Medical Companies Pay $72 Million to Doctors in Missouri Over 17 Months

KBIA Radio, July 8, 2015

Financial disclosures aren’t just for political candidates. New data released by the Centers for Medicare and Medicaid Services shows that Missouri doctors received at least $71.9 million from medical device and drug companies in 2014 and the latter half of 2013. Illinois doctors pulled in $104 million during that same time period, many of whom hail from the Chicago area.

The statewide totals were compiled in a searchable database by ProPublica, a nonprofit data journalism center. The payments included fees for speaking engagements, drug samples, and travel. In other cases, doctors received royalty payments from companies for devices they had helped to develop, like orthopedic surgeon Dr. Lawrence Lenke.

Lenke received about $5.4 million from drug and medical device companies during the reporting period, the biggest amount for any doctor in the St. Louis area. The vast majority of the payments — about $5.2 million — were royalty fees for the Solera Spinal system, which he helped develop during his time at Washington University. Other payments included consulting, promotional speaking fees and food and beverage from medical device companies.

“It is not ideal that the payments are presented without any context of the work provided or separated out by the type of payment,” Lenke wrote in an e-mail. He moved his clinical practice for complex spinal deformity surgeries from St. Louis to New York City this summer.

“Hopefully in the future, more granularity can occur with this Open payment system, which I am in favor of in the context of full disclosure to the public and my patients,” Lenke wrote.

The long-time, but little known, practice of payments to doctors has drawn criticism from people who worry a doctor’s financial ties to a drug company could affect their judgment when writing prescriptions. On the other hand, some doctors argue the disclosures are inaccurate, misleading and create a “chilling effect” on their ability to seek information about drugs from manufacturers.

The payments are far from uncommon: According to the data, 607,000 physicians and 1,121 teaching hospitals received payments in 2014 and half of 2013. (The United States has only about 900,000 active physicians.)

Because the payments are so common and often involve the exchange of information, many doctors would reject the notion that industry relationships have any effect on how they conduct their practice, said Dr. Ed Weisbart, a board member for the Consumers Council of Missouri.

“You have this nice, attractive person coming into your office with food, who your staff adores, who’s dropping off little bits of information for you,” said Weisbart. “It becomes a name brand familiarity. So it does influence how we prescribe. How can it not?”

Dr. Michael Stadnyk, a radiologist and president of the St. Louis Metropolitan Medical Society, said he supports the transparency of the program but believes the data don’t tell the whole story.

Stadnyk, for example, received $68 worth of food last year during a meeting with Hologic Inc., in which they discussed a breast imaging system he is developing. He said the disclosures have created a chilling effect on industry relationships with doctors.

“There’s a good percentage of physicians interacting with these companies to try and better health care, to try and improve physician knowledge and come up with a better mousetrap. But that’s being hindered now.”

Because the payments are reported by companies, and often without confirmation from physicians, medical groups argue that the data are often misleading or inaccurate.

(In the interest of full disclosure, this reporter received a fellowship this year to attend a continuing education conference, which receives donations from multiple funders including the Missouri Foundation for Health.)

Regardless of the payments’ sway, they represent a significant investment by drug and medical device companies. The largest Missouri payer is Mallinckrodt Pharmaceuticals, an Irish drug company whose U.S. headquarters are in St. Louis. The company’s nearly 50,000 payments to physicians totaled around $3.4 million in 2014.

“Collaboration among physicians and industry helps drive innovation in patient care, contribute to the economic well-being of communities and provide resources for advancement of medical knowledge, to the ultimate benefit of patients,” Mallinckrodt wrote in a statement.

That collaboration includes supporting clinical trials conducted by individual physicians, payments for doctors who consult company reps on how they use a product in their practice and meals provided during an informational presentation, the statement said.

Where Stadnyk and Weisbart find common ground is in the data’s ability to flag doctors whose ties with the industry might be too close.

“If Dr. Smith has been taken out to dinner 42 times in the last month and a half by Company B, that would raise a red flag for me,” Stadnyk said. “It’s looking at the data … and making that conclusion for yourself. And if there’s ever any question, they need to contact their doctor and ask.”

Click here to look up payments received by your doctor.

Click here to see a chart about payments to Missouri doctors.

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