How useful would a database cataloguing the money that doctors receive from medical drug and device makers—for speaking, research, meals, travel, etc.—be to journalists trying to ferret out potential conflicts of interest?
Just ask ProPublica, which launched its Dollars for Docs database in October 2010. It was the first, freely available resource of its kind, based on data that a dozen drug companies began posting on their websites in 2009 as a result of legal settlements with the federal government.
With it, the investigative news outlet “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.” A couple of months later, it revealed that several medical schools had failed to enforce policies barring their doctors from giving paid promotional talks for pharmaceutical companies. The site’s reporting prompted Stanford University to take disciplinary action against five faculty members. And it’s not only ProPublica that has made use of the database.
Following the launch, reporters Charles Ornstein and Tracy Weber, who helped construct Dollar for Docs, held a conference call for reporters and editors from dozens of news organizations to talk about how to best use the database to find stories their readers would care about. The effort paid off. Papers such as The Boston Globe, St. Louis Post-Dispatch, The Denver Post, Orlando Sentinel, and The Plain Dealer in Cleveland have used ProPublica’s data to “localize stories about conflicts of interest in medicine—bringing the discussion to communities large and small.”
“It’s clear that journalists and the public are hungry for this information,” Ornstein wrote in an e-mail to CJR. “Because the companies that have released data only account for about 40 percent of US prescription drug sales, and a far smaller percentage of firms, there’s much data that have not been released.”
Thankfully, the data is on the way. The New York Times reminded readers in a front-page story on Tuesday that provisions in the 2010 health-care reform law mandated that all drug or device makers with at least one product covered by Medicare or Medicaid must begin disclosing the money they give to physicians (other than its own employees) for a wide variety of reasons. While such remuneration is not illegal, and while advocates say it fosters better service and innovation, it also clearly affects the way physicians treat their patients.
“Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves,” the paper’s Robert Pear reported. “The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.”
Under the new standards, which are supposed to go into effect this year, companies must report their payments to doctors to the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), which will then post the data on a publically available website. Unfortunately, it will be a while until that useful bookmark is available to reporters.
In the Times, Pear pointed out that the new disclosure requirements are already overdue. CMS was “supposed to establish payment-reporting procedures by Oct. 1, 2011,” but it didn’t get the proposed regulations into the Federal Register until mid December. Because of the late entry, companies didn’t have to begin collecting payment data on January 1 as they were originally supposed to. Nonetheless, CMS hopes to finalize to the rule in time for companies to begin reporting payments by the March 31, 2013, as originally required. If all goes well—and there’s no guarantee that it will—CMS will start posting the data online by September 30, 2013.
In the interim, journalists have an opportunity to offer their input on how the database should be designed. Requesting public comment on how to structure it for “ultimate usability,” CMS noted that:
The public Web site must be searchable, understandable, downloadable, and easily aggregated on various levels, as stated in the statute. In addition, section 4 of Executive Order 13563 calls upon agencies to consider approaches that “maintain flexibility and freedom of choice for the public,” including the “provision of information to the public in a form that is clear and intelligible.”
Making that happen may not be easy. ProPublica noted that relying on companies’ voluntarily reported data to construct Dollars for Docs was a serious challenge:
Some of the firms constructed their sites in a way that made it near impossible to analyze or, in some cases, even download their data. And each firm disclosed its data differently. Some, for example, simply included speaking. Others also detailed consulting. Sometimes, research, business travel costs and meals were listed, too.
Dan Nguyen, a news application developer at Propublica and the chief architect of Dollars for Docs, wrote a terrific guide to “scraping” companies’ websites for useful information, but given the difficulty involved, the importance of a standardized database can’t be overstated.
“Some company websites provide the information as PDFs, others require that you enter in a first name, last name and state to look up a doctor,” ProPublica’s Ornstein explained. “If you are a journalist looking for all doctors in a given city, neither of these formats would help you. You’d have to pull the data into Excel and sort it on your own in the first case. In the second case, you’d have to scrap the data from the company’s site or hand-enter it (impossible) to be in a position to analyze it.”
The key for CMS will be not only systematizing reporting procedures, but also making the federal data user friendly, Ornstein added. People should be able to search and cross-reference as many variables—name, city, state, zip code, medical specialty, etc.—as possible for doctors, companies, drugs, and devices.
“Reporters and the public have different things they may be looking for. Some may want to see top-paid speakers, others may be curious about speakers and consultants in their community. And still others may look for certain specialties (information not currently released),” Ornstein said. “It’s rare to find these in the current data released by companies. There’s no uniformity right now in the way companies are releasing the information. The federal rules will create that.”
Until that happens, reporters can continue to use Dollar for Docs, which was updated in September with data from five additional companies beyond the original dozen. There is also a similar database called PharmaShine, but it requires a subscription.
Shrewd reporters have other tools, such open records requests, at their disposal, and outlets like Milwaukee Journal-Sentinel have put them to good use. It launched the ongoing series Side Effects, which investigates the financial relationships between doctors and pharmaceutical industry, in 2009, earning high praise from critics like the Knight Science Journalism Tracker.
But the public-service value of a legally mandated website that tracks drug and device makers’ payments to doctor is considerable, according to ProPublica, which reported on January 3 that drug companies in its database reduced payments to doctors last year “in the wake of mounting scrutiny.”
One only hopes that the federal database arrives sooner rather than later, and that reporters, editors, publishers, and journalism organizations—such as the Association of Health Care Journalists (of which Ornstein is president)—take the opportunity to give their input on its design.