Med Society: 41% percent of Massachusetts docs support single payer

The Massachusetts Medical Society is out with its annual survey of doctors. It’s full of information about the ongoing shortage of primary care docs and select specialists. No surprise. What is unexpected  is the growing support among state docs for a single-payer system — 41 percent, up from 34 percent last year.

Opinions of U.S. Health Care System
For the second year, physicians were asked their opinions on the best option for the U.S. health care 
system. While support for a single-payer system saw a 7 percent jump from last
year, 59 percent of physicians prefer other options.  The responses from the
2011 study: 23%  (versus 32% in 2010) preferred both public and private plans with a
public buy-in option for businesses and individuals

  • 15% (v. 17%) said keep the existing mix of public and private plans, but
    allow insurers to sell plans with limited benefits and high deductibles to keep
    premiums low
  • 17% (v.14%) preferred the current Affordable Care Act
  • 41% (v. 34%) preferred a single-payer national health care system
  • 4% (v. 3%) other

More from single payer advocates @ MassCare here.

The survey also asks docs about their willingness to participate in accountable care organizations and the global payment system now on the table at the State House.

Views of Massachusetts Payment Reform Initiatives
For the  first time in the workforce studies, physicians were asked about payment reform

initiatives being undertaken in the Commonwealth, specifically global payments
and accountable care organizations (ACOs). Responses to questions about both
showed many physicians to be hesitant to participate in either global payments
or ACOs.

Findings on Global Payment Systems

  • Familiarity with global payments is high, with 57 percent of physicians
    saying they were   familiar with global payments.
  • Of all respondents, 42 percent said they were likely, and 58 percent said
    they were not likely to participate in a voluntary global payment system.
  • Of those respondents who said they were familiar, 45 percent said they are
    likely to participate in a voluntary global payment system; 55 percent said they
    were not likely.
  • Primary care physicians (61.4%) are more likely to participate in a
    voluntary global payment system than specialists (32.2%). 

Findings on Accountable Care Organizations (ACO)

  • Familiarity with ACOs is high, with 58 percent of physicians saying they
    were familiar with ACOs.
  • Of all respondents, 49 percent said they were likely, and 51 percent said
    they were not likely to participate in a voluntary ACO
  • Of those who said they were familiar, 59 percent said they were likely to
    participate in a voluntary ACO, and 41 percent said they were not likely.
  • Primary care physicians (71.9%) were more likely to participate voluntarily
    in an ACO than specialists (50.2%).

NYTimes on “Small Fixes” for global health problems

The entire New York Times “Science” section is dedicated “low-cost innovations that are making a big difference”  in solving global health problems. It’s a great topic and a nice package including longer stories and sidebars on individual projects, like a biodegradable, single-use toilet called the PeePoo.  Don’t laugh. As this story and others point out, 40 percent of the world population does not have access to a toilet. The resulting water contamination leads to diarrhea. And, as the story notes,  1.5 million babies die each year from diarrheal disease.

One story profiles a local company called Diagnostics for All:

The diagnostic tests designed in Dr. (George) Whitesides’s Harvard University chemistry laboratory fit on a postage stamp and cost less than a penny.       

His secret? Paper.       

His colleagues miniaturized diagnostic tests so they could move into the field with tiny pumps and thread-thin tubes. Dr. Whitesides opted for a more novel approach, reasoning that a drop of blood or urine could wick its way through a square of filter paper without any help.       

We heard about this company at a meeting last year sponsored by the Mass Device website. Speakers at that meeting discussed how to create “a business model that helps solve the global problem of providing healthcare to the planet’s poorest people

No comment from Boston for story on the business of #children’s #hosptials #hcr #pediatrics


Kaiser Health News and McClatchy newpapers offer a big take out on the rise of the mega-childrens hospitals.

Comment from Children’s Boston: None.

From their humble origins more than a century ago, many of the nation’s biggest and best known children’s hospitals today are health care juggernauts with sprawling medical centers and suburban satellites, extensive real estate holdings and thousands of well-paid employees and millionaire CEOs. 

The billions of dollars flowing through children’s hospitals every year pay for care for tens of thousands of kids, many of them extremely sick or suffering from chronic conditions requiring a lifetime of treatment. Hospital officials say costs are high because the care is complicated and the technology expensive. In addition, the hospitals help fund research into the causes and treatment of diseases.

But the surge in spending is also helping to fuel a multibillion-dollar building boom as hospitals add towers and beds.  That in turn is spurring more spending on staff and technology, even as Washington, the states and employers grapple with budget-busting increases in health care spending. While children’s hospitals represent a small slice of the nation’s health care bill, they offer a case study of the expansive ambitions of hospital leaders and the faltering efforts of government to control spiraling costs

The 39 largest hospitals, KHN found, had accumulated $21 billion in stocks, bonds, real estate and other investments as of 2010 – more than enough to provide an entire year’s worth of medical care for free They had net assets – the equivalent of net worth for nonprofits – of $23 billion.

Children’s Hospital of Boston, arguably the nation’s best known hospital for children, listed $2.6 billion in stocks and other investments in bond filings.

Last year, the 400-bed hospital was cited as having some of the highest charges in Massachusetts in a report critical of hospital charges filed by State Attorney General Martha Coakley.  Hospital officials declined numerous requests for an interview, but noted on their website that they have lowered the rate of their increases.

Even with their tax breaks and wealth, top children’s hospitals provide relatively little charity care. On average, about 2 percent of what children’s hospitals spend is for free medical care, according to the National Association of Children’s Hospitals and Related Institutions (NACHRI), an industry group. Some of the largest and richest children’s hospitals spend less than one percent.

Commonhealth on new books re: reform, medical decisions #hcr #hcr2

WBUR’s Commonhealth offers two item linked to new books. The Q & A with Dr.Pamela Hartzband and her husband Jerome Groopman comes with the publication of  Your Medical Mind: How to Decide What Is Right for You.

And, HSPH prof John McDonough offers these thoughts from his new book Inside National Health Reform. “The law is already starting to make dramatic changes in the delivery of  health care in the US to emphasize quality and improve efficiency.”

Children’s Boston: Preschool flu shots cut ER vistis

The study compared 2-4 year olds in Montreal to kids at Children’s in Boston

Canadian Medical Journal

The divergence in influenza rates among children in the US and Canadian
sample populations after institution of the US policy to vaccinate children two
to four years of age is evidence that the recommendation of the US Advisory
Committee on Immunization Practices resulted in a reduction in
influenza-related morbidity in the target group and may have indirectly
affected other pediatric age groups. Provincial adoption of the 2010
recommendation of teh National Advisory Committee on Immunization in Canada to
vaccinate childen two to four years of age might positively affect influenza
morbidity in Canada

NYT: A federal government recommendation to give preschoolers the flu
has resulted in a large decrease in emergency room visits

among 2- to 4-year-olds, new research has found. And there were benefits for
older children as well.

Dr. John Brownstein @ Children’s

Public Health Surveillance Systems: Dr. Brownstein and his colleagues work on the
development of advanced, informatics-based, real-time surveillance systems that
monitor population health from a variety of health information sources ranging
from formal clinical data to informal rumor-based surveillance

Essay contest: Cost awareness in medicine

Doc-run group seeks scribes:  


Costs of Care, a physician-run nonprofit based in Boston, has launched its second
annual national healthcare essay contest, with the goal of expanding the public
discourse on the role of doctors, nurses, and other care providers in
controlling healthcare costs. 

BOSTON, MA (PRWEB) SEPTEMBER 12, 2011—Last year Costs of Care ( launched an innovative essay contest that elucidated the importance of price transparency in everyday
medicine by gathering more than 100personal stories  from patients, nurses, and doctors across the nation. This year, Costs of Care is looking for more stories, and will award prizes for anecdotes about the importance of price transparency as well as solution-oriented stories that
illustrate ways to reduce harmful healthcare spending and save patients’ money

As the economy struggles to recover, the spiraling costs of healthcare in the
United States have become a contentious political focal point without an
obvious solution. Traditionally, health care providers have been reluctant to
discuss their own role in healthcare spending. However according to Neel Shah,
M.D., Executive Director at Costs of Care, “Ultimately, no amount of
regulating, reorganizing, or otherwise reforming the healthcare system will
successfully contain costs unless healthcare providers are invested in fixing
the problem.”

To help mobilize healthcare providers to examine their own role in spending, Costs
of Care is launching an essay contest that will collect and widely
disseminate stories from the frontlines of medicine. Costs of Care will award
$4000 in prizes to top submissions. Two $1000 prizes will be reserved for
patients, and two $1000 prizes will be reserved for care providers. Preference
will be given to stories that best demonstrate the importance of cost-awareness
in medicine. Examples may include a time a patient tried to find out what a
test or treatment would cost but was unable to do so, a time that caring for a
patient generated an unexpectedly a high medical bill, or a time a patient and
care provider figured out a way to save money while still delivering high-value

To help select the winning entries, Costs of Care has partnered with five health
luminaries who will serve as judges:

  • Peter Orzsag, former Director of the White
    House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer
    research advocate
  • Dr. Alan Garber, health economist and Harvard
    University Provost

Anyone looking to learn more about the successful entries from last year’s contest can
find our more at

All submissions will be due on November 15th, 2011. Finalists will be announced on
December 15th, 2011 and the $1,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at
during the 2012 calendar year, and will be made available to the media. 

The  contest is sponsored in part by through the generosity of Blue Cross Blue
Shield of Massachusetts and Harvard Pilgrim Health Plan.


About Costs of Care

Costs of Care is a nonprofit  organization that gives patients and healthcare workers the information they  need to deflate medical bills, while expanding the national discourse on the
role of care providers in responsible resource stewardship. Costs of Care was
founded by a resident physician based at Harvard Medical School who noticed
that even the best physicians sometimes overlook something critical—the bill.

Full contest details are available at

#Science in the news and wonks on the web #health #boston

Check out this week’s Health Wonk Review, hosted by Boston’s own David Williams at the Health Business blog. The digest of blog posts offers opinion, reporting, and more on ACOs, HIT, NBC, the PPACA, ALEC, CMS and the GDP. Your typical discussion of health policy — an acronym fest

Then, check out Science in the News, a great series of talks organized by Harvard Med School students. They start next week:

9/21 – Mind-Machine Interface: Computers and the Wired Brain

9/28 – How to Spot a Virus: The Origins of an Immune Response

10/5 – Toward the Final Frontier of Manned Space Flight

10/12 – Beneath the Surface: The Present and Future of Our Oceans

10/19 – Are we Programmed to Age?

10/28 – The Evolution of the Universe: Building Earth From Cosmic Soup

11/2 – Obesity: How Science Approaches Weighty Matters

11/9 – Species Interactions: More Than the Sum of Their Parts

11/16 – 30 Years with AIDS: Where it Came From and Why It’s Still With Us

Perils of predisease: What we already knew about bone loss and osteoporosis drugs

Now that the FDA will require a stronger warning on bone loss drugs, we look back.

From The Boston Globe

Specialists differ on the
value of tests for bone density

By Tinker Ready

Globe Correspondent


When Winchester gynecologist Robert Shirley does an ultrasound bone scan  of a patient’s heel, the news he delivers is often less than comforting.
Based on the heel scan, which measures bone density in the foot, Dr.
Shirley diagnoses 1 in 3 of his older patients with either osteoporosis or
osteopenia, the bone-thinning disease that is common in aging women and
also affects some older men.

“It’s a very helpful tool to make them realize that osteoporosis is
real, and they need to think about it,” said Shirley.

Certainly, few women will fail to take notice when they hear they have
a disease that may lead to brittle bones, a hunched back or “Dowager’s
hump,” and painful, disabling fractures. As frightening as the diagnosis
sounds, however, it does not always lead to serious fractures _ the most
severe of which is hip fracture _ and the bone scan itself cannot
accurately predict who will get hip fractures, or even fully measure bone strength.

Still, osteoporosis is now defined by bone density, even though
density only accounts for about 70 percent of bone strength. Other factors
_ such as the actual shape, structure and size of a bone, and the presence of
tiny cracks know as “microdamage” _ seem to factor in as well.

But these things are not measured by bone scans. And, when it comes
to hip fractures and the elderly, a person’s risk of falling seems to play as
much of a role in fracture risk as does bone density.

So, when a group of scientists convened by the National Institutes of
Health met for three days in late March to review the most current data on
the diagnosis and treatment of osteoporosis, they declined to endorse the
bone scan as a screening test for osteoporosis. In its March 29
consensus statement, the panel noted that the risks for osteoporosis _ as
reflected by low bone density _ and the risks for fracture, overlap but are not

In addition, the panel expressed concern that different bone scanning
devices and techniques produce conflicting results. A committee of scientists
is working on a plan to standardize the tests, but right now, an ultrasound bone
scan of the heel might indicate osteoporosis, while an x-ray scan of the spine may
not. And even though bone loss can accelerate at menopause, tests in women under the age
of 60 are particularly weak at predicting hip fractures.

“There are other things outside of bone density that we may want to
measure to better improve our prediction of fracture risk,” Mary Bouxsein,
an instructor in the Orthopedic Biomechanics Laboratory at Beth Israel
Deaconess Medical Center told the panel.

This is in stark contrast to what many doctors and advocacy groups
say about bone scans and osteoporosis. Many see the disease as a silent
epidemic that goes undiagnosed in millions of women. The National
Osteoporosis Foundation cites an alarming list of statistics to drive that
point home: 28 million people either have the disease or are at risk, and

half of all women will suffer a fracture of the spine, hip or wrist

during their lifetime. The group recommends bone scan screening for all women
over 65, has lobbied Medicare to cover the test, and is now pushing formandatory private insurance coverage.

Bone scans are not perfect, but they are the best tool available to identify women with the disease, said Conrad Johnston, director of the Bone Studies Laboratory at Indiana University, who is the current president of the National Osteoporosis Foundation. “Everybody who has high cholesterol doesn’t have a heart attack, and everyone who has low bone mass doesn’t have a fracture. But for many women, he said, “low bone density is the single best predictor of who will fracture.”

So should women just ignore this? The pharmaceutical industry certainly isn’t. The makers of bone building drugs are active in promoting bone scans. Merck, which makes Fosamax, recently ran ads in magazines like Good Housekeeping and Parade encouraging healthy women to seek testing. Warning that undiagnosed osteoporosis can lead to broken bones or the disfiguring Dowager’s hump, the ad equates the simple, painless bonedensity test with mammography to detect breast cancer.

Osteoporosis is serious business for many who have it. According to the National Osteoporosis Foundation, the disease causes 1.5 million fractures annually, about half of them in the spine. Spinal fractures cancause a range of symptoms; some people may feel nothing at all, others may have back pain, and yet others may develop the Dowager’s hump.

The scientific data on the incidence and severity of spinal fractures is incomplete. But, all agree that the hip fracture, which strikes about 300,000 people per year in their 70s and 80s, can be a devastating and sometimes deadly event. About 30 percent of older people who fall and break a hip end up in a nursing home.

Bone density contributes to hip fractures, but so does a long list of other factors including age, low body weight, smoking, mobility, exercise habits, and poor eyesight, which can make someone more vulnerable to falls,says Dr. Arminee Kazanjian, the director of the British Columbia Office of Health Technology Assessment.

After reviewing years of research into bone mass and fracture, her agency released on of the most scathing critiques on the use of bone scans. It concluded that as many as 70 percent of the women who eventually break ahip will not be diagnosed at menopause with osteoporosis, if that diagnosis is based on a bone scan alone. And, only half of the 30 percent of women identified as having osteoporosis or osteopenia will go on to have a fracture.

“The important health outcome is bone fracture,” said Kazanjian.“Bone mineral density is a minor factor. Any other combination of factorsis much more important.”

Rather than rely on the bone scans alone to diagnose osteoporosis, Kazanjiam and others suggest that doctors focuson the other factors that contribute to fracture risk.

For example, a woman with low bone density, but who doesn’t smoke(which contributes to thinning bones) and has good eyesight, may be less likely to break a hip than a woman with high bone density who uses a walker and has afamily history of fractures, she said.

Amy Allina of the National Women’s Health Network, a Washington,D.C.-based advocacy group, says that women who are told they don’t have osteoporosis based on a bone scan alone may not take steps to prevent the falls that cause hip fractures, even though they may be at risk. And those whose bone scans indicate that they have osteoporosis may spend years on medication, even though they may never have broken a bone.

That’s a problem, Allina said, because the treatments for osteoporosis themselves come with risks. Hormone replacement therapy, which millions of women take to both treat and prevent osteoporosis, can increase a woman’s odds of developing breast cancer. And Fosamax, a non-hormone drug that builds bone, irritates the throat and its long-term effects are unknown.

A 1993 decision by a World Health Organization panel set the stage for the bone scan to inadvertently become a routine diagnostic test for osteoporosis. The panel established a scale _ based on the average bone density of a
premenopausal woman _ that allows doctors to measure bone loss, diagnose osteoporosis, and establish fracture risk.

The average 55-year-old woman has a 15 percent chance of breaking her hip someday. If her bone density is 1 point below the WHO average, she is defined as having osteopenia, a level of bone thinning that increases the lifetime risk of hip fracture by 20 to 45 percent. Osteoporosis is diagnosed when bone density falls 2.5 points below the WHO average. This, by  some measures, raises the risk of hip fracture to greater than 45 percent.

Brigham and Women’s Hospital in Boston recently produced a detailed set of osteoporosis diagnosis and treatment guidelines for its patients and doctors. The guidelines don’t endorse bone scans to be used as screening tools alone, but they advise doctors to recommend bone scans to all women over the age of 65.

Dr. Robert Barbieri, chairman of the Department of Obstetrics and Gynecology at Brigham and Women’s, sees the bone scan as a useful tool but he emphasized that a diagnosis of osteoporosis should not be based on the testalone. He says he is confident that doctors are considering other factors when assessing a patient’s bone strength and risk of a fracture.

“They use history and physical exams and laboratory tests in an integrative  way and pull them all together,” he said.

But Mark Hefland, a researcher at the Oregon Health Sciences University, told  the NIH pane that doctors are relying too heavily on bone scans, even though  many of them admit that they don’t understand how bone scan scores relate to fracture risk.

“However we may like it, this is how diagnosis is occurring in everyday practice,” said Hefland, the director of the school’s Evidence-Based Practice Center.

Dr. Shirley of Winchester says he relies on bone scans to diagnose osteoporosis, but said that he also spends a lot of time with patients talking about fracture risk and alternatives to drug therapy like increasing weight-bearing exercise and boosting calcium intake.

But according to Diane Saparoff, who runs a monthly support group for women with osteoporosis at the Jenks Senior Center in Winchester, Dr. Shirley’s approach differs greatly from that of other doctors. “Many ofthe doctors order these tests but there is no follow up,” she said. The

doctors often don’t explain the test scores or help women come up with a  fracture prevention plan, she said. “They just throw Fosamax at them.”

Dr. Johnston of the National Osteoporosis Foundation acknowledges that some doctors may be relying too much on bone scans to diagnose osteoporosis.

“I think that’s probably happening but it shouldn’t be,” he said. “Thisis a reasonably new area. Bone mineral measurements have only been around for about 10 years. Its takes a while for people to get up speed.”


Report lists ways to avoid injuries

A recent report  from the National Institutes of Health offers advice on how to build and maintain strong bones:

*Get adequate calcium and vitamin D both early in life and throughout

* Engage in regular exercise; it contributes to the development of peak

bone mass and may reduce the risk of falls in older individuals.

*As needed, use drugs that enhance bone mass; medications have been been

shown to reduce the risk of osteoporotic fractures.

In addition to regular exercise, there are several steps seniors can

take to avoid falls, according to the National Center for Injury Prevention

and Control:

* Use non-slip rugs and bath mats. Put grab bars in the bathroom

and handrails on the stairs.

* Ask your doctor to review medicines that may cause drowsiness or

confusion when combined with others you may be taking.

*Stay current with eye exams.

–Tinker Ready

This story ran on
page D01 of the Boston Globe on 4/25/2000.

© Copyright 2000 Globe Newspaper Company.

More drug company payments to docs in Mass and elsewhere

The investigative reporters over at Pro Publica are out with an update of their series on pharma payments to doctors. Since 2009 , docs in Massachusetts have earned a total of $22,135,703 in speaking fees from drug makers.

Eight pharmaceutical companies, including the nation’s three largest, doled out more than $220 million last year to promotional speakers for their products, according to a ProPublica analysis of company data. (Read the entire story at the end of this post.)

The Globe localized it this morning
Total payments to doctors for promoting pharmaceutical companies’ products to their colleagues appear to be falling in Massachusetts, suggesting that new restrictions designed to distance doctors from industry are leading some to abandon the lucrative speaking circuit.

Eli Lilly and Company, one of the nation’s largest drug makers, paid health care providers here $866,919 in 2010 for speaking about their drugs, a 46 percent drop from 2009, according to an analysis by the Boston Globe and ProPublica, a nonprofit online investigative journalism organization…

The data also show that many Harvard-affiliated doctors have dropped out of company speakers bureaus, a sideline that has allowed many physicians to earn tens of thousands of dollars.

Industry reps put out a trio of tweets including this one #PhRMA companies are deeply committed to responsible, ethical interactions with healthcare professionals:

And Tom Stossel, a Harvard doc, put out a statement via the organization he helped found, The Association of Clinical Researchers and Educators. The group opposes what it calls. “the improper use of physician-industry payment data by ProPublica…” The stories “failed to objectively portray such payments and offered minimal, if any, contextual information.  Numerous articles were published describing the “potential” negative consequences of physician-industry collaboration, while failing to obtain any alternative perspectives, a tenet of high quality journalism.  News sources also frequently published articles with inflammatory headlines such as, “Docs paid to talk about drugs,” to further sensationalize and discredit ethical and legal collaborations that provide value to patients in the form of new treatments, drugs, devices, and more efficient and cost-effective care

From Pro Publica:

Piercing the Veil, More Drug Companies Reveal Payments to Doctors

by Charles Ornstein, Tracy Weber and Dan Nguyen ProPublica, Sep. 7, 2011,

Eight pharmaceutical companies, including the nation’s three largest, doled out more than $220 million last year to promotional speakers for their products, according to a ProPublica analysis of company data.

For the first time, all these companies have reported a full year of payments, allowing for head-to-head comparisons of how much they spent on physicians to help push their pills. Some appear to be paring back.

Firms with the highest U.S. sales last year didn’t spend the most on physician marketers. Industry leader Pfizer, with sales of $26.2 billion, spent $34.4 million on speakers, ranking third among the eight companies. By comparison, Eli Lilly and Co. spent the most on speakers, $61.5 million, even though its sales were about half of Pfizer’s.

“We continue to believe in the benefits and value that educational programs led by physicians provide to patient care,” Lilly spokesman J. Scott MacGregor said in an email.

The data provide a preview of what the public can expect to see in 2013 [1], when all drug and medical-device companies — potentially hundreds — must report such figures to the federal government.

Until 2009, pharmaceutical company payments to health professionals were closely held trade secrets. But several companies began reporting the information publicly under pressure from lawmakers or as a condition of settling federal whistle-blower lawsuits.

Lilly $61,477,547 $14.3 billion
GlaxoSmithKline $52,755,793 $13.6 billion
Pfizer $34,382,574 $26.2 billion
AstraZeneca $31,647,101 $18.3 billion
Merck $20,365,446 $18.8 billion
Johnson & Johnson $11,712,900 $12.9 billion
Cephalon $4,241,080 $2.1 billion
ViiV Healthcare $3,975,102 Unavailable

In October, ProPublica published a database called Dollars for Docs [2] that included information from those companies. It allows the public to search for individual physicians to see whether they’ve been on pharma’s payroll.

Today, ProPublica is updating that tool to include payments made to health professionals by 12 companies. Eight of those published data for all of 2010: Lilly, GlaxoSmithKline, Pfizer, Merck, Cephalon, Johnson & Johnson, ViiV Healthcare and AstraZeneca.

In addition to the payments made to speakers, some of the companies also disclosed how much they’ve spent on consulting, travel, meals and research.

In all, payments to doctors and other health-care providers in ProPublica’s database total more than $760 million and cover reports from drug companies between 2009 and the second quarter of 2011.

Some Docs Pull Out

The new data offer a glimpse of how the firms have adapted their strategies over time, both to changes in the marketplace and to increased scrutiny of their sales techniques.

Many experts predict physicians will back away from working for the companies once their names and pay are publicly revealed.

It’s too early to know if this is true, but ProPublica’s analysis shows that the payouts to dozens of doctors and other health professionals took a steep dive last year.

Pulmonologist Veena Antony, for example, was paid at least $88,000 to give promotional talks for GlaxoSmithKline in 2009. But last year, the Birmingham, Ala., doctor gave them up out of concern that patients might think her advice was tainted.

“You don’t even want the appearance that I might be influenced by anything that a company gave,” she said.

Cancer specialist Nam Dang was a regular on Cephalon’s speaking circuit, pulling in $131,250 in 2009. But those promotional gigs stopped, he said, after he took a job at the University of Florida in Gainesville, which bans such talks. In 2010, he received $10,000 for consulting for Cephalon and Pfizer.

Nurse practitioner Terri Warren, who runs a Portland, Ore., health clinic, earned at least $113,000 from Glaxo in 2009, mostly talking about its herpes drug Valtrex. In 2010, that dropped to $300 after the drug went off patent and Glaxo no longer had a financial incentive to promote it.

“It’s a business decision, clearly,” said Warren, who felt her talks helped educate other health professionals about treating a taboo illness. “My money [from Glaxo] went into keeping this little clinic alive, and now we have to figure out some other way to do that.”

Another group of physicians has ramped up speaking engagements and consulting.

Buffalo hematologist Zale Bernstein earned $49,250 from Cephalon in 2009. The following year, his pay jumped to $177,800 (plus an additional $35,500 for travel). Bernstein did not return calls for comment.

Pain specialist Gerald M. Sacks spoke and consulted for four companies in the database and was among the highest paid. The Santa Monica, Calif., doctor earned $270,825 from Pfizer, Johnson & Johnson, Lilly and Cephalon in 2010, up from $225,575 in 2009. Those figures do not include travel costs and meals.

Over 18 months, Pfizer alone paid Sacks $318,250 for speaking. He did not return repeated calls for comment.

Pfizer’s new disclosure also revealed an unusual recipient. Its top-paid physician consultant last year, Dr. Christiana Goh Bardon, runs a hedge fund in Boston that bets on the rise and fall of health-care companies. She was paid nearly $308,000 to “provide input on our BioTherapeutics business development plan,” Pfizer spokeswoman Kristen Neese wrote in an email.

Bardon, who started her hedge fund after her Pfizer contract ended, was required to sign a confidentiality agreement and not allowed to invest in Pfizer or any of the biotech companies that Pfizer was looking at acquiring or partnering with for projects, Neese said.

Bardon said in a voice-mail message that she does not currently practice as a physician and her work was based on her business acumen.

Drug Companies Change Their Strategies

Some companies apparently have used fewer physician speakers and consultants since they began posting their data publicly.

Cephalon, a relatively small Pennsylvania company that specializes in pain, cancer and central nervous system drugs, paid physicians nearly $9.3 million in 2009 for speaking and consulting. That figure dropped to $5 million last year.

“There wasn’t one big thing that happened that shifted the focus,” said spokeswoman Jenifer Antonacci. Rather, the company’s marketing strategies for its brands changed.

AstraZeneca cut its spending on speakers from roughly $22.8 million in the first half of 2010 to about $9.2 million in the second half.

The company’s U.S. compliance officer, Marie Martino, said AstraZeneca typically holds most of its speaker events in the beginning of each year. But she acknowledged that the company’s spending on promotional talks has been decreasing.

“We’re in a period now where we don’t have a lot of new indications [approved uses] or new products that have been introduced in recent months, and that really is the fundamental explanation for what you’re seeing,” Martino said.

AstraZeneca, like other companies, is also replacing some in-person speaking events with teleconferences, webcasts and video conferences.

Glaxo’s spending on speakers also slowed in 2010, averaging about $13.2 million per quarter in 2010, down 15 percent from the last three quarters of 2009. (Glaxo did not report data in the first quarter of 2009.)

Company spokeswoman Mary Anne Rhyne said the company is working to reduce its speaker rolls by 50 percent. “We feel it is a better use of resources to use fewer speakers more often. This cuts down on training costs as well as lessens the number of contracts needed,” she wrote in an email.

And Lilly’s speaker payments dropped 10 percent from 2009 to 2010, which spokesman MacGregor said was likely due to “normal year-to-year fluctuation.”

ProPublica’s early analysis of the data is limited because so few companies report their spending and even then, disclose different information. Lilly, for example, reports every health professional it pays to speak, while Pfizer includes only those who can prescribe.

“It’s really unclear how much money is being spent in any one of these areas,” said Vincent DeChellis, a principal at NHHS Healthcare Consulting, which has studied the data. “As you get more and more companies participating and submitting this information, you’re going to get an initial look” at what may be a multibillion-dollar practice.

When Massachusetts required drug and device companies to report payments to doctors in that state last year [3], 286 companies did so.

Scrutiny of speaker programs has prompted changes.

After ProPublica reported last year that some drug-company speakers had been sanctioned by their state medical boards [4], the firms pledged to toughen their screening procedures [5] and exclude physicians with disciplinary records.

Separately, ProPublica found that universities were not enforcing their own policies [6] barring physicians from giving promotional speeches. In response, a number of schools said they would begin using the payment rosters to check for rule-breakers [7].

Pharma’s trade group said the focus of most companies right now is ensuring the accuracy of data that will be publicly released in 2013. But this transparency also must be put into context for patients, said Diane Bieri, executive vice president and general counsel for the Pharmaceutical Research and Manufacturers of America.

Doctors help develop new medicines, advise companies on marketing and help educate their peers about appropriate uses of new drugs, she said.

“If the only information that’s available is that company A paid doctor B $75,000 for a consulting arrangement,” she said, “that’s typically not enough information to really educate the patient about what was involved in that relationship.”

MGH publication promises to reverse age-related memory loss and more

This arrived in the mail today. Sounds a tad overstated to me.

One thing is clear — seems MGH has opened Harvard Health Letter-ish publishing arm, with a touch of Sham Wow marketing.


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