Big Pharma’s Big Isle advocates
For the last four years, a Big Island doctor received more money in speaking fees than any other Hawaii physician from drug manufacturer GlaxoSmithKline.
Allergist and immunologist Dr. Allan Wang collected about $48,000 from the company, which makes Advair, used to treat asthma; Flovent, another asthma drug; and Wellbutrin, an antidepressant. Hawaii, at $236,000, was sixth-lowest on the list of payments by GlaxoSmithKline, by state, from 2009 to 2012. Wang’s payments made up about 20 percent of the total payments to Hawaii physicians.
Wang did not respond Wednesday to a phone message and email seeking comment.
Information about Wang and other Hawaii Island doctors was compiled by ProPublica, an independent, nonprofit newsroom, and presented in a database named Dollars for Docs. ProPublica reporters collected information from 15 pharmaceutical manufacturers’ websites and other disclosures and compiled the information in a format that is searchable by name, institution, drug company and location.
Dr. Thomas Pollard, a pulmonologist with offices on Oahu and in Hilo, said drug companies will ask him to speak about certain drugs. If he believes the drugs are effective, he might agree to do the talk, he said. According to the ProPublica database, Pollard has collected about $39,000 in speaker fees since 2009 from several companies, including Forest, GlaxoSmithKline and Pfizer.
Most of the speeches are done within Hawaii, talking to doctors here, Pollard said.
“It’s more for education, to let these physicians hear about” the different drugs, Pollard said, adding he doesn’t think he or other doctors are unduly influenced by the speakers fees or by hearing fellow doctors talk about particular medications.
Further, he said, pharmaceutical companies now are doing less to influence doctors than they did in the past. A few years ago, companies gave doctors lots of free marketing materials, such as pens and notepads, and a few decades ago, drug manufacturers would take doctors on two-day cruises to promote new prescriptions. Those activities are no longer allowed, Pollard said.
The company that most often paid for a doctor’s meal on Hawaii Island, according to the database, is Allergan, likely best known for manufacturing Botox.
Messages left for several other doctors on the list were not returned Wednesday.
Retired emergency room Dr. Sharon Bintliff, who also sits on the Hawaii Medical Board, said she has concerns about the practice of paying doctors to talk about drugs.
“My feeling is this practice is more about marketing and not really about education,” Bintliff said. “I wonder, if drug companies were not allowed to do this, if the price of certain drugs would be less.”
The practice is legal, she added, but she said doctors should consider how ethical it is.
Bintliff said she doesn’t remember the topic even coming up when she first attended medical school. She practiced as a pediatrician specializing in treating birth defects for many years before becoming an emergency room doctor for the past two decades. During her emergency room training, doctors were talking about the practice more, she said.
Dr. Barry Blum, an orthopedic surgeon with Alii Health, said he doesn’t see ethical concerns with most doctors talking about a particular drug, or with some drug companies’ participation in the medical field. A drug manufacturer sponsors a monthly tumor board meeting at Kona Community Hospital, paying for lunch, but no one is promoting a particular cancer-treating drug, Blum said. The conversations during those lunches focus on care and treatment, and provide a sounding board for doctors who are not oncology specialists to bring patients’ cases, at no cost to the patient, to oncologists and other experts, he added.
Regular marketing efforts — the pens, the notepads, even other doctors talking about particular drugs — are a long-standing tradition in the medical field, Blum said.
“Drug companies have done these for years,” he said. “It doesn’t persuade me to use the drug.”
Blum is more concerned about other pharmaceutical company activities, particularly the direct marketing of drugs to patients, via television and other advertisements. Direct-to-consumer advertising took off about 15 years ago.
“That’s what costs the money,” he said. “They say that’s research. It’s not research.”
Sen. Josh Green, an emergency room doctor at Kohala Hospital, said he has never been comfortable with drug companies buying expensive meals or rounds of golf for doctors.
People already distrust the medical system, and those actions don’t increase anyone’s trust, he said.
ProPublica’s research found some mainland physicians earning up to $500,000 a year in speaking and other fees.
“That’s pure corruption,” Green said. “They’re buying a hired gun.”
The database is available at projects.propublica.org/docdollars.