Years after many big academic medical centers cracked down on industry perks, drug companies still regularly buy meals fordoctors affiliated with smaller hospitals, a new analysis shows, with some physicians receiving dozens of lunches and dinners in a single year.
At a number of community hospitals, well over half of the affiliated doctorswere beneficiaries of industry payments, suggesting there may be fewer restrictions on meals there than at large teaching hospitals.
In 2014, about 77 percent of doctors at tiny Baystate Noble Hospital in Westfield received payments, mostly in the form of meals. Drug and device makers reported they made more than 200 payments each to Dr. Ira Nathanson and Dr. Arthur King. Most meals were under $25 and were given while company representatives provided information on brand name medications for asthma, high cholesterol and blood clots.
Similarly, 74 percent of doctors affiliated with Mercy Medical Center, a Catholic hospital in Springfield, got payments, also mostly in the form of food.
The analysis, of 2014 federal data, was done by the Globe and ProPublica, an investigative journalism group. It matched data on company payments to doctors with Medicare data on the primary hospitals physicians were affiliated with that year.
There are caveats, though: Some doctors have found errors in the payment information companies report to the Centers for Medicare and Medicaid Services. The analysis looked only at doctors in the 100 most common medical specialties.
Overall, the analysis shows, a lower proportion of Massachusetts doctors receive payments than the national average.
While community hospitals registered the largest percentages of doctors receiving any type of payment, teaching hospitals — in Massachusetts and nationally — generally had higher percentages of physicians who earned large amounts from companies. About one-quarter of physicians at Dana-Farber Cancer Institute, for instance, got at least $5,000 in 2014, followed by 13 percent at New England Baptist Hospital and 10 percent at Brigham and Women’s.
Baystate Health, which acquired Noble Hospital last year, said drug companies are no longer allowed to supply lunches in doctors’ offices, which is in line with the policy at its flagship teaching hospital, Baystate Medical Center. Noble’s previous conflict-of-interest policy was more general and did not include specific restrictions, said Baystate spokesman Brendan Monahan.
Nathanson and King did not return e-mails and phone calls from the Globe.
Mercy Medical Center said it monitors company payments to doctors and has “confidence in our physicians to do the right thing.’’ When they don’t, its statement read, “we take action.” The hospital declined to comment further.
A growing body of research has found that doctors who receive free meals tied to specific drugs tend to prescribe more of those drugs. Also, these perks can create a perception among patients that a doctor has been unduly influenced.
Because most doctors work in community hospitals rather than academic medical centers, “a lot of patients are still being exposed to those relationships,’’ said Dr. Aaron Kesselheim, who heads a research program on legal issues related to drugs and devices at Brigham and Women’s Hospital.
Eric Campbell, a health policy researcher at Massachusetts General Hospital, said community hospitals have come under less scrutiny.
“This is a holdover from a very long history of perks in medicine,’’ he said.
“Over the years, there’s been a huge kind of universal movement among academic medical centers to strictly and strongly limit the ability of companies to bring food into hospitals, and to limit doctors who are employees from going out to dinner with them. They have realized very clearly that these are marketing opportunities.’’
Pharmaceutical Research and Manufacturers of America, an industry group based in Washington, believes that it “is sometimes necessary to exchange information over meals,’’ said its spokeswoman, Holly Campbell.
The organization’s policy allows companies to provide “modest, occasional meals’’ to providers, but does not define what “occasional” means. And compliance is voluntary.
Physicians at teaching hospitals are mostly paid for consulting and speaking and as part of royalty agreements — usually signaling longer-term relationships with the drug companies.
Dana-Farber doctors are paid to participate on scientific advisory boards and data safety monitoring boards, to review the accuracy of clinical trial data submitted to the Food and Drug Administration, and to speak around the world about cancer treatments.
Nationally, five of the 10 hospitals with the highest percentage of physicians receiving at least $5,000 in 2014 specialized in oncology.
Dr. Christopher Sweeney and Dr. Paul Richardson, who earned the most from pharmaceutical companies in 2014 at Dana-Farber, said the educational talks they give are very different from those given as part of so-called “speakers bureaus’’ — which have been banned by many teaching hospitals, including their own.
They said they — and not the pharmaceutical companies — create and control the presentations.
Sweeney, a prostate cancer specialist, led a project showing that the generic drug docetaxel, added to hormonal therapy, improves life expectancy for certain patients with metastatic prostate cancer.
In an e-mail, he said that he has shared his findings with medical oncologists, urologists, and radiation oncologists around the globe.
Richardson, a specialist in multiple myeloma, said the FDA has approved 18 drugs for this blood cancer since the early 2000s, and that Dana-Farber had a leadership role in 15 of those drugs. Average survival time has improved to seven to 10 years as a result, up from two to three years.
He said he speaks to groups about how to integrate these drugs into treatment plans and has consulted with the companies developing the drugs. He said meals are provided as part of the travel.
Kesselheim said one shortcoming of the government’s Open Payments program is that it doesn’t distinguish between legitimate consulting and payments that raise red flags.
Dr. Roy Poses, a Brown University professor and president of the Foundation for Integrity and Responsibility in Medicine, a nonprofit organization, said there is debate about what constitutes appropriate payment. But he believes companies need to hire doctors for certain work, such as specialized technical tasks, including lab tests for patients in a clinical trial.
“As long as it’s not an exorbitant amount and it’s disclosed, I don’t have a problem with that,’’ he said.
Poses said that’s different from paying a doctor to advise a company on how to best market a particular drug, which is clearly a promotional activity.
At New England Baptist Hospital in Boston, which specializes in orthopedics, royalties are paid to surgeons who help develop artificial hips and knees and spinal implants. The medical staff are private practice doctors, so the hospital does not believe it has the right to limit their ability to earn outside income, spokesman David Passafaro said.
But doctors can’t participate in discussions and votes on new products if they have a financial interest in the product. And they do not earn royalties when the products they’ve patented are used at the Baptist.
Physicians must disclose their financial interests. Patients get a card saying the hospital recommends they discuss with their doctor “any financial or other interest they may have in the selection of drugs or devices used in your care.’’
Spokeswoman Lisa Rand said the Baptist doesn’t police whether surgeons are complying with that.
Dr. Richard Scott, who earned $5.8 million from DePuy Synthes Products in 2014, said he gives patients a letter explaining that their hip or knee implant may have been designed by him.
He said in an e-mail that he has had no complaints or even questions. “They all seem pleased that their surgeon is an innovator,’’ he said.
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SOURCE: Centers for Medicare and Medicaid Services; ProPublica analysis
CREDIT: Fan Fei and Sisi Wei/ProPublica
Correction: An earlier version of this story misstated the timing of Dr. Richard Scott’s earnings from pharmaceutical companies. He earned $5.8 million over an 18-month period starting in mid-2013. About $2 million of the total was paid in 2014.