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Minnesota doctors defend payments from drug companies

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Approximately 200 Minnesota doctors have received thousands of dollars from seven major drug companies over the last 18 months, according to a national news investigation. 

NPR, the nonprofit investigative group ProPublica, and four other news organizations have created a searchable database that tracks the fees that doctors receive for speaking or consulting on behalf of the companies. 

Some of the Minnesota doctors on the list received payments in excess of $100,000.

The database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. The companies include Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck and Pfizer.

Advocates say the database brings much needed transparency to the relationship between doctors and pharmaceutical companies. But some doctors say they're worried that patients will draw conclusions that aren't accurate.

  Dr. John Bantle, a University of Minnesota endocrinologist who treats diabetics, is one such doctor. Over the past 18 months, Bantle has been paid more than $104,000 from pharmaceutical giants Eli Lilly and Merck. 

"The companies come to me because I'm using their products a lot," Bantle said. "They realize that as a heavy user of their products, I must find value in their products, and they want me to help convey that idea to other doctors that might use them." 

Bantle estimates that he gives about one speech a week to various doctors' groups about the diabetes drugs he uses. He also gets paid for educational talks on diabetes that are not tied to any specific drug promotion. 

Bantle earns roughly $2,000 each time he speaks. He uses his own vacation time if he has an out-of-town speaking engagement. 

"I guess the question I have to ask myself is, 'How do I know that being compensated by the company doesn't make me want to scratch their back and use their products?' And that is a tricky issue. It does take some introspection, and I have to think about it," he said.  

Bantle said his main motivation for working with pharmaceutical companies is that he believes it's the best way to spread the word to other doctors about promising new treatments.

  But his relationship with those drug companies is likely to change due to a new conflict-of-interest policy at the University of Minnesota, which prohibits him from promoting any drugs. 

  In any case, Bantle said he has not been influenced by his relationship with Eli Lilly and Merck. 

  Dr. Todd Hess shares Bantle's philosophy. During the same 18-month period, Hess received nearly $170,000 from Eli Lilly, Pfizer and Johnson & Johnson for promoting their pain medications.

"I work pretty much every day off, and a lot of weekends. I do meetings all over the country," said Hess. "And I work on groups such as fibromyalgia and other pain disorders, that are really misunderstood and not well-cared for." 

Hess, an anesthesiologist at United Pain Center in St. Paul, said he has no problem disclosing his drug company payments. He just worries that people who view the new database will draw the wrong conclusion about the nature of his relationship with drug companies. 

"All the expensive meals, all the expensive wine and travel, has stopped. Thank God," said Hess. "That's been, oh heavens, 10 years ago. And I never took any of those. That always felt gross." 

Drug company payments don't automatically imply corruption, said Steven Miles, a professor of medicine and bioethics at the University of Minnesota. But he said there have been instances where drug companies have paid doctors to promote a drug that had serious problems.

He points to the recent Food and Drug Administration decision to restrict sales of the Avandia diabetes drug, after it was linked to nearly 50,000 needless heart attacks, strokes and deaths in the United States.

"Largely because of science that was built by the drug companies to oversell benefits, undersell risks and by relationships with medical opinion maker," said Miles.  

Information in the new database is currently limited to data supplied by seven major drug companies.  More than 70 other drug companies have yet to publicly report their payments to doctors.

Gary Schwitzer, publisher of HealthNewsReview.org, said patients should know that if their doctor is not listed in the database, that doesn't mean he or she hasn't received payments from outside sources. 

"This is just the tip of the iceberg, with most of that iceberg being below the surface -- of what we don't even know about the extent of industry influence and payments to doctors," said Schwitzer, adding "there's nothing here about device industry payments."

Schwitzer said patients who are concerned that their doctors have been influenced by drug company money should ask their physicians to explain why they received payments. 

If a doctor balks at the request, Schwitzer said  it's a sign that the physician might not be the best caregiver for you.