They were among the 17,000 doctors nationwide who were paid a total of $257.8 million by seven companies in 2009 and the first two quarters of 2010, according to data collected by ProPublica, a non-profit investigative news organization.
One doctor in Wayne — internist Thomas Dayspring — pocketed $203,200 during that period, making him the highest-paid speaker and consultant for the pharmaceutical firms in the state and the 37th highest paid in the country.
In Bergen and Passaic counties, 13 doctors who each earned more than $25,000 accounted for a combined $1 million in payments from drug firms. Many other local doctors received smaller payments.
"I’m one of the most requested speakers in the country and I’ve given over 800 speeches in continuing education, some of which were funded by the pharmaceutical companies," Dayspring said about the payments he received from GlaxoSmithKline. "I’m not some fly-by-night guy who doesn’t know what he’s doing. When I’m traveling, I’m not making any money in my practice, so the money I’m paid makes up for that."
The practice is legal, but some in the medical profession have raised questions about what they say is a perceived conflict of interest in having doctors promoting certain drugs to their peers and getting paid by the drug companies to do it. Former drug company employees and officials in the federal government have argued in several federal whistle-blower suits against drug companies that the companies use the speech payments as rewards for doctors who are prolific in prescribing their drugs.
"I’d be concerned about this if I were a patient," said Dr. Steven Nissen, a cardiovascular specialist at the Cleveland Clinic and a vocal opponent of the practice. "What does a patient want but to have their doctor be an advocate for them and their needs? But when they’re taking money from drug companies, the doctors are in effect working for those companies, and the interest of the drug companies may in fact be in conflict with the patient’s."
He said the drug company naturally wants to sell as much of its often expensive brand-label drug as possible, while a patient might be better served by a lower-priced generic drug that works equally well.
"It puts the physician in an unethical position," Nissen said.
Drug companies say the practice is designed to better serve patients by educating doctors about illnesses and the drugs available to combat them.
"AstraZeneca works with doctors so they can provide their colleagues information on appropriate use, safety and benefits of medication, and that’s beneficial to patients because doctors are better informed about our medicines and their treatment options," said Tony Jewell, an AstraZeneca spokesman.
Mary Anne Rhyne, a GlaxoSmithKline spokeswoman, agreed. "We participate so doctors can share their expertise about treatment options with their peers, to improve patient care," she said.
Credentials cited
Both companies say they restrict the speaker pool to doctors with certain credentials, such as an ongoing record of publishing in medical journals, a staff position at a teaching hospital and a leadership position with a national medical association.
Dayspring, who was paid for speaking engagements and educational programs, is an expert in cholesterol management and is director of the North Jersey Institute of Menopausal Lipidology.
Besides Dayspring, two other North Jersey doctors earned six figures from drug companies during the period studied: Dr. Joseph P. Valenza, a Saddle Brook pain medicine specialist and director of pain management at the Kessler Institute for Rehabilitation, earned $176,118, while Dr. Les A. Burns, a Wayne obstetrician and gynecologist, earned $136,150.
Messages were left Thursday at the offices of the 13 Bergen and Passaic doctors who earned the most money from the pharmaceutical companies. Three returned calls.
Oradell psychiatrist Sharad Wagle was paid $25,560 by AstraZeneca to speak and collect data from physicians around the country about a drug he declined to name. Wagle, chief of psychiatry at Holy Name Hospital in Teaneck, said he never advocated for a particular drug.
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"People in different parts of the country react differently to drugs, so the company likes to collect as much information as it can — that’s how the drugs are improved," Wagle said.
Wagle said he resigned from consulting for AstraZeneca in August for personal reasons.
In all, AstraZeneca made nearly $22 million in payments to doctors in the first six months of this year, including $600,000 in payments to New Jersey doctors.
Burns, who spoke to doctors on behalf of GlaxoSmithKline about the benefits and risks for several drugs and a vaccine, said physicians are chosen by the drug companies based on their expertise. He declined to name the medicines that were the subject of his lectures.
"Not everyone gets to do this — it’s based on your credentials," Burns said. "The companies find doctors based on who is already using their drugs. And most companies have a cap as to how much they will pay one doctor."
GlaxoSmithKline used to limit doctors to $150,000 a year in payments for their speeches, but tightened the limit to $100,000 a year, after the company started posting its payment data on the Internet in December 2009, Rhyne said. The number of speakers has declined in the past year as well, she said.
The ProPublica database was compiled from information posted on the drug companies’ websites as well as the result of settlements in whistle-blower suits. The drug companies in the ProPublica database represent about a third of the $300 billion U.S. pharmaceutical market.
A report by ProPublica found that, nationally, hundreds of doctors paid by drug companies to speak had been accused of professional misconduct, were disciplined by state medical boards or lacked credentials as researchers or specialists. A Record review of disciplinary actions by the New Jersey Board of Medical Examiners found no record of actions against any of the North Jersey doctors who received significant money from drug companies.
In all, 384 of the 17,700 or so medical professionals across the nation in ProPublica’s database earned more than $100,000 during the 2009-10 period studied.
"That’s why this needs as much sunshine on it as possible," said Nissen. "For most working people to hear that doctors are making several hundred thousand dollars on the side is amazing. And they’re giving speeches using slides produced by the drug companies. They don’t even have to do any work."
Reporting payments
More than 70 drug companies do not currently reveal their payments to doctors, so the total amount paid out to doctors nationally is much higher. The federal health care reform law that Congress passed this year will require all drug companies to report their payments to doctors by 2013. The federal government will then post that information on the Web.
"We believe in providing more clarity and openness to the public, to doctors and to the government, and that it will lead to a higher level of trust between all the parties involved," said AstraZeneca’s Jewell.
Dayspring has no problem with the drug company payments’ being made public. "Being aboveboard is the way to go," he said.
Burns agreed. "I believe in what I do," he said. "I deserve everything I’ve earned and maybe a little more."
