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Drug makers spending less on MD speakers

Payments decline as scrutiny from public increases

Some of the nation’s largest pharmaceutical companies have slashed payments to health professionals for promotional speeches amid heightened public scrutiny of such spending, a ProPublica analysis shows.

Eli Lilly and Co.’s payments to speakers dropped by 55 percent, from $47.9 million in 2011 to $21.6 million in 2012.

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Pfizer’s speaking payments fell 62 percent over the same period, from nearly $22 million to $8.3 million.

And Novartis, the largest US drug maker as measured by 2012 sales, spent 40 percent less on speakers that year than it did between October 2010 and September 2011, reducing payments from $24.8 million to $14.8 million.

The sharp declines coincide with increased attention from regulators, academic institutions, and the public to pharmaceutical company marketing practices.

A number of companies have settled federal whistleblower lawsuits in recent years that accused them of improperly marketing their drugs.

In addition, the Physician Payment Sunshine Act, part of the 2010 health care overhaul law, will soon require all pharmaceutical and medical device companies to publicly report payments to physicians. The first disclosures required under the act are expected in September and will cover the period of August to December 2013.

‘It’s possible the number of physicians they need to support sales of these items is less, leading to lower payments overall.’ - Aaron Kesselheim, Harvard Medical School

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The Globe reported in September 2011 that payments to doctors for promoting pharmaceutical companies’ products to their colleagues appeared to be falling in Massachusetts, according to an analysis by the newspaper and ProPublica, coinciding with restrictions on the practice adopted by some of the state’s major academic medical centers.

The state Department of Public Health collects data on all company payments to Massachusetts health care providers, but the most recent data posted on its website are for 2011. A department spokeswoman said the agency is working on updating the information, but she could not say when more recent data would be available.

Within the industry, some companies are reevaluating the role of physician speakers in their marketing repertoire. GlaxoSmithKline announced in December that it would stop paying doctors to speak on behalf of its drugs. Its speaking tab plummeted from $24 million in 2011 to $9.3 million in 2012. Not all companies have cut speaker payments: Johnson & Johnson increased such spending by 17 percent from 2011 to 2012; AstraZeneca’s payments stayed about flat in 2012 after a steep decline the previous year.

ProPublica has been tracking publicly reported payments by drug companies since 2010 as part of its Dollars for Docs project. Users can search for their doctors to see if they have received compensation from the 15 companies that make such information available online. Some companies in the database said their declines have less to do with the Sunshine Act and more to do with the loss of patent protection for key products. Lilly, for example, began facing generic competition to its blockbuster antipsychotic Zyprexa in late 2011. Its antidepressant Cymbalta lost its patent at the end of 2013.

“The value of educational programs tends to be higher when we’re launching a new medicine or we have new clinical data/new indication,” Lilly spokesman J. Scott MacGregor said in an e-mail, adding that the drop in speaking payments also reflects the increased use of Web conferencing.

Pfizer’s patent on Lipitor, its top-selling cholesterol drug, expired in 2011.

“Like any other company, our business practices must adapt to the changing nature of our product portfolio, based in part on products going off patent and new products being introduced into the market,” company spokesman Dean Mastrojohn said in an e-mail.

Novartis’s patent for its breast cancer drug Femara expired in 2011, its hypertension drug Diovan in 2012, and its cancer drug Zometa in 2013. In a statement, Novartis said that speaking payments dropped in 2012, in part, because of a shift from big blockbuster drugs that many doctors prescribe toward specialty products prescribed by fewer physicians.

The industry’s increased emphasis on expensive specialty medications for such conditions as multiple sclerosis and Hepatitis C has been striking, said Aaron Kesselheim, assistant professor of medicine at Harvard Medical School. A piece in the New England Journal of Medicine last week noted half of the 139 drugs approved by the Food and Drug Administration since 2009 were for rare diseases and cancers.

“It’s possible the number of physicians they need to support sales of these items is less, leading to lower payments overall,” Kesselheim said.

Many bioethicists and leaders of major academic medical centers frown upon physicians delivering promotional talks for drug companies, saying they turn doctors into sales representatives rather than leaders in research and patient care.

Officials at Pharmaceutical Research and Manufacturers of America, the industry trade group, disputed this characterization. They said they are working with their member companies to prepare for the Sunshine Act and have created a campaign to promote the value of drug company-doctor collaborations.

Liz Kowalczyk of the Globe
staff contributed to this report. ProPublica, a nonprofit investigative news organization, is based in New York.
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