22 April 2010
by Peter Aldhous and Jim Giles
They are billed as “healthcare professionals who spend years building expertise in their fields\”. Using materials firmly grounded in science, they educate their peers in the risks and benefits of drugs.
This is how Pfizer, the pharmaceuticals giant, describes the experts it hires to lead educational forums in which doctors are lectured on the use of its products.
Yet New Scientist has found that some of Pfizer\’s experts have been disciplined for deficiencies in patient care, while others have been reprimanded for how they conducted drug research trials.
The findings add to a growing controversy surrounding the pharmaceutical industry\’s efforts to market drugs by influencing patterns of prescribing.
Doctors paid to educate peers are a particular worry, argues Sidney Wolfe of consumer advocacy group Public Citizen in Washington DC. \”They are doing things that may be influencing your doctor and you have no way of knowing about it,\” he says. \”It\’s made worse by the fact that some of them have been disciplined.\”
Many drug companies sponsor educational events for doctors. They range from informal evenings with a slide presentation to workshops at multiple venues dedicated to the use of a particular drug. The talks may include research results, advice on identifying patients suitable for treatment and guidance on doses that should be prescribed.
New Scientist matched doctors licensed to practice in the four most populous US states – California, Texas, New York and Florida – against Pfizer\’s records of payments to doctors and medical researchers in the second half of 2009. These were published on 31 March as a condition of Pfizer\’s record $2.3-billion settlement with the US government over charges of illegal drug marketing.
Our search revealed 26 doctors paid to lecture on the company\’s drugs whose records include disciplinary actions related to problems with patient care or drug prescribing. We also cross-referenced Pfizer\’s expert lecturers against US Food and Drug Administration (FDA) records and found another four who have received warning letters over problems with how they conducted drug research.
The censured doctors we found are a small minority of the doctors paid by Pfizer to speak at educational forums – within the four largest states, about 1 in 50 of Pfizer\’s experts had disciplinary records for problems with patient care or drug prescribing.
However, campaigners for patients\’ rights say that the number could be close to zero if drug companies screened experts using medical-license verification websites provided by most US states. Only a small proportion of doctors are disciplined by state medical boards for problems involving patient care.
Elizabeth Woeckner, president of Citizens for Responsible Care and Research, based in Philadelphia, Pennsylvania, believes doctors with disciplinary records should not be educating their peers. \”If it\’s Pfizer\’s position that these are respected thought-leaders, they should have clean records,\” she says.
Some of the 26 doctors were under probation from their state medical boards as they lectured about the company\’s products. They include Joseph Altieri, a psychiatrist in Vero Beach, Florida, who was paid $1000 to speak about the anti-psychotic drug Geodon. In 2008, Altieri was fined $30,000 and ordered to take courses in prescribing controlled drugs and medical ethics, for problems that included prescribing methadone to a patient who had admitted using another narcotic bought on the street.
Psychiatrist Mark Kosins of San Clemente, California, was paid $2500 to lecture on Geodon while on probation. His disciplinary action concerned a patient who was taken into intensive care after Kosins prescribed a combination of drugs that the medical board said \”significantly increased\” the chance of an adverse drug reaction.
Other Pfizer experts ran into trouble during their research. Among them is Thomas Gazda of Scottsdale, Arizona, who was paid to lecture about Geodon after being reprimanded by the FDA over irregularities in his conduct of a trial of the same drug\’s use in children and adolescents with bipolar disorder – one of whom was given more than the maximum allowable dose for five days. The FDA had earlier told Pfizer to exclude Gazda\’s data from the results submitted by Pfizer during its efforts to win approval to use the drug for this purpose.
These three Pfizer speakers deny that their records make them unsuitable to educate other doctors. \”One learns from mistakes,\” says Gazda, who adds that he has extensive clinical experience outside of research trials.
Altieri and Kosins both argue that their disciplinary actions have no bearing on their lectures for Pfizer, because they concerned the prescription of drugs other than Geodon.
Pfizer is not alone in hiring doctors who have been disciplined over problems with patient care. Other drug companies have released doctor-payment records, but mostly in formats that are hard to search systematically against other records. Of the 26 we found speaking on Pfizer\’s behalf, four were also paid to speak for GlaxoSmithKline in 2009.
Return on investment
The influence of pharmaceutical industry educational events is unclear, says Joel Lexchin of York University in Toronto, Canada, who studies doctors\’ prescribing habits. \”But given the amount of money spent on this, it\’s clear that they must be getting a return on their investment.\” Pfizer\’s records indicate that the company paid more than $9.6 million to its lecturers in the US in the second half of 2009.
Pfizer says that it already excludes those who are debarred from US government healthcare schemes.
\”We are continually refining our review process to ensure we are selecting the most appropriate healthcare providers to partner with to educate the medical community,\” says company spokeswoman Kristen Neese.