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Drug Companies Focusing Payments On Doctors In Small Hospitals

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The big academic medical institutions may have cracked down on industry perks a long time ago, but doctors from smaller hospitals are still enjoying regular free meals from drug companies, a new study shows.

The Boston Globe reports that an analysis has discovered that over half of the physicians from multiple community hospitals receive dozens of lunches and dinners in a year, and were benefiting from industry payments. This suggests that there may be fewer restrictions in place on meals in smaller hospitals than at large teaching hospitals.

In 2014, 77% of doctors at the Baystate Noble Hospital in Westfield reportedly received payments in the form of meals. Drug companies and medical device makers said that they had made more than 200 payments each to Dr. Ira Nathanson and Dr. Arthur King. Most meals were under $25 and were provided while company representatives gave information on brand name medicines for high cholesterol, asthma and blood clots.

Likewise, 74% of doctors at the Mercy Medical Center, a Catholic hospital in Springfield, received payments in the form of meals.

The 2014 analysis of federal data was completed by the Globe and ProPublica, an investigative journalism organization. The study matched data on company payments to doctors with Medicare data on the main hospitals doctors were affiliated with that year.

There were some limitations though, as some doctors found errors in the payment information drug companies reported to the Centers for Medicare and Medicaid Services. The analysis only looked at physicians in the 100 most common medical specialties, as well.

On the whole, the analysis showed that a smaller percentage of Massachusetts doctors receive payments compare to the national average.

While community hospitals racked up the largest proportion of doctors receiving payments of any kind, teaching hospitals, both nationally and in the state, had higher percentages of physicians who were given large amounts from companies. About 25% of doctors at Dana-Farber Cancer Institute, for example, earned at least $5,000 in 2014, followed by 13% at New England Baptist Hospital and 10% at Brigham and Women’s Hospital.

Baystate Health, which acquired Noble Hospital in 2015, said drug companies are now prohibited from supplying lunches in doctors’ offices, which is in line with the policies at the flagship teaching hospital of Baystate Medical Center. Noble’s former conflict-of-interest policy was broader and excluded specific  restrictions.

Mercy Medical Center said it tracks payments to doctors and has “confidence in our physicians to do the right thing.” When they don’t follow policy, the hospital said it “takes action,” but did not comment any further.

More and more studies are showing that doctors who receive free meals linked to specific drug companies tend to prescribe those drugs more. These benefits can also create a perception among patients that a doctor’s decision has been externally influenced.

Since many doctors work in community hospitals rather than academic medical institutions, many patients “are still being exposed to those relationships,” said Dr. Aaron Kesselheim. He is the head of a research program on legal issues on drugs and devices at Brigham and Women’s Hospital.

Eric Campbell, a health policy worker at Massachusetts General Hospital, said community hospitals have come under less observation. “This is a hold over 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.’’

Doctors at large teaching hospitals are mostly paid to consult or speak at events, and as part of royalty contracts, usually signing long-term relationships with companies.

On a national scale, five of the ten hospitals with the highest number of physicians receiving at least $5,000 in perks were from oncology.

Dr. Christopher Sweeney and Dr. Paul Richardson, who both received the highest payments from drug companies in 2014 at Dana-Farber, said the talks they give were very different from the talks given as a part of what they call “speakers bureaus,” which have been banned by many teaching hospitals, including Dana-Farber. They say that they control the presentations, not the companies.

Sweeney, a specialist in prostate cancer, headed a project that showed how the generic drug docetaxel, which is added to hormonal therapy, improves life-expectancy rates for some patients with metastatic prostate cancer. He said he has shared his results with oncologists, urologists and radiation oncologists worldwide.

Richardson, a multiple myeloma specialist, said that Dana-Farber had a big role in getting approval for 15 of the 18 FDA-approved drugs for the blood cancer he treats. He said he speaks to groups about how these drugs can be integrated into patient treatment plans and has spoken to companies developing the drugs. Meals, he said, are provided as part of travel arrangements.

Kesselheim mentioned that one limitation of the government’s Open Payments program is that it does not draw a line between legitimate consulting and questionable payments.

Dr. Roy Poses, a professor at Brown University and president of the Foundation for Integrity and Responsibility in Medicine, said there is an ongoing debate on what is deemed appropriate payment. But he agrees that companies need to hire physicians for specific tasks, such as technical work like lab tests for patients in clinical trials. He believes as long as the amount is fair and is disclosed, there wouldn’t be a problem.

Poses said this is clearly different from when a company pays a doctor to advise it on how best to market their drugs, which is a promotional activity and subject to a red flag.

At New England Baptist Hospital in Boston, which specializes in orthopedics, doctors who have helped develop artificial hips, knees and spinal implants are awarded royalties. The medical team are private practice doctors, so the hospital does not limit their right to earn outside income, according to hospital spokesperson David Passafaro.

But doctors at New England Baptist are not allowed to participate in discussion and votes on products they have a financial stake in, and do not earn royalties when the products they have patented are used at the hospital. Doctors must also tell their patients if they have a financial interest in a product, and patients are given a card that reads they should discuss “any financial or other interest they may have in the selection of drugs or devices used in your care” with their physicians.

Dr. Richard Scott, who received $5.8 million from DePuy Synthes Products in 2014, said he gives patients a letter that lets them know that their hip or knee implant may have been designed by him. He said that he has had no complaints or questions, and his patients seem happy that their doctor is “an innovator.”


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