Payments from pharmaceutical companies touch hundreds of thousands of doctors. The 17 companies ProPublica have tracked spent $1.4 billion in 2013 alone. Here are the top five takeaways from following all that money
This story was co-published with The New York Times.
On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country.
The information is being made public under a provision of the 2010 Affordable Care Act.
The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research.
It's not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That's because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project.
We've aggregated information from the websites of some large drug companies, which publish their payments as a condition of settling federal whistle-blower lawsuits alleging improper marketing or kickbacks. Today, in cooperation with the website Pharmashine, we've added data for 2013, which now covers 17 drug companies accounting for half of United States drug sales that year. (You can look up your doctor using our easy search tool.)
Here are some facts we've learned from the data:
Many, many health professionals have relationships with industry.
Dollars for Docs now includes 3.4 million payments since 2009, totaling more than $4 billion, of which $2.5 billion was for research. For 2013 alone, there were 1.2 million.
It's not possible to calculate the exact number of physicians represented, because drug companies haven't used unique identification numbers that cross company lines. But it's clear that the figure is in the hundreds of thousands.
Excluding research payments, the drugmaker Pfizer appeared to have interactions with the most health care professionals last year — about 142,600. AstraZeneca came in second with about 111,200. Johnson & Johnson and Forest Labs each had nearly 100,000. There are an estimated 800,000 to 900,000 active doctors in the United States.
"Most physicians that are in private practice are touched in some way" by the industry, said George Dunston, co-founder of Obsidian HDS, the creator of Pharmashine. "You add that up and it's a pretty significant number."
Surveys conducted in 2004 and again in 2009 showed that more than three-quarters of doctors had at least one type of financial relationship with a drug or medical device company. The figure dropped from about 94 percent in 2004 to 84 percent in 2009, said the lead author, Eric Campbell, a professor of medicine at Harvard Medical School and director of research at the Mongan Institute for Health Policy at Massachusetts General Hospital.
Dr. Campbell, who has been critical of physician-pharma ties, says he hasn't conducted a follow-up survey but suspects that the percentage of doctors receiving payments has probably decreased somewhat since then.
"The old approach was just to try to get as many docs as you can, blanket coverage, and establish relationships," he said. "I think they're being much more targeted and specific."
Some doctors have relationships with many companies.
Those who read the fine-print disclosures accompanying medical journal articles know that doctors often have relationships with several companies that compete in a drug category (such as heart drugs or those for schizophrenia). Our data bear that out.
Some highly sought-after key opinion leaders, as they are known in the industry, work for half a dozen or more companies in a given year.
Dr. Marc Cohen, chief of cardiology at Newark Beth Israel Medical Center, received more than $270,000 last year for speaking or consulting for six companies listed in Dollars for Docs. He is a prolific researcher and author.
While keeping key rates unchanged, the RBI has reduce the liquidity provided under the export credit refinance facility from 32 % of eligible export credit outstanding to 15% with effect from October 10, 2014
The Reserve Bank of India (RBI), in its fourth bi-monthly credit policy review on Tuesday has kept repo, reverse repo, cash reserve ratio (CRR) and bank rate unchanged. The central bank has sought to reduce the liquidity provided under the export credit refinance (ECR) facility from 32% of eligible export credit outstanding to 15% with effect from 10 October 2014. The reverse repo rate under the liquidity adjustment facility (LAF) will remain unchanged at 7%, and the marginal standing facility (MSF) rate and the bank rate at 9%.
In a statement, RBI Governor Dr Raghuram Rajan said, “since June, headline inflation has ebbed to levels which are consistent with the desired near-term glide path of disinflation— 8% by January 2015. The most heartening feature has been the steady decline in inflation excluding food and fuel, by a cumulative 111 basis points since January 2014, to a new low.”
He however cautioned that, there are risks from food price shocks as the full effects of the monsoon’s passage unfold, and from geopolitical developments that could materialise rapidly. Therefore, “the future policy stance will be influenced by the Reserve Bank’s projections of inflation relative to the medium term objective (6% by January 2016), while being contingent on incoming data,” the RBI governor added.
The RBI will continue to provide liquidity under overnight repos at 0.25% of bankwise NDTL at the LAF repo rate and liquidity under 7-day and 14-day term repos of up to 0.75 per cent of NDTL of the banking system through auctions and continue with daily one-day term repos and reverse repos to smooth liquidity.
Speaking on economic activity the governor mentioned that, “The momentum of activity in all sectors of the economy is yet to stabilize. Agriculture should shed the effects of recent shocks and pick up in Q4 of 2014-15. Industrial activity will await improvement in the business environment and the resumption of consumption and investment demand before gaining sustained speed. Post-monsoon revival in construction activity and the likely strengthening of momentum in business and financial services should sustain the recent signs of expansion in the services sector. The key to a turnaround in the growth path of the economy in the second half of the year is a revival in investment activity – in greenfield as well as brownfield stalled projects – supported by fiscal consolidation, stronger export performance and sustained disinflation.”
With no change in key policy rates, the repo rate (the rate at which the RBI lends money to banks) remains at 8%. Similarly reverse repo rate (the rate at which the RBI borrows from banks), CRR, and bank rate remains at 7%, 4.00% and 9%, respectively.
The fifth bi-monthly monetary policy statement is scheduled on Tuesday, December 2, 2014
Reverse Repo Rate...........7%
If your monthly salary was over Rs6,500, you were excluded from EPF (Employee Provident Fund)...