Drug payments to doctors
Following in the footsteps of the State of Minnesota, the State of Vermont recently required drug companies to disclose payments to physicians. Although Vermont is a small state without a significant number of specialists, some intriguing numbers came out of the Vermont data. For example, just as in Minnesota, it turns out that Psychiatrists take home more drug company money than any other specialty. Further, the numbers show that Psychiatrists who took the most money also tended to be more likely to prescribe dangerous, expensive and controversial antipsychotics to children--a practice which has been questioned. The Minnesota study also found that a significant share of the psychiatrists who were highly compensated had been disciplined in the past and had impaired credibility.
Overall, in 2006 drug makers paid $2.25 million dollars to Vermont doctors, their universities or hospitals, for fees and travel expenses. Payments to psychiatrists doubled from 2005 from $20,835 to $45,692 on average. This number does NOT include the cost of free drug samples or the salaries or expenses of sales representatives. The manufacturers' data show that they spend roughly twice as much on marketing the drugs as they spend on researching them.
Endocrinologists earned the second largest average marketing fees from drug makers: $33,730 per year. The top 100 doctors who received the highest compensation included 11 psychiatrists and 5 endocrinologists. Although we are not privy to the data and couldn't tell for certain, it appears that the averages annual payment was computed for the highest-paid specialists, not for all specialists in the state.
It appears to be self-evident that doctors' prescribing decisions should not be influenced by drug money. This kind of back-scratching behavior is inappropriate in any circumstance, but it is deplorable when it occurs in two wealthy professions and the health of innocent people is at issue. "Bribing" doctors to prescribe a company's drugs should be criminalized so that there is not even the appearance of unethical behavior. The studies in Minnesota and Vermont confirm our common sense assumption that these payments are influencing the treatment decisions of medical professionals.