The News-Press (Fort Myers, Florida)

Pharmaceutical companies have paid doctors in Lee and Collier counties almost $1.5 million for consulting, speaking, research and other work since 2009, according to newly released data by investigative news organization ProPublica.

Top payments include more than $100,000 to Fort Myers physician Richard J. Weiss, largely in speaking and educational fees; about $168,000 to Naples anesthesia expert Dr. Joseph Pergolizzi – again, mostly in speaking/consulting fees; and $88,000 to Fort Myers psychiatrist Dr. Fred Schaerf and his clinic, primarily related to medical research.

ProPublica, a nonprofit Web-based news outlet, has been collecting information on a national level for the past two years, after legal settlements the drug companies reached with the federal government.

Total pharmaceutical company spending on doctors and health organizations has topped $56 million in Florida since 2009, making the Sunshine State the fourth highest beneficiary nationally, the data show.

Critics consider these financial deals a potential conflict of interest for physicians. Others say cooperative arrangements, especially for research, are needed in a time of shrinking federal spending on science and medicine.

Either way, these partnerships should be made public, said Jay Wolfson, a professor of public health and medicine at the University of South Florida.

\”It\’s just the right thing to do,\” Wolfson said. \”However you present that to patients, it should be done in as open and transparent a way as possible.\”

\’We are not shills\’

Weiss received $100,716, largely from the drug companies Merck and Eli Lilly, to take part in a half-dozen speaking and educational engagements since 2009.

An endocrinologist and diabetes expert, Weiss considers these kinds of events a good way to teach and learn about the latest in drug developments.

\”These are not advertisements. These are not sales pitches. We are not shills,\” said Weiss, a doctor with Internal Medicine Associates in Cape Coral. \”We are being compensated for our time and expertise in providing a message to physicians.\”

Still, he concedes, the issue is sensitive. Doctors in the past have crossed the line, particularly those who have promoted uses for drugs that had not yet been approved by federal regulators, he said.

Schaerf, who received funding from Pfizer for Alzheimer\’s and other brain-based disease research, agrees.

\”There\’s certainly been abuse of the system, physicians going out and giving talks for drug companies and making statements that might not be completely valid,\” said Schaerf, of the Fort Myers-based Neuropsychiatric Research Center of Southwest Florida.

But, he said, research funding is used almost exclusively to pay for staff and equipment.

\”How much did Fred Schaerf get to take home and use at Publix? It might be zero,\” he said.

Other area physicians who received higher levels of drug company funding since 2009 either could not be reached for comment or declined to comment.

Ethical rules

Aside from laws against kickbacks and fraud, the prevailing ethical guide for such relationships is outlined in a drug industry developed and enforced \”Code on Interactions with Healthcare Professionals.\”

These rules condemn such things as noneducational gifts, such as sports and theater tickets, and deals that compel a physician to exclusively use a particular drug or medical device.

The guidelines also suggest compensation should pay only for modest meals and reasonable speaking fees.

Not all such financial relationships have been made public. And many of the payments are often vaguely defined, such as those for unspecified speaking and research jobs.

That will change in 2013, when federal health reform regulations require more complete and detailed reporting.

For now, it\’s unclear which partnerships are legitimate and which ones constitute conflicts of interest, said Susan Chimonas, a research scholar for the Center on Medicine as a Profession at Columbia University in New York.

\”I feel like we don\’t have enough information,\” Chimonas said. \”I\’m sure a lot of it is legitimate. But a lot of it could be stuff like marketing activities, things people like me would say don\’t serve any legitimate role.\”

Institutions benefit

Large institutions also are the beneficiaries of drug company largesse, principally from the drug manufacturer Pfizer.

Such funding often includes reimbursements for patient care, staff time and equipment costs.

Some examples:

• The University of Miami received almost $300,000 from Pfizer last year to take part in research.

• Taxpayer-supported Sarasota Memorial Hospital received $22,500 from Pfizer in 2009 and 2010, also for research.

• Pfizer also paid the University of South Florida almost $172,000 in 2010 to conduct research.

\”We should have more public funds investing in clinical (drug) trials, but we have not been doing that,\” Chimonas said. \”So drug companies have stepped in to fill that void.\”

Approval needed

Lee Memorial Health System does not allow on-staff physicians and medical staff to accept gifts or payments without prior approval.

And, if the work takes place during an employee\’s normal work hours and/or employs Lee Memorial equipment, the funding is turned over to the system\’s coffers, said spokeswoman Mary Briggs.

The health system has up to 200 government- and industry-funded research projects under way at any given time. All must be approved by special committees.

Hospital administrators are drafting rules that would require independent physicians in a position to influence health system drug and equipment purchasing to disclose all financial partnerships with drug and device companies.

\”It\’s going to enhance our internal controls,\” Briggs said. \”We want to have knowledge if there\’s been a conflict of interest.


To find out more about drug company disclosures and to search providers, go to projects.propublica.org/docdollars.