Doctors' paid talks in question
The pharmaceutical industry funneled nearly $3 million to South Carolina doctors in 18 months, prompting concerns over whether the cash payments influence physicians' prescription writing.
The data, compiled by national investigative news organization ProPublica, shows the payments of $258 million that seven drug companies made to doctors across the country between January 2009 and June 2010.
While the payments are legal, critics charge that they are unethical, creating a conflict of interest that could cause doctors to ramp up prescriptions for drugs they are paid to hawk during speaking engagements.
"Their decision to prescribe a drug becomes influenced by money instead of which drug is the most effective, least dangerous or least expensive," said Sidney Wolfe, director of the Health Research Group of Public Citizen, a nonprofit consumer watchdog group in Washington, D.C.
Local doctors say the paid talks are necessary forums for educating their colleagues on new medicines that could help patients.
Caught in the crossfire between patients and doctors are academic hospitals, whose teacher-physicians are recruited heavily by the industry.
Officials at the Medical University of South Carolina, whose doctors have received the lion's share of industry payments to the Lowcountry, said they have struggled to enforce policies that provide oversight on the relationships between their staff and drug companies.
MUSC administrators are considering toughening the school's conflict of interest policy, which will be discussed in-depth during an upcoming deans' meeting.
Dr. Etta Pisano, dean of the MUSC College of Medicine, acknowledged last week that the school's policy on industry-paid talks, which discourages but does not forbid doctors from speaking about specific drugs on behalf of drug companies, "has some holes in it."
Doctors are required to disclose their relationships with pharmaceutical companies, but the school "relies on the honor system," she said.
"My guess is there are people who haven't done it," Pisano said of the mandatory disclosure.
She added: "Patients should know about that potential influence on your behavior."
Many of the highest-paid doctors in the Lowcountry are in the field of psychiatry.
Dr. Deborah Deas, a professor in MUSC's department of psychiatry and behavioral sciences, netted $81,000 from Eli Lilly for "advising/consulting" for the pharmaceutical giant.
Dr. Benjamin Weinstein, a former assistant professor in the school's adult psychiatry division, captured $63,000 for speaking for AstraZeneca.
Neither returned messages seeking comment.
Dr. Ricardo Fermo, of East Cooper Psychiatric Solutions in Mount Pleasant, earned about $107,000 from Eli Lilly, Johnson & Johnson and Pfizer.
Fermo said the companies regularly hire him to talk to other doctors about their drugs because he is an expert in psychopharmacology. He sometimes is paid to talk to primary care doctors and nurses in rural parts of the state, including recently in Florence County, where they otherwise might not hear about new drugs.
Fermo said the payments create no conflict of interest for his practice, where he and his colleagues prescribe medication based on the patient's specific needs, he said.
"We get the right medications to suit the person" regardless of which company produces it, he said.
Dr. Ward Katsanis, a Charleston-area gynecologic oncologist who was paid $12,750 from GlaxoSmithKline, said he speaks only about drugs he strongly values.
He said he was traveling to Columbia last week to talk to doctors about a cervical cancer vaccine.
Other physicians, such as Dr. Aljoeson Walker, an assistant professor in MUSC's department of neurosciences, said they feel duty-bound to do prescription-drug consulting.
GlaxoSmithKline and Pfizer paid Walker about $27,000 for speaking engagements.
"As an academic physician, I consider it my responsibility to teach and instruct inside and outside of the university," he said in an e-mail.
The doctors said the payments do not influence prescription decisions.
Still, some patients appear to be skeptical.
An October poll conducted by Consumer Reports in conjunction with ProPublica showed that three-quarters of the 1,250 people questioned said they disapproved of doctors taking money in exchange for promoting specific drugs to other doctors.
About 77 percent of them said they would be concerned about the quality of treatment or advice they got from a doctor who took payments from drug companies, according to the poll.
Seven out of 10 of the respondents said they think doctors should tell their patients about payments they have gotten from a company whose drugs they are about to prescribe.