Drug companies' payments to doctors questioned; Farrington says he's named because of research he helps with
By Karissa Minn
SALISBURY - When federal requirements go into effect in 2013, the public will be able to see exactly how much money drug companies are giving their local doctors.
Some companies already have begun to release those records to prepare for the Physician Payment Sunshine Act, which is a part of the new health care reform law requiring that payments to doctors be made public.
More than a dozen Rowan County health professionals accepted payments of more than $250 from pharmaceutical companies in 2009 and 2010, according to nonprofit investigative journalism group ProPublica. The payments were made in exchange for speaking, consulting, research and associated meals and travel.
ProPublica has collected all the data it could find in a searchable database on its website.
That database lists Dr. Cecil Farrington, of Farrington Family Medical Center in Salisbury, with more than $531,000 in funds paid in 2009 and 2010 by GlaxoSmithKline and Pfizer.
Though a recent WSOC-TV report said Farrington accepted the funds, the ProPublica database shows that $528,000 of it was actually paid to Crescent Medical Research. Farrington was the doctor who provided the services, which is why his name is listed.
That money paid for clinical research trials, Farrington said, to test medications for conditions like hypertension, heart disease, diabetes, gout and acne.
The remaining $2,800 was given by Pfizer as reimbursement for travel and meal expenses associated with the trials, Farrington said.
Jennifer Jessing Byrne, president and chief operating officer of PMG, said roughly 20 percent of research trial funding typically goes to physicians.
Farrington's name was associated with payments to Crescent because he was the lead investigating physician in the trials, Byrne said. At least one other doctor is usually involved, she said, and sometimes several others.
"We are paying him for the research services he's providing, and that's just a fraction of the total amount," Byrne said.
She said the rest of the money pays for research professionals' salaries, laboratory testing, diagnostic scans and patient reimbursement.
The doctors know which pharmaceutical companies are funding the trials, Byrne said. But almost all of the studies are double-blind, meaning neither the doctors nor the participants know whether they're testing that company's drug, a competing drug or a placebo (sugar pill).
Even when the results of a double-blind study are released, Farrington said he does not learn which group was taking which product.
"Any drug that you've ever taken has gone through this process," Byrne said. "To get a drug approved, there might be 4,000 or 5,000 volunteers over the course of 50 or 60 research trials over eight to 10 years."
Someone has to monitor the health of those participants in studies across the country, and that's where the doctors come in. Farrington, who has been involved in clinical research for about 12 years, is one of about 120 physicians who partner with PMG Research in the Carolinas and Tennessee.
"When we're doing a study, the protocol tells us everything we're supposed to do," Farrington said. "We may have 15 things on visit one, two things on visit two and three and 15 again on visit four."
The research doctors are compensated for their time based on the services they provide - such as checking a patient's mouth for thrush - at each visit.
As far as Pfizer's compensation for meals and travel, Byrne said those expenses are probably related to investigators' meetings, which often take place out-of-state and bring together all of the doctors and the research team involved a study.
Farrington said he has gone to four such meetings this year, each for a different study.
The ProPublica database also includes Vance Merhoff, another doctor who partners with Crescent (now PMG). Pfizer paid about $20,000 in 2010 for a trial he led.
In 2009, 2010 and 2011, GlaxoSmithKline paid a total of $21,500 to Merhoff for speaking.
Byrne said she thinks doctors should be commended for being willing to help with clinical trials, because without them, new breakthrough drugs could not get federal approval. The doctors also provide participants with frequent medical care and, in the process of testing, can sometimes alert the patients to health problems they didn't know they had.
Joy Bryde, assistant director of the Institutional Research Compliance Program at the University of North Carolina at Chapel Hill's School of Public Health, said clinical research necessarily involves doctors and paying them for their time and expertise.
Bryde, who is also the program's conflict of interest officer, said faculty physicians at a public university follow stricter rules than those in private practice. They are not allowed to be part of speaker's bureaus, for example, that private physicians often participate in.
"I think there's a distinction between direct or indirect payment. ... Specifically with the FDA, for physicians to be paid for their time for clinical trial, that's considered normal and usual," she said. "The possible conflict of interest is if they also receive additional payment for consulting, speaking and things like that."
If the same company is paying a physician both for research and for other purposes, for example, Bryde said there could be a concern that the doctor's research is being influenced. She said the U.S. Food and Drug Administration (FDA) and National Institutes of Health (NIH) have different standards for how much payment is acceptable in these cases.
In other cases, she said, there could be a concern about a conflict of interest in patient care or prescribing if a doctor is receiving large amounts of money directly from a drug company.
Physicians who work with PMG have to disclose any potential conflicts of interest at the beginning of each trial, said Byrne.
Other local health professionals listed by ProPublica as receiving more than $1,000 from pharmaceutical companies include:
• Wanda Honeycutt, of Salisbury, $10,182 from Eli Lilly for patient education programs and travel
• Mark R. Ippolito, of Salisbury, $5,500 from Cephalon for honoraria
• Bradley Scott Chotiner, of Rockwell, $5,000 from Pfizer for speaking
• Monica E. Doerr, of Salisbury, $2,531 from Eli Lilly for speaking
• Suzanne Spivey Brown, of Kannapolis, $2,267 for consulting, travel and meals
• Parag Shantilal Dalsania, of Salisbury, $1,750 from Pfizer for consulting
• Joseph Nathan Champan, of Salisbury, $1,001 to $10,000 from Allergan for a combination
These records include payments over $250 made in 2009, 2010 and the beginning of 2011. Some companies did not publish records or only published some for the given years. Not all of the people listed are prescribing physicians.
The full ProPublica database can be found at projects.propublica.org/docdollars.
Contact reporter Karissa Minn at 704-797-4222.