How much is a Miami doctor’s endorsement worth? A lot, if you’re a pharma company

Nov. 10--This story used data from ProPublica's Dollars for Docs database.

Pharmaceutical companies and medical device manufacturers are flooding South Florida doctors with millions of dollars in payments for consulting and promotional talks to drive higher prescription rates.

The payments have been commonplace in the industry for more than a decade, and have continued at a steady pace despite increased scrutiny from prosecutors and academics, according to an analysis of federal data by ProPublica, a nonprofit investigative journalism organization.

More than 2,500 physicians nationwide -- 64 of them in the South Florida counties of Miami-Dade, Broward and Palm Beach -- have received $500,000 or more in payments since 2014, the analysis found. ProPublica analyzed data from the first five years of the federal Open Payments Initiative, requiring companies to publicly disclose payments as part of the Affordable Care Act.

The 64 South Florida doctors received more than $60 million since 2014. Payments recorded in the database fell into different categories, ranging from promotional talks for brand-name drugs to reimbursement for medical expertise and other reasons.

Not all payments signify a cause for concern, but doctors should disclose to their patients whether they've received money from a company that has anything to do with their practice, said Marin Gillis, a bioethicist and professor at Florida International University's Herbert Wertheim College of Medicine.

"What's on the line is nothing less than trust in the profession of medicine," she said.

Jay Skyler, a physician and diabetes researcher who received about $2.2 million in payments since 2014, said he was paid in part for an exercise of stock options from being on the board of directors for a diabetes glucose-monitoring device manufacturer.

But Skyler said he always discloses to his patients if he is prescribing the device from the company where he has a financial stake. And he said he also prescribes his competitors' devices.

"There are different indications where theirs is more appropriate and others where ours is more appropriate," Skyler said. "One has to be realistic about that, not to do things just because I am associated with it."

Still, Skyler said the influence of profit-driven companies is a growing problem in the medical field, and patients should be wary.

Pharmaceutical companies have long picked up the tab for academic talks with educational purposes, Skyler said, but in recent years, they have grown more aggressive in marketing their products -- and they're using doctors as salespeople.

"What's happened is that companies have taken on the notion that this is part of their marketing campaign," Skyler said. "They force speakers to use a slide deck that they have prepared, and they're totally promotional."

Ken Goodman, founder and director of the University of Miami Miller School of Medicine's Institute for Bioethics and Health Policy, said slide decks for presentations prepared by pharmaceutical companies are prohibited at UM.

"What we want, and what all credible organizations want, is to have our intellectual excellence unsullied by the appearance that we're hired guns for industry," Goodman said.

Doctors outside academia also accept payments from pharmaceutical companies.

One South Florida neurologist and researcher, Stuart H. Isaacson, received about $2.3 million in payments since 2014 from various medical companies. Many of the payments appeared to be associated with promotional speaking for brand-name neurological medications, according to the federal data.

According to a website biography for Isaacson, he has been involved in over 75 clinical trials and co-authored nearly 100 abstracts, journal articles and book chapters.

Isaacson did not return voicemails or emails requesting comment, but the ProPublica records show that the manufacturers of an anti-psychotic drug called Nuplazid, which is used to treat Parkinson's disease psychosis, paid the neurologist about $118,000 in 2018. That payment was the second-highest Nuplazid-related payment for all physicians in the country last year, according to the ProPublica database.

And Isaacson received $116,000 last year from the manufacturers of Austedo, the brand name for a drug used to treat involuntary muscle movements associated with Huntington's disease. Isaacson's name appears on a slideshow bearing the Austedo logo from a presentation about side effects from anti-psychotic medicines dated October 17 at a steakhouse in Houston.

Goodman said that UM's medical school allows its physicians to give talks, but they must be educational and not promotional or commercial in nature.

Pharmaceutical companies aren't just paying physicians who write prescriptions in their day-to-day practice. Some of the payments go to research-oriented doctors who conduct clinical trials. For that reason, Goodman said UM's medical school has a conflict-of-interest committee that scrutinizes payments for consulting and research.

"We want to make sure that any science we do, especially when there is tax money used for it, is not corrupted by financial considerations," he said.

Several of the doctors who have received more than $500,000 since 2014 had some affiliation with UM, but it's unclear whether any of those payments would violate the school's policies, because the medical school doesn't share them.

Goodman spoke highly of UM's policies to safeguard against pharmaceutical companies' influence, but a spokeswoman for the medical school wouldn't provide them to the Miami Herald. She also wouldn't answer specific questions about what would be forbidden under the policies.

Lisa Worley, the UM spokeswoman, said in a statement that "the University of Miami has clear disclosure policies that uphold the highest scientific and ethical standards."

"As an innovative academic institution, we constantly reevaluate our procedures and policies in order to assure the integrity of scientific discovery," Worley said.

Most medical schools changed or developed policies on pharmaceutical industry influence after the "PharmFree" campaign launched in 2002 by the American Medical Student Association, which sought to clear what was then a longstanding presence of industry representatives on medical school campuses.

The medical-student-run organization uses a "PharmFree" scorecard to grade schools on policies designed to combat pharmaceutical industry influence. Florida International University's Herbert Wertheim College of Medicine received an A grade and UM's Miller School of Medicine received a B.

AMSA said on its website that it located UM's policies online. FIU provided the policies to the organization in 2016.

Gillis, the FIU bioethist, said pharmaceutical companies train their representatives to follow scripts that are designed to persuade doctors. She said she teaches her students at FIU how to counter those strategies by simulating them in the classroom.

"Even first- and second-year medical students have already had experience dealing with medical reps in hospitals," Gillis said. "They're already really exposed to it."

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