Thursday, 10 May 2018

Neurologists supplement their income

The NHS Doctor can supplement their income by private practice, but also from the Pharma Industry.

In the USA they are transparent about this, So what do they get?

Anyone one who reads the blog knows that people get compensated for working with the pharmaceutical industry. This paper aims to document this.


However, it is not about getting wads of cash and something secretive.

In the US they have taken a path of openness and doctors have to declare these earnings. So you can look at publically available databases to find out who got what. 

Does this mean that the people receiving money from pharma are bought? 

Come-on People, Neuros have more integrity than that. Does it mean they will push the pharma drug? In most cases, the pwMS choose what they will take.

People are providing a service and it is correct that they are reimbursed for this. 

You don't go to a mechanic and expect them to repair your car for free. Why should pharma get free advice? 

So 50% of Neuros don't get any pharma dosh. Is this because they are "holier than thou" or because their opinion isn't worth hearing. 
I suspect the latter for many. After all MS may not be their speciality and the area of their interest may have no pharma cash

However, key opinion leaders, no doubt, do OK from this. They are on many advisory Boards. Some pay the taxman whereas others put it into discretionary funds.  I could give examples of both, but I won't.

However, when they do get something the average of about $80 is hardly something to shout about. Hardly the stuff that would get a supermodel out of bed. As a MouseDoctor it wouldn't get me out of Bed either. 

This probably represents a bit of travel money or as can be seen food and drink, which is the major fraction of the cost. Alcoholic drinks are excluded so the Neuros are not dining on Dom Perignon.

If you go for a private consultation the neuro gets more than $81, should we have a list of these expenses? I guess that could be another publication.

Ahlawat A, Narayanaswami P. Financial relationships between neurologists and industry: The 2015 Open Payments database. Neurology. 2018 May 4. pii: 10.1212/WNL.0000000000005657.

OBJECTIVE: To analyze research and non-research payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments database.

METHODS: In this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce data book, 2015.

RESULTS: In 2015, approximately 51% of US neurologists received non-research payments totaling $6,210,414. The median payment per physician was $81. Payments to the top 10% of compensated neurologists amounted to $5,278,852 (84.5%). Food and beverage was the most frequent category (86.5% of the total number of payments). The highest amount was paid for serving as faculty/speaker for non-continuing medical education activities (58%). The top sponsor of non-research payments was Teva Pharmaceuticals ($1,162,900; 18.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%).

CONCLUSIONS: The Open Payments program was established to foster transparent disclosure of physician compensation from industry, in response to legislative and public concerns over the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.

29 comments:

  1. This is Wrong

    If you go on Dollars for Docs

    https://projects.propublica.org/docdollars/


    You have the break down by company paymest and doc income for that

    payments

    Example

    HEIDI CRAYTON
    Listed Specialty: Neurology
    8320 OLD COURTHOUSE RD, SUITE 400, VIENNA, VA, 22182-3831


    Receive



    2015 757 $399,584 16
    payments payment total companies paid this doctor


    Promotional Speaking/Other $200K

    Promotional Speaking/Other $200K

    Nonaccredited Training $82,060

    Travel and Lodging $53,503

    Consulting $52,005

    Food and Beverage $11,852

    Education $81


    ReplyDelete
  2. Hardly the stuff that would get a supermodel out of bed.

    MD - don’t you mean in? :)

    ReplyDelete
  3. What about academic scientists on the take? Or do they donate their time to Pharma for free?

    ReplyDelete
    Replies
    1. What do you think?

      You can see my and MD2 conflicts on the blog, as you can for all contributors

      Delete
    2. MD - I'm not really interested in conflicts of interest as just a list of companies. I am interested in how much individuals actually receive from these companies. Would you, Prof G etc. be willing to share the actual numbers in £s? If not, why not?

      Delete
    3. I do donate my time for free to pharma,charties, blog etc but if pharma offer payment I will take it. How, much is between me the university and the taxman. Personally I think it is none of peoples business of what I get or don't, likewise it is none of my business to know what you may or may not get.

      Delete
    4. MPs have to disclose all their income from different sources. Why do you think you can be less transparent. What if Prof X was giving most of his / her patients drug ZZ for their MS but was receiving £500k for consultancy work from the company which makes drug ZZ? As a patient I would like to know this. My real interest is that Team G always winge about the hours they put in / all the work they have to do / all the foreign travel etc. I suspect the total income of some / all of the members of Team G is likely to be very high - eye watering to most of us. Not bad for a disease where the cause is not known and the treatments for advanced MS are non existent. Money talks as they say.

      Delete
    5. Mouse, with your university salary and your additional income (from Pharma etc.) do you earn more than the Prime Minister (£140k per year)? When your antispasticity drug comes good you'll be a millionaire (Delboy Trotter of the MS Research world). Good to see that you and other members of Team G are card carrying members of The Labour Party. Greed is Good says Gordon Gekko. Poor old MSers living on benefits, poor NHS nurses living on a pittance, Neurologists and MS Researchers = loadsamoney.

      Delete
    6. Rest assured that MD hasn't put his name down for a new Ferrari just yet ;-)
      I suggest you direct your ire at more deserving targets.

      Delete
    7. I'm not a MP..and I am not in control of public expenditure..That's why.

      "What if."....Should we ask if there is consultancy or simply ask what treatments are being used? Pharma know this because they have got this information from Hospital by FOI.

      Wouldn't it be interesting to get a map of MS prescriptions and then we can see where the aggressive verses the wait and watch Neuros are?

      TeamG always whinge...get your facts straight...most people from the Team do not post comments..End of Story.

      Delete
    8. Mouse - you could probably buy the pit village you came from. Welsh Mouse - you could probably buy Wales. Enjoy your weekend living it up in your fancy London apartments (or are you off to your second homes). The Times Rich list is published on Sunday so I'll be scanning it for neuros and neuro-science researchers. Prof C will be doing his church duties on Sunday. He knows that "it's easier for a camel to pass through the eye of a needle that for a rich man to enter the kingdom of heaven".

      Delete
    9. neurologists must be rich. That's why they all live in London and we can't ever find any elsewhere in the country

      Delete
    10. The only pits where I come from...are Arm pits I'm afraid:-)

      Delete
  4. HEIDI CRAYTON (cont.)

    Drugs & Devices in 2015

    ALEMTUZUMAB $11,207

    AMPYRA $35,661

    AUBAGIO $91,765

    AVONEX $28

    Betaseron $26

    COPAXONE $23

    DRUG INFUSION SYSTEMS $852


    GILENYA $111K


    LEMTRADA $95,003

    Rebif $52

    TECFIDERA $553

    TYSABRI $740

    https://projects.propublica.org/docdollars/doctors/pid/74955

    Ps: I sad look at this numbers and Education item deserves only $81


    :( :( :(

    ReplyDelete
  5. Would like to see top UK neuros on that list unfortanately

    i can find any

    :(

    ReplyDelete
    Replies
    1. "Would like to see top UK neuros on that list unfortunately"
      i can find any

      Not surprising as it is a list of US-based neurologists:-)

      Delete
    2. Luck you :)

      Pardon you not an neuro....Lolll

      Delete
  6. This explains to some extend why there is no real progress in MS research....... :(

    ReplyDelete
    Replies
    1. I think to suggest there has been no progress in MS research to be a little hyperbolic. Much more to be done but real progress has been made, certainly compared to when I started working in the field.

      Delete
    2. "I think to suggest there has been no progress in MS research to be a little hyperbolic."

      Perhaps but..

      PPMS..ALS..ALZ..nothing

      Delete
    3. PPMS-ocrelizumab and I think that is just the start. I'd like to see BTK inhibitors being trialled in PPMS.

      Delete
    4. PSP which Dudley Moore suffered from
      and Lewy Body Dementia of Robin Williams...the list goes on.

      https://www.scientificamerican.com/article/how-lewy-body-dementia-gripped-robin-williams1/

      Delete
  7. Dig deep and deep

    AUBAGIO

    Companies Making Payments Related to this Drug

    GENZYME CORPORATION $24.8M

    Top Doctors Receiving Payments Related to this Drug



    Please dont be naive :)

    Obrigado

    https://projects.propublica.org/docdollars/products/drug-aubagio

    DOUGLAS JEFFERY HIGH POINT, NC $323K

    ReplyDelete
  8. Political naivety or personal interests?

    In Greece, Novartis bribed politicians in order to maintain their high drug prices (especially those for autoimmunes and cancer) and avoid any momentum restrictions. They targeted the local market but they also did that because prices in Greek drugs affect the global drug prices and a 10 cent discount would mean loss of millions of dollars internationally.

    Then, they bribed doctors to prescribe their drugs instead of the competitors ones. In order to make sure that this would happen, they created a secret database which was connected to the national health system database in order to have control over all prescriptions.
    -The database was the only thing that the other Pharma companies hadn't thought of yet.

    And they bribed journalists to promote their drugs, especially the rebranded old pattent ones.

    Novartis follows the same motif to a bunch of other countries and the millions they pay for those scandals is nothing compared to the money they make out of this business.

    The US Novartis scandal is still unfolding...
    https://www.theguardian.com/us-news/2018/may/09/robert-mueller-michael-cohen-special-counsel-novartis

    Novartis just slightly crosses the line of the legal drug cartels, nothing really unseen.


    So, seriously "Come-on People, Neuros have more integrity than that. Does it mean they will push the pharma drug? In most cases, the pwMS choose what they will take." ?? Come on...

    ReplyDelete
  9. If it wasn't for financial support from pharma, most MS clinics in the US couldn't afford to stay in business. A potential conflict of interest - yes. But one that works in favor of most PWMS.

    ReplyDelete
  10. I don’t know if my previous comment made it through as my battery was dwindling. But please elaborate on how many MS clinics are financially strapped to Pharma for their existence.It would seem that it is in the best interest of Pharma to perpetuate the use of their meds in the MS clinic. Are patients supposed to be beholden to Pharma and their magnanimity?

    ReplyDelete
  11. Are doctors being paid enough if they feel the need to either do private work or take money from pharma? Would you like to see a neurologist who thought his or her private patients were more important than NHS patients? What if a doctor is too tired from doing private work or pharma work?

    ReplyDelete
  12. As others have noted, the numbers provided in the abstract in the article above differ tremendously from those that can be found on the "Dollars for Docs" Website.

    Here in the US the pharmaceutical companies are involved in what amounts to legal bribery when it comes to their payments to MS neuros. Some of these doctors collect more than $500,000 in an 18 month period, according to Dollars for Docs.

    As new regulations are put in place, the pharmaceutical companies find ways around them. One of the latest scams is to have doctors take surveys, for which they accrue points which can be redeemed for luxury items such as European vacations and tickets to high-profile sporting events. In many instances, the points can be directly converted to cash.

    The pharmaceutical companies wouldn't be engaged in these endeavors if they weren't seeing a healthy return on investment. And if you think such payments don't influence prescribing recommendations, even if only on a subconscious level, then I have a bridge to sell you in Brooklyn…

    Before I was forced to retire I worked in the music industry. If we compensated the DJs who played the records we put out in any way we would be guilty of "Payola". Quite a few people have seen the inside of federal penitentiaries for just such transgressions. What's the difference between these practices and what the pharmaceutical companies are doing with doctors, and which poses a greater threat to society? The answers should be self-evident.

    Here is one of your fellow countrymen giving his rather hilarious and biting take on the issue. Well worth a watch if you fail to see the inherent problems with this insidious form of legal bribery…

    John Oliver on Big Pharma Payments to Doctors

    ReplyDelete
  13. MD with all the corruption happening in the Pharma industry, affecting not only health care systems but also science itself, all you felt the need to say is "I think it is none of peoples business of what I get or don't, likewise it is none of my business to know what you may or may not get.".
    We get enough dose from profG agendas trying not to disrupt the pharma's state of the things, we could use some ethics for a change.

    ReplyDelete

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