Pharma Paid Physicians $6.5B in 2014 – Looking into the Open Payments Dataset | Hacker News Reader

Pharma Paid Physicians $6.5B in 2014 – Looking into the Open Payments Dataset

troyshu.com

157 pointstmshu154 comments

My favorite tidbit about pharma payments to physicians comes from Ben Goldacre's book, Bad Pharma. Based on a survey, most physicians think that the money doctors receive from pharma definitely affects their prescribing choices, HOWEVER, that only applies to other doctors. Each doctor is convinced that they are perfectly unbiased and that they can receive money without having their opinion swayed, but other doctors are not as strong willed.

This sounds like the same thing you often hear about Congress. People like their congressman but think the others are doing a poor job.

Isn't this the same as the rest of the population's opinion about advertising? Everyone thinks advertising works on other people, but not them.

I wonder how that works, mentally. Most doctors are, I suppose, reasonably intelligent, so I guess that most of them who take bribe-money would prescribe drugs that are from a different brand, just to avoid any suspicion.

(If pharma companies can deduce which brands are prescribed by which doctors, then perhaps there lies a problem we can easily solve.)

Yes, pharma companies can tell what brands a specific doctor prescribes. Pharmacies sell Rx information to companies like IMS who sell it to pharma companies or pharma companies pay the pharmacies themselves for the information.

Ugh, this is really sick.

how many bad engineers have you worked with that knew they were bad? The mental tricks probably aren't that difficult, they are simply getting paid to get educated about some new life saving wonder drug.

How about buying technology? You've never been treated to lunch or drinks or something by a vendor? "You aren't buying a product, we are forming a relationship, you'll be a partner in the future of <widget>". Did you guys buy it?

Most doctors are reasonably intelligent on paper, they all have advanced degrees and all their friends think and tell them they are smart... But why would the ratio of great to bad be different than in tech? I'd think that you could "hide" more easily in medicine, there are all sorts of ways to make a big pay check without doctoring, like selling medical marijuana cards or simply selling prescriptions for big pharma, people will actually come in and ask for certain drugs because they saw an ad. Fact is, most sicknesses are defeated by your immune system, not some pills. Cultivate the right practice and they can simply be legal drug dealers, get paid and their customers will be happy. And nobody wants to think their doctor is bad, but before anything substantial or chronic treatment (like you need this drug forever) you should always seek some additional opinions.

Yes, the Lake Wobegon Effect (https://en.wikipedia.org/wiki/Lake_Wobegon); aka illusory superiority (https://en.wikipedia.org/wiki/Illusory_superiority). I can handle it, they can't.

https://en.wikipedia.org/wiki/Lake_Wobegon

In Brazil the industry is forbidden from giving money directly to physicians, so the bribe comes in the form of expenses paid to a cardiology congress at some tropical paradise. They also sponsor talks and things like that.

Orthopedists often take off-the-books kickbacks from physiotherapy clinics they recommend, Dermatologists take kickbacks from handling pharmacies for custom "hydrating lotions", and so on.

The worst case is the field of orthopedic prosthesis: it is controlled by a mob, the same gangsters control other surgical materials like the stents used for coronary angioplasty. A congressional committee investigated the issue and indicted 10 people from 16 companies:

  * Empresas Oscar Iskin
  * Totalmedic
  * Life X
  * Orcime
  * IOL
  * Brumed
  * Strehl
  * Intelimed
  * Prohosp
  * Tellus Rio Comércio e Importação e Exportação Ltda
  * Elfa Produtos Hospitalares
  * Atma Produtos Hospitalares
  * Osteocare Serviços Médicos, Locação e Representação Ltda
  * Signus do Brasil Comércio de Materiais Hospitalares Ltda
  * Biotronik Comercial Médica Ltda
  * Biomet
  * Intraview

Like many other countries in South America, crime goes more or less unpunished.

Here is a blog post by a psychiatrist looking at one of the dynamics involved in this: http://slatestarcodex.com/2015/02/17/pharma-virumque/

Great perspective from someone on the ground, thanks for sharing!

Shameless plug for a series of blog posts that I wrote in 2014 about this dataset. The aim was to demonstrate how to analyze data with Spark and Python, but probably the most interesting two sections turned out to be Outlier analysis (http://blog.caseystella.com/pyspark-openpayments-analysis-pa...) and Benford's Law analysis (http://blog.caseystella.com/pyspark-openpayments-analysis-pa...)

Super fascinating analysis! I'm a complete newb/just starting to explore all things Spark, what kind of set-up have you found works best? Did you just run Spark locally for your analysis?

Hey, sorry, got busy yesterday and forgot to respond to this.

Well, I work for a Hadoop distribution, so I may have some biases showing through in my setup. I like to use spark in conjunction with Hadoop; I've never actually used it stand-alone before, honestly. For relational data, I'll ingest into Hive as that allows me to pivot to the right tool for the kind of analysis that I need to do whether it be simple SQL via Hive, something more suited for Pig via HCatalog or Spark via SparkSQL. I'll often do my analysis on a Hortonworks Sandbox for small data like this.

For larger data and a more professional setting, I like to do prototyping/ad hoc investigation/etc in python with pyspark inside of jupyter. Generally that transitions either to Java or just plain python (depending on the degree to which it's difficult to transition).

Anyway, hope that helps! Happy to answer any other questions you might have too. :)

No worries! Gotcha, that is indeed very helpful! I appreciate it, will be in touch if I have more questions in the future :)

See whether your doctor has received drug company money - https://projects.propublica.org/docdollars/

> See whether your doctor has received drug company money - https://projects.propublica.org/docdollars/

This is a decent site, but it has a tendency to overstate the significance of some of the 'payments'.

First, it doesn't seem to be properly distinguishing between multiple doctors in a given private practice. That's a hard problem, and I don't fault them for it, but then it's a bit misleading to attribute a payment to a particular doctor's name when it could very well be a gift accepted by someone else in the same practice.

It's also including transfer of money that's associated with conferences. Physicians are required to perform continuing education in order to keep their skills up-to-date (which is a good thing!). Because of this, pharmaceutical companies have a really strong incentive to get themselves financially integrated into this process - and they've succeeded. This is certainly an unfortunate aspect of the medical field, but it's not really something that's possible to avoid, particularly in certain specialties. Personally, I'd rather have a physician who's up-to-date in their knowledge and practice than one who's not. It'd be great if this process were easily separable from pharmaceutical money, but in fields like oncology and psychiatry, it's near impossible.

The descriptions are a bit misleading too. For example, the tooltip for 'Food & Beverage' gives as an example, 'a salesperson asks a doctor if they can talk about a drug over a meal... and the salesperson pays for the meal'. This also includes gifts that are sent to the physicians (e.g., they send the office for the practice a bottle of wine, which was signed for by the receptionist, etc.).

Granted, if you see that your physician received $50,000 in payments for the very drug he/she wants to prescribe you, yes, that's definitely something to ask him/her about. But the data on this site, as it stands, is a lot less indicting than it first seems - it's really best used as a conversation starter between you and your physician rather than a condemnation of individual physicians or even the industry at large.

Precisely.

Anecdotal, I know, however I have a family member that shows up on the site. His number is low—less than a couple of hundred dollars—but I asked him about it when I first heard of the site from Last Week Tonight. His response was that they were medical device manufacturers taking his team out for meals to discuss devices they were either already using regularly or were in the process of trialing. I can't imagine anyone can find fault in such a thing.

I think the problem is that the current system lands somewhere in the "gray zone". The money doesn't appear to have an influencing effect, but we also don't know at what level it would start. I think a lot of people think it's uncomfortably close to "coercive".

With respect to conferences and continuing medical education, there's no need for this to be "subsidized" by drug companies, such conferences are already expensive to attend, despite such "subsidies" in any case.

Perhaps the conferences would end up being in less glamorous locations, but that would have little impact on their educational benefit.

Isn't continuing education in most fields sort of a laugh, such as it is in the legal profession? Is this the case in medicine as well?

At least in Urban Planning, and certainly in software engineering it's definitely not a joke.

I've never heard of formal continuing education in software engineering in any way analogous to that in legal. Curious to know to what you refer.

Yes, in SE you've got to work hard to keep current, but this is not achieved by attending seminars and the like.

Pharma is a drop in the bucket friends. The major source of healthcare cost escalation is hospitals. Then doctors, then devices. Pharma's a scapegoat down at the bottom of the barrel with a mere 10% of the pie, about the same as hospital non-physician staff.

That isn't what this article is about

Yes, yes it is. From the article

> a product of the Sunshine Act, part of the Affordable Care Act.

> Why does this database exist? Basically because of the incentives created by industry being able to pay doctors to work on things that will ultimately help industry–like new drugs or medical devices. The hope is that more transparency will reduce any harmful influence that industry could have on medical research, education, and clinical decision making.

The idea that the major source of graft in medicine is Pharma is a red herring the other actors keep flogging so no one asks who's really skimming.

The third graph pretty much says it all; research, licensing fees, consulting and speaking engagements (mostly training pharma staff from what I understand) make up almost all of the payments.

Glad to see that the data is so boring.

https://plot.ly/~troyshu/14.embed

Now what do those "speaking engagements" actually entail? For example, Hillary Clinton has not disclosed the speeches she's made despite making millions in speaking fees for wall street firms and others.

What are you implying. Next thing you'll be saying her daughter really isn't qualified to work for a hedge fund. How rude.

I would agree that most of the spending is pretty innocuous or at least on the low-end of "inappropriate".

That said, speaker engagements are a bit of a hot button in the industry right now. Speaker engagements are when pharma pays a physician to speak to other physicians. They typically present material that is authored by the pharmaceutical company. The doctor that presents tend to be pretty high profile and leaders in their field of study.

GSK has decided they will not be doing speaker engagements any longer due to the appearance of using money to influence clinical decisions. They're getting a decent amount of flak from other companies about it (i.e. "it will only hurt them"), but we'll see how it goes. It might cause a change in the industry. GSK will now have their own employees present the material (will it be as effective as a outside physician doing it?).

The pharma-sponsored presentation is a time-honored tradition. Usually held at an upscale restaurant in the evening, the well-paid speaker goes through "the drill" about the product. Slides (and their great graphics) provided by the manufacturer of course.

Years ago being a drug company speaker was a pretty good gig. The presenter was expected to more or less stick to the script, but back then there was a fair amount of leeway and speakers often made the subject more lively by inserting anecdotes or clinical "pearls" from their own experience. Sadly that's no longer allowed to happen.

In the 90's and early 00's intermittent I was a speaker for several pharma companies. Besides the pay it was a lot of fun interacting with colleagues, and getting to be the "expert" on the drug. There were other benefits too, paid travel to speaker and consultant meetings at venues I'd never be able to afford to frequent on my own.

But those days are gone forever. In the current environment the pharma companies don't even hand out ballpoint pens anymore, let alone put speakers up at 5-star resorts.

Haven't worked for any of the firms for nearly 15 years. It's a very different thing now. Once in a great while I'll still attend a dinner presentation, but mostly it's a waste of time.

The drug companies have become virtually paranoid about incurring regulatory or public scorn. Speakers are strictly constrained to say only what's FDA approved, the same info provided in the package insert which I can easily read on my own (and most of the time I already have read it). Why bother going over it again?

So I suspect if companies are terminating speaker programs it's because attendance has fallen off even when "high profile leaders" are presenting. Kind of a shame to see traditions fade away, but the message is clear, "drug dinners" and other ways to market pharmaceuticals will soon be relegated to the dustbin of history.

Thanks for the insights, it's always amazing who reads and comments on HN.

The drug companies have become virtually paranoid about incurring regulatory or public scorn.

Thanks for sharing your experience. I'm only familiar with how it is today and yes, companies are absolutely paranoid about following the rules (which is a good thing). Not that surprising considering some of the monster fines these companies have paid.

There are outliers (Genentech, Stryker, Medtronic, DePuy, etc.) when looking at the share of "Royalty or License" payments.

And what the graph doesn't show is how these companies are related. Who owns who? Who's independent and who isn't?

Are there any similar open dataset but for retail? Want to know user behavior, which products are popular, items bought together and so on.

If anyone is currently conducting medical or scientific research and would like to be part of a new beta for a platform that should make your lives easier let me know.

My email is lane (at) myire dot com

The author's implication that the majority of these payments are shady or illegitimate is bizarre. I don't know much about it, but performing research, paying for hospital space, and paying licensing fees to doctors who have invented novel devices all seem like healthy aspects of a medical system working as it should. Perhaps I'm being naive?

Hey etrautmann! Author here, thanks for reading! I agree with you, most payments do seem to be for legitimate purposes (sorry if it seemed like I implied otherwise). But I believe that some types of payments--e.g. industry paying for research--creates incentives with potential negative effects--e.g. on the quality of research; whether these incentives actually do result in negative effects is another question that others have done research on.

My friend had a cyst on the eyelid. His eye doctor changed 3 antibiotics for a period of 3 months. Didn't work. Finally he insisted the doctor to surgically drain it. That worked and it should have been done in the first place. The doctor should have known it. The whole medical system in the US is organized crime.

Yeah, this anecdote definitely proves that.

Antibiotics are cheap. A three month supply may well be cheaper than even simple surgical drainage.

The doctor's obligation is not to "find the cheapest possible treatment" (especially one where the over prescription of generic antibiotics is more problematic than beneficial), especially if the patient is informed.

In the individual case, it's dubious to suggest that surgery is a less conservative option than antibiotics. Yes, antibiotics are woefully over-used (though the overwhelming majority of their use — something on the order of 80% — is in livestock), but the physician's obligation to their patients is to treat their presenting problem, and in the way that is least harmful. Typically, that's taken to mean more conservative approaches first.

Obviously. This one doctor erring on the conservative side and not immediately taking a sharp instrument to your friend's eyelid proves that all doctors are corrupt and/or stupid, and the whole system is a scam.

Or maybe doctors generally know what they're doing and can, on average, perform their profession better than a random guy on the internet.

I'm convinced it's a scam based on my own experiences in U.S.A and the third world. I got a throat infection in India. I went to the pharmacy, took antibiotics for $2. It's done. If that happens in the US, I'm forced to first visit the doctor, pay $250. Then pay some $30 for the antibiotic and even before that have to pay the insurance company hundreds of dollars anticipating these things. Another recent one is spine issue. I paid $4 for orthopedic consultation and $50 for MRI. Check what it costs in US. I have several such experiences. So I'm not a "random guy on the internet". I know what I'm talking about.

I can't speak about operational costs. However drugs in india are so cheap because India is the country where most generic drugs are manufactured. There is a 30 min documentary on YT about it called "India the Pharmacy of the World"". Very interesting to watch, it gives you a good history on pharma companies doing the chemistry equivalent of patent trolling that you see in the big consumer electronic & software companies

It's a scam, but not because you didn't get your preferred treatment first time but because you're required to pay ridiculous amounts for the service in the first place.

(The equivalent experience in England&Wales would be free, apart from $10 prescription charge for each prescription, which is waivable for quite a lot of categories of people with low income)

No prescription charges in Scotland or Northern Ireland:

http://www.bbc.co.uk/news/uk-12928485

True, good point.

What are your consulting fees?

? All medical consultations are free in this system. It's rationed by queuing - if your condition isn't urgent you may have to wait a few more months for a specialist.

Someone pays. All the software devs in this thread ranting about overpayment of physicians should think about their hourly consultation rate and their praise of articles like "fuck you, pay me". Or other articles talking about how "many years of experience built to give me the ability to provide a solution in 5 minutes, which is why I deserve to charge $150 an hour".

Physicians are the same. Someone has to pay for our services. In other systems, taxes pay. In the USA, insurance and the patient does.

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