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60 doctors took speaker fees from drug giant

By Liz Kowalczyk
Globe Staff / September 29, 2009

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At least 60 Massachusetts doctors collectively have earned more than a half-million dollars this year as speakers paid by pharmaceutical giant Eli Lilly & Co. - including two Boston Medical Center physicians whose participation is being reviewed for possible violation of a hospital policy against marketing activities by its doctors.

After learning of the doctors’ company-sponsored talks from the Globe, Boston Medical Center said it would investigate the matter and directed the physicians not to make any further presentations on behalf of Lilly in the meantime.

The use of physicians in speakers programs or “bureaus’’ like Lilly’s, in which doctors generally use company-prepared materials to explain a drug’s uses and dosing to their colleagues, is widespread in the drug industry. But the practice is under growing scrutiny and some academic medical centers are barring their doctors from participating, believing that physicians essentially become hired advertising guns, with weakened credibility.

Politicians, regulators, and some physicians also are concerned that doctors who give company-sponsored talks may present biased information that could underplay harmful side effects, or encourage the use of expensive brand name medications instead of less costly alternatives. When the company provides the power point, the risk of bias is even greater, they say.

Physicians on speakers bureaus, however, argue that they carefully screen the information for accuracy, and that the talks are a good way to educate the medical community about new drugs.

Because of this debate and other problems - pharmaceutical firms have paid millions in fines for illegally marketing medications - companies are under political pressure to disclose their financial relationships with doctors. Lilly is one of the first companies to publicly release a list of paid consultants and speakers. It includes more than 60 Massachusetts doctors, who were paid approximately $588,000 for its speakers programs in the first three months of 2009. Some doctors earned up to $50,000 giving talks to their colleagues.

At Boston Medical Center, Dr. Brian McGeeney, a neurologist, received $30,000 during that period, and Dr. Elliot Sternthal, an endocrinologist, was paid $11,587.50, according to a faculty registry on Lilly’s website.

Hospital spokeswoman Gina Digravio initially told the Globe last week that the two doctors did not violate the hospital’s policy, because they said they “fully determined their presentations.’’ The two-year-old rule bars doctors from giving industry-sponsored talks unless the “lecture’s content, including slides and written materials, are determined by the clinician.’’ Lilly, however, says on its website that it alone provides the information presented by speakers. Spokeswoman Carole Puls said the company provides slides and other materials.

Later in the week, the hospital revised its position, saying, “we have instructed the doctors to refrain from any further presentations pending a review by the medical campus provost.’’

In e-mailed statements, the doctors defended their talks. Sternthal said he determines “the structure of the presentation by my choice of disease state and clinical trial slides, order of presentation and emphasis of teaching points. This is in compliance with BU/BMC policy.’’ McGeeney said he has “worked with Eli Lilly on their product Cymbalta,’’ a depression drug, “and have been compensated for this work in accordance with FDA’’ and industry guidelines.

Puls said Lilly made public its payments to physician speakers “because greater transparency is integral to rebuilding trust in our industry.’’ She acknowledged that the talks are promotional and are regulated by the US Food and Drug Administration’s marketing division.

In addition to BMC, the region’s other academic medical centers also have or plan to adopt policies restricting physicians’ role as speakers for companies. These rules could force some doctors to withdraw from the Lilly program - though some hospitals essentially leave it up to physicians themselves to decide whether they are in violation.

According to Lilly’s speaker list, the company paid two Beth Israel Deaconess Medical Center doctors: $9,000 to Dr. Roy Freeman and $21,600 to Dr. John Sharp. Spokeswoman Judy Glasser said the hospital would investigate whether the doctors can continue in the speaker program, given a new hospital policy that says speaking “is not allowed if the content of the presentation has been determined or controlled by the vendor.’’

Lilly also paid more than a dozen doctors from Massachusetts General Hospital, Brigham and Women’s Hospital, and McLean Hospital between $1,250 and $47,800 each, but those hospitals will prohibit doctors from participating in speakers bureaus as of Oct. 1.

Massachusetts patient advocacy groups pushed state legislators to bar doctors from joining speakers bureaus, but a law passed last year instead requires drug companies to publicly disclose speakers and their fees starting next July.

The practice is “a complete violation of the hallmark of academia: independence,’’ said Eric Campbell, a Mass. General researcher who found in surveys published in 2007 that 16 percent of all US doctors and 25 percent of hospital department heads belong to speakers bureaus. “Academics who want to be drug salesmen should go be drug salesman. But don’t do it under the shroud of academia.’’

Campbell said doctors have told him they need the money to pay for their children’s college educations. In return, he said, the companies get a renowned doctor talking about their drug who can draw a bigger audience than would a pharmaceutical company salesperson.

Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic Foundation, said doctors in speakers bureaus “are actually acting as an agent for the pharmaceutical company. That does create divided loyalties, and universities are realizing the challenges that presents.’’

Even so, speakers programs are still popular, and some doctors argue they are providing an educational service.

Puls said less than 1 percent of doctors declined to renew their speaking contracts with Lilly this year.

Just how lucrative the speaking bureaus can be is apparent in an offer from Schering-Plough Corp., which is recruiting doctors to promote its new schizophrenia and bipolar drug Saphris, which was approved in August.

In a letter to doctors, Schering-Plough says “you must present the Schering-Plough approved materials provided to you.’’ The company offered one psychiatrist, Dr. Daniel Carlat, a Tufts University Medical School professor, up to $170,000 over two years to give 125 45-minute talks in restaurants, in his office, and by telephone and the Internet. A well-known critic of the drug industry, Carlat declined.

“The idea is to have respected experts in the field educating other doctors,’’ said Schering-Plough spokesman Robert Consalvo. “It’s a promotional activity.’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.