Investigative innovator ProPublica launched a new project this week, a national database of doctors and the money they have received from pharmaceutical companies. It teamed up with the Boston Globe, Consumer Reports, NPR, the Chicago Tribune, and PBS as investigative partners. To compile the Dollars for Docs database, web developer Dan Nyugen and reporters Charles Ornstein and Tracy Weber collected the information from seven major pharmaceutical companies who have posted their payroll information online, and cross-referenced the doctors’ names with other publicly available disciplinary records. The database is searchable by state or by doctor’s name, and there’s also a list of the 384 top-earning health providers who made at least $100,000 from pharmaceutical companies (in 2009 and early 2010).
The implied story, of course, is that checks from pharmaceutical companies—usually for speaking fees at pharma-sponsored conferences, but sometimes for travel and meals as well—would inappropriately influence doctors to prescribe those companies’ drugs at a higher rate than they normally would. Indeed, there have been some hefty lawsuits through the years involving some cases where a quid-pro-quo link could be clearly drawn.
But in general, that remains a tricky thing to investigate, as individual drug prescriptions are not public information. ProPublica is quick to point out throughout the Dollars for Docs web pages that it’s perfectly legal for doctors to receive payments from pharmaceutical companies, “but it does raise ethical issues.”
What ProPublica can show, however, is that the highest earning doctors on Big Pharma’s payroll are not necessarily the most reputable in the medical field:
Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.
But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.
(The details of some of those disciplinary cases will make you cringe.)
This project is a huge undertaking, which some have criticized for being too big, and others for being too limited (see the debate going on over at Knight Science Journalism Tracker). Regardless of the conclusions ProPublica and its partners have been able to tease out of the data thus far, the database alone is an important resource; it’s a great opportunity for reporters and editors to localize an aspect of health care reform that’s often merely abstract. For example, Judy Graham from the Chicago Tribune (one of the media partners) wrote a piece listing the twenty-five highest earning doctors in Illinois, where they work, what kinds of drugs they get paid to present on, and what they had to say when Graham asked them about it.
In a conference call on Thursday, ProPublica reporters Ornstein and Weber spoke to reporters and editors from dozens of news organizations about how to best use the database to find stories their readers would care about. Weber stressed several important caveats. First, with such a large database, there are bound to be doctors who share the same name, so it’s important to double-check before publishing anything about a particular person. For instance, Weber said that while researching disciplinary records, they found seven doctors with the same name in Manhattan alone.
Second, the database is in its beginning stages, so one can’t take the doctor payments at face value: some drug companies reported on the last eighteen months of payments, others only reported on the last six months, and only seven drug companies have thus far disclosed anything at all. So just because a doctor isn’t listed in the database, doesn’t mean that he or she hasn’t received payments from drug companies, and those doctors who are listed may have received way more than the amount listed. (By 2013, as a result of the health care bill recently passed by Congress, all U.S. pharmaceutical companies will have to disclose this information, and ProPublica will continue updating the database to reflect that information.)
Some reporters on the conference call asked how they could best localize the story for their readers, besides just confronting the doctors in their area who appeared in the database. Weber suggested looking up doctors in the area and taking the list to the county courthouse to look for malpractice suits that would match up with those names. You can do what Weber and Ornstein did for their Top Earners list, and look up those doctors on the state medical board websites and the FDA website for disciplinary actions or warning letters. You can also usually find out other possible conflicts of interest that they are required to disclose, such as the other companies that they are currently advising or assisting with research. It is often public information which pharmaceutical companies the doctors own stock in, though it might require some digging.
Here are some links Weber and Ornstein provided in a follow-up e-mail to reporters:
Weber encouraged journalists to ask other medical professionals in the field about the higher-paid doctors. The drug companies say that they invite the most well-respected experts in the industry to come speak at their events, but, Weber said, “in several cases we could find almost nothing [published] on some of the top-paid speakers, but also that their colleagues around the country had no idea who they were, even sometimes in their own towns had no real sense of their qualifications.”
It can also be useful to find out where these payrolled doctors work, and ask the doctors’ employers and patients for reactions. Some reporters have already found that the institutions where the doctors are employed aren’t aware of all of the fees they are collecting on the side.
“Sometimes the wives don’t even know that they’re making the speaker money,” said Weber. She added that in many cases, they found that the doctors themselves had no idea how much money they were making.
For more behind-the-scenes reading: Megan Garber at Nieman Lab wrote about how ProPublica managed to wrangle so many partners into an efficient investigative team, and Rosland Gammon on BusinessJournalism.org reported on a tool that helped ProPublica streamline their database info, called Google Refine.
Of course, non-journalists are certainly encouraged to use the database, too; its main function is to inform people about their own doctors. ProPublica’s Nicholas Kusnetz wrote this Q & A about how patients can find the information they need, whether they should be concerned about what they find out, and, if appropriate, how to broach the topic with their doctors.
Update: This post previously misspelled reporter Charles Ornstein’s name. The error has been corrected.