease with Providence, received $36,441, according to Open Payments. More than 80 percent of the total is related to speaking engagements.

“Dr. Kresa-Reahl is routinely asked to speak around the country. She’s a nationally recognized expert and highly respected in the multiple sclerosis community. We are fortunate to have her working with us,” Gary Walker, Providence spokesman, wrote in an email.

Dr. Y. Pritham Raj, the medical director of the internal medicine practice at Oregon Health & Science University, received $35,268, primarily from AstraZeneca Pharmaceuticals, during the last five months of 2013, according to Open Payments. The activities were approved in line with the university’s current conflict of interest policies, said Tamara Hargens-Bradley, an OHSU spokeswoman.

That amount is just a sliver of his consulting income, however. A separate database of payments to doctors, called Dollars for Docs and maintained by independent nonprofit news organization ProPublica, gives details of payments to Dr. Raj of more than $400,000 dating back to 2010.

The database lists payments from AstraZeneca to Dr. Raj of $92,450 in both 2012 and 2013 in the “speaking” category. The company reported paying an additional $27,000 for his meals and travel in 2012.

Under the Physician Payments Sunshine Act, pharmaceutical companies must disclose their payments and other “transfers of value” to the Centers for Medicare and Medicaid Services, which maintains Open Payments and gives physicians the opportunity to review the data and dispute any errors.

OHSU has worked with its faculty to help them understand the need to check the database and confirm the accuracy of the payments attributed to them, before their patients raise questions, said Kara Drolet, associate director of the university’s Integrity Office and chair of its conflict of interest in research committee.

In anticipation of questions from patients, OHSU created a pamphlet to explain that the university has procedures in place to review consulting agreements between faculty members and drug companies, for example, and why doctors should be allowed to be paid consultants in the first place.

“There’s a lot of things for the lay public to understand,” Drolet said. “That’s not something that the Sunshine Act database goes into.”

“The industry relationships are valuable to the advancement of healthcare,” Drolet said. “There is a need for consulting agreements to help advance the development of new therapeutics, particularly of new clinical trials to test those new therapies.”

It should be little surprise that funding to sponsor clinical trials and other research is the largest category tracked by Open Payments. The biggest such transaction in the state was a little more than $1 million from Novartis to OHSU for research of RAD001T, a cancer drug. Dr. Rodney Pommier, a surgical oncologist, is listed as the primary investigator for the trial.

In total, OHSU collected more than $2.9 million in research funds that can be attributed to specific drugs within the database. Combined, other hospitals in the state managed to collect just $200,000 for research – or, only slightly more than Jewell, the Eugene plastic surgeon, collected by himself.

Dollars for Docs also tells a much richer story for Jewell, who tops the Open Payments list for Oregon with $178,000 in general payments and an additional $18,000 for research. Dollars for Docs reports Jewelll made more than $400,000 in 2013 from Allergan.

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There have been multiple studies that show that 1) doctors generally believe their prescription patterns are not at all influenced by drug company gifts or front men, and that 2) their prescribing patterns are, in fact, dramatically influenced by those same things that they say have no effect. I can only imagine that receiving finanicial payments would make that pressure much harder to resist. I'd be more confident in someone saying, "I know that money puts pressure on me to prescribe differnetly. I'm aware of it and take action regularly to assure I remain objective." Saying it has no influence is just plain unrealistic.