New database shows how much drug companies pay doctors

Warren Joseph is a podiatrist on a mission. He wants the medical world to become better informed about the devastating consequences of diabetic foot ulcers. He says he has no problem that Pfizer, the world's largest drug company, pays him to get the word out. Since 2009, the Roxborough foot doctor has made $67,000 in speaking fees, plus $4,600 for consulting and $13,000 in expenses.

The bigger point, Joseph says, is that diabetic foot ulcers cause more than 80,000 amputations each year. By getting the word out, "I'm saving limbs," says Joseph, who specializes in treating diabetics.

He is among thousands of doctors in the United States who are paid by the companies making the drugs they prescribe. Many critics see this as a conflict of interest that's damaging to the medical profession and, ultimately, patients. They question whether doctors can be objective about prescriptions when drug companies pay them handsomely.

Last week, a database showing how much money the seven biggest drug firms have paid physicians was launched by the nonprofit investigative reporting group ProPublica. The list covers 17,700 individuals who have amassed $258 million in payouts since 2009.

Of those, 384 doctors made more than $100,000.

The companies had posted these payments online, but they were hard to understand. On the ProPublica site, patients can do a search to see if their doctors got anything for speaking, consulting, and other services.

Drug firm payments to doctors have long posed a huge ethical challenge in medicine.

Tufts University psychiatrist Daniel Carlat used to think it was harmless that Wyeth Pharmaceuticals was paying him about $30,000 in yearly speaking fees, he said. He was, after all, educating other doctors on how to recognize and treat depression - and Wyeth's drug, Effexor, did look good in studies at the time, in 2001.

But subsequent studies started to suggest that the side effects might outweigh any advantage, he said. "Gradually I sensed a subtle pressure to embellish the advantage of the antidepressant that I was speaking of and downplay the side effects."

In 2002, Carlat quit working for Wyeth, now part of Pfizer.

Some of the biggest earners in the Philadelphia region said that they were doing some good by educating other doctors about conditions and new treatment options - and that they believed in the company's products.