Since mid-2013, pharmaceutical and medical device companies have spent more than $42.8 million to entertain, feed, train, pamper and even directly pay doctors in Oregon, according to a massive dataset that investigative journalists at nonprofit ProPublica compiled and made available to The Lund Report.
Extensive research has documented the subtle and direct ways Big Pharma spending influences medicine; physicians who are treated to lunch, offered free training or otherwise paid by pharmaceutical companies have repeatedly been shown to prescribe more of those companies’ drugs. In a paper in JAMA Internal Medicine, researchers argued that these relationships distort how diseases are researched, defined, prevented and treated – not always to the benefit of patients.
The Physician Payment Sunshine Act, passed alongside the Affordable Care Act as part of Barack Obama-instigated healthcare reform, required pharmaceutical and medical device companies to publicly report these payments starting in August 2013. Industry officials defend the money they spend, telling ProPublica that meetings with doctors allow them to keep in touch with the needs of local communities, and that other funds compensate medical providers for assisting with research, or for providing or attending training.
The data show that more than 9,652 medical professionals in Oregon have accepted at least one gift or payment from 706 distinct medical device or pharmaceutical companies since data tracking began.
Some of these disclosed payments are too tiny to raise much concern: Hyperion Therapeutics spent $5.54 on in-kind items and services, Shofu Dental Corp made a $10 cash payment. All told, 98 companies spent $100 or less on gifts, training and other spending during this time, and 286 companies spent less than $1,000.
Unsurprisingly, the companies that have spent the most to influence Oregon medicine are also some of the largest medical firms on the planet. The 20 highest-spenders in Oregon are:
- A-dec, Inc.: $4,323,323.90
- Takeda Pharmaceuticals U.S.A., Inc.: $1,349,854.03
- DePuy Synthes Sales Inc.: $1,309,755.75
- Sanofi and Genzyme US Companies: $1,236,563.49
- Valeant Pharmaceuticals International: $1,203,111.53
- AstraZeneca Pharmaceuticals LP: $1,146,245.74
- Zimmer Biomet Holdings, Inc.: $1,017,445.99
- Janssen Pharmaceuticals, Inc: $1,010,987.99
- Pfizer Inc.: $945,391.71
- Zimmer Holding Inc: $941,554.02
- Allergan Inc.: $892,611.91
- Ormco Corporation: $868,626.22
- Stryker Corporation: $821,859.34
- NUVASIVE, INC.: $780,369.30
- Cepheid: $692,382.74
- Genentech, Inc.: $671,027.93
- Covidien Sales LLC: $600,430.03
- Novartis Pharmaceuticals Corporation: $590,968.48
- Biomet, Inc.: $571,620.90
- KARLSTORZ Endoscopy-America: $557,530.06
All told, 85 companies spent at least $100,000 in the state. Click here for a spreadsheet that breaks out this spending, showing how much these pharmaceutical and device firms made in direct payments, how much in other forms of gifts, and how much in stock or ownership interests.
Most spending was not targeted at promoting a single specific drug, but $12.8 million was spent in association with individual medications or other treatments. Pharmaceutical companies spent especially heavily to promote type 2 diabetes and multiple sclerosis treatments. The ten medications linked to the highest industry spending in Oregon are:
- Invokana, used in treatment of type 2 diabetes: $467,781.67
- Bydureon, used in treatment of type 2 diabetes: $372,005.26
- Copaxone, used in treatment of forms of multiple sclerosis: $326,878.88
- Tecfidera, used in treatment of some forms of multiple sclerosis: $283,439.26
- Symbicort, used in treatment of asthma or chronic obstructive pulmonary disorder: $274,318.66
- Xeljanz, used in treatment of rheumatoid arthritis: $252,557.44
- Oncaspar, used in treatment of leukemia: $225,573.19
- Eliquis, an anticoagulant: $203,814.36
- Seroquel XR, an antipsychotic used to treat several mental health conditions: $202,535.01
- Plegridy, used in treatment of multiple sclerosis: $198,804.61
Click here for a spreadsheet that shows how much drug companies have spent to promote their products with doctors in Oregon.
The ways that pharmaceutical companies and medical device manufacturers spend vary enormously – and often do not involve direct transfers of cash to physicians. Though these businesses made $529,783 in gifts to Oregon doctors and awarded another $1.9 million in grants, far more often their payments were for services (such as $8.8 million in speaking fees) or were less tangible to the doctors on the receiving end (such as $3.5 million spent on food and beverages, and $4.4 million spent on travel and lodging). Broken down by category, here’s how the industry has spent money on Oregon doctors since reporting began in 2013:
- Accredited Training: $116,859.57
- Charitable Contribution: $4,689,488.51
- Consulting: $9,475,239.16
- Education: $1,731,763.55
- Entertainment: $5,902.50
- Food and Beverage: $3,475,998.12
- Gift: $529,783.42
- Grant: $1,874,086.15
- Honoraria: $789,790.69
- Nonaccredited Training: $430,616.78
- Ownership or Investment Interest: $411,915.14
- Promotional Speaking: $8,881,908.57
- Royalty or License: $5,588,281.18
- Space Rental or Facility Fee: $416,713.97
- Travel and Lodging: $4,424,246.77.
The enormous database of pharmaceutical and medical device manufacturer payments compiled by ProPublica was analyzed with the assistance of software developer Sarah Fullmers. In future stories, The Lund Report will look into which physicians are accepting the most gifts and payments from industry, and will examine geographical variations in how doctors are paid.
Reach Courtney Sherwood at [email protected], or follow her on Twitter at @csherwood.
