
Pharma Paid Physicians $6.5B in 2014 – Looking into the Open Payments Dataset - tmshu1
http://www.troyshu.com/blog/2016/01/15/pharma-paid-physicians-6-5b-in-2014-looking-into-the-open-payments-dataset/
======
Fede_V
My favorite tidbit about pharma payments to physicians comes from Ben
Goldacre's book, Bad Pharma. Based on a survey, most physicians think that the
money doctors receive from pharma definitely affects their prescribing
choices, HOWEVER, that only applies to other doctors. Each doctor is convinced
that they are perfectly unbiased and that they can receive money without
having their opinion swayed, but other doctors are not as strong willed.

~~~
amelius
I wonder how that works, mentally. Most doctors are, I suppose, reasonably
intelligent, so I guess that most of them who take bribe-money would prescribe
drugs that are from _a different brand_ , just to avoid any suspicion.

(If pharma companies can deduce which brands are prescribed by which doctors,
then perhaps there lies a problem we can easily solve.)

~~~
refurb
Yes, pharma companies can tell what brands a specific doctor prescribes.
Pharmacies sell Rx information to companies like IMS who sell it to pharma
companies or pharma companies pay the pharmacies themselves for the
information.

~~~
amelius
Ugh, this is really sick.

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scardine
In Brazil the industry is forbidden from giving money directly to physicians,
so the bribe comes in the form of expenses paid to a cardiology congress at
some tropical paradise. They also sponsor talks and things like that.

Orthopedists often take off-the-books kickbacks from physiotherapy clinics
they recommend, Dermatologists take kickbacks from handling pharmacies for
custom "hydrating lotions", and so on.

The worst case is the field of orthopedic prosthesis: it is controlled by a
mob, the same gangsters control other surgical materials like the stents used
for coronary angioplasty. A congressional committee investigated the issue and
indicted 10 people from 16 companies:

    
    
      * Empresas Oscar Iskin
      * Totalmedic
      * Life X
      * Orcime
      * IOL
      * Brumed
      * Strehl
      * Intelimed
      * Prohosp
      * Tellus Rio Comércio e Importação e Exportação Ltda
      * Elfa Produtos Hospitalares
      * Atma Produtos Hospitalares
      * Osteocare Serviços Médicos, Locação e Representação Ltda
      * Signus do Brasil Comércio de Materiais Hospitalares Ltda
      * Biotronik Comercial Médica Ltda
      * Biomet
      * Intraview
    

Like many other countries in South America, crime goes more or less
unpunished.

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afarrell
Here is a blog post by a psychiatrist looking at one of the dynamics involved
in this: [http://slatestarcodex.com/2015/02/17/pharma-
virumque/](http://slatestarcodex.com/2015/02/17/pharma-virumque/)

~~~
tmshu1
Great perspective from someone on the ground, thanks for sharing!

------
frak_your_couch
Shameless plug for a series of blog posts that I wrote in 2014 about this
dataset. The aim was to demonstrate how to analyze data with Spark and Python,
but probably the most interesting two sections turned out to be Outlier
analysis ([http://blog.caseystella.com/pyspark-openpayments-analysis-
pa...](http://blog.caseystella.com/pyspark-openpayments-analysis-part-4.html))
and Benford's Law analysis ([http://blog.caseystella.com/pyspark-openpayments-
analysis-pa...](http://blog.caseystella.com/pyspark-openpayments-analysis-
part-5.html))

~~~
tmshu1
Super fascinating analysis! I'm a complete newb/just starting to explore all
things Spark, what kind of set-up have you found works best? Did you just run
Spark locally for your analysis?

~~~
frak_your_couch
Hey, sorry, got busy yesterday and forgot to respond to this.

Well, I work for a Hadoop distribution, so I may have some biases showing
through in my setup. I like to use spark in conjunction with Hadoop; I've
never actually used it stand-alone before, honestly. For relational data, I'll
ingest into Hive as that allows me to pivot to the right tool for the kind of
analysis that I need to do whether it be simple SQL via Hive, something more
suited for Pig via HCatalog or Spark via SparkSQL. I'll often do my analysis
on a Hortonworks Sandbox for small data like this.

For larger data and a more professional setting, I like to do prototyping/ad
hoc investigation/etc in python with pyspark inside of jupyter. Generally that
transitions either to Java or just plain python (depending on the degree to
which it's difficult to transition).

Anyway, hope that helps! Happy to answer any other questions you might have
too. :)

~~~
tmshu1
No worries! Gotcha, that is indeed very helpful! I appreciate it, will be in
touch if I have more questions in the future :)

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noondip
See whether your doctor has received drug company money -
[https://projects.propublica.org/docdollars/](https://projects.propublica.org/docdollars/)

~~~
chimeracoder
> See whether your doctor has received drug company money -
> [https://projects.propublica.org/docdollars/](https://projects.propublica.org/docdollars/)

This is a decent site, but it has a tendency to overstate the significance of
some of the 'payments'.

First, it doesn't seem to be properly distinguishing between multiple doctors
in a given private practice. That's a hard problem, and I don't fault them for
it, but then it's a bit misleading to attribute a payment to a particular
doctor's name when it could very well be a gift accepted by someone else in
the same practice.

It's also including transfer of money that's associated with conferences.
Physicians are required to perform continuing education in order to keep their
skills up-to-date (which is a good thing!). Because of this, pharmaceutical
companies have a _really strong incentive_ to get themselves financially
integrated into this process - and they've succeeded. This is certainly an
unfortunate aspect of the medical field, but it's not really something that's
possible to avoid, particularly in certain specialties. Personally, I'd rather
have a physician who's up-to-date in their knowledge and practice than one
who's not. It'd be great if this process were easily separable from
pharmaceutical money, but in fields like oncology and psychiatry, it's near
impossible.

The descriptions are a bit misleading too. For example, the tooltip for 'Food
& Beverage' gives as an example, 'a salesperson asks a doctor if they can talk
about a drug over a meal... and the salesperson pays for the meal'. This also
includes gifts that are _sent_ to the physicians (e.g., they send the office
for the practice a bottle of wine, which was signed for by the receptionist,
etc.).

Granted, if you see that your physician received $50,000 in payments for the
very drug he/she wants to prescribe you, yes, that's definitely something to
ask him/her about. But the data on this site, as it stands, is a lot less
indicting than it first seems - it's really best used as a conversation
starter between you and your physician rather than a condemnation of
individual physicians or even the industry at large.

~~~
sisk
Precisely.

Anecdotal, I know, however I have a family member that shows up on the site.
His number is low—less than a couple of hundred dollars—but I asked him about
it when I first heard of the site from Last Week Tonight. His response was
that they were medical device manufacturers taking his team out for meals to
discuss devices they were either already using regularly or were in the
process of trialing. I can't imagine anyone can find fault in such a thing.

~~~
refurb
I think the problem is that the current system lands somewhere in the "gray
zone". The money doesn't appear to have an influencing effect, but we also
don't know at what level it would start. I think a lot of people think it's
uncomfortably close to "coercive".

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niels_olson
Pharma is a drop in the bucket friends. The major source of healthcare cost
escalation is hospitals. Then doctors, then devices. Pharma's a scapegoat down
at the bottom of the barrel with a mere 10% of the pie, about the same as
hospital non-physician staff.

~~~
CyberDildonics
That isn't what this article is about

~~~
niels_olson
Yes, yes it is. From the article

> a product of the Sunshine Act, part of the Affordable Care Act.

> Why does this database exist? Basically because of the incentives created by
> industry being able to pay doctors to work on things that will ultimately
> help industry–like new drugs or medical devices. The hope is that more
> transparency will reduce any harmful influence that industry could have on
> medical research, education, and clinical decision making.

The idea that the major source of graft in medicine is Pharma is a red herring
the other actors keep flogging so no one asks who's really skimming.

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hodwik
The third graph pretty much says it all; research, licensing fees, consulting
and speaking engagements (mostly training pharma staff from what I understand)
make up almost all of the payments.

Glad to see that the data is so boring.

[https://plot.ly/~troyshu/14.embed](https://plot.ly/~troyshu/14.embed)

~~~
refurb
I would agree that most of the spending is pretty innocuous or at least on the
low-end of "inappropriate".

That said, speaker engagements are a bit of a hot button in the industry right
now. Speaker engagements are when pharma pays a physician to speak to other
physicians. They typically present material that is authored by the
pharmaceutical company. The doctor that presents tend to be pretty high
profile and leaders in their field of study.

GSK has decided they will not be doing speaker engagements any longer due to
the appearance of using money to influence clinical decisions. They're getting
a decent amount of flak from other companies about it (i.e. "it will only hurt
them"), but we'll see how it goes. It might cause a change in the industry.
GSK will now have their own employees present the material (will it be as
effective as a outside physician doing it?).

~~~
jrapdx3
The pharma-sponsored presentation is a time-honored tradition. Usually held at
an upscale restaurant in the evening, the well-paid speaker goes through "the
drill" about the product. Slides (and their great graphics) provided by the
manufacturer of course.

Years ago being a drug company speaker was a pretty good gig. The presenter
was expected to more or less stick to the script, but back then there was a
fair amount of leeway and speakers often made the subject more lively by
inserting anecdotes or clinical "pearls" from their own experience. Sadly
that's no longer allowed to happen.

In the 90's and early 00's intermittent I was a speaker for several pharma
companies. Besides the pay it was a lot of fun interacting with colleagues,
and getting to be the "expert" on the drug. There were other benefits too,
paid travel to speaker and consultant meetings at venues I'd never be able to
afford to frequent on my own.

But those days are gone forever. In the current environment the pharma
companies don't even hand out ballpoint pens anymore, let alone put speakers
up at 5-star resorts.

Haven't worked for any of the firms for nearly 15 years. It's a very different
thing now. Once in a great while I'll still attend a dinner presentation, but
mostly it's a waste of time.

The drug companies have become virtually paranoid about incurring regulatory
or public scorn. Speakers are strictly constrained to say only what's FDA
approved, the same info provided in the package insert which I can easily read
on my own (and most of the time I already have read it). Why bother going over
it again?

So I suspect if companies are terminating speaker programs it's because
attendance has fallen off even when "high profile leaders" are presenting.
Kind of a shame to see traditions fade away, but the message is clear, "drug
dinners" and other ways to market pharmaceuticals will soon be relegated to
the dustbin of history.

~~~
refurb
_The drug companies have become virtually paranoid about incurring regulatory
or public scorn._

Thanks for sharing your experience. I'm only familiar with how it is today and
yes, companies are absolutely paranoid about following the rules (which is a
good thing). Not that surprising considering some of the monster fines these
companies have paid.

------
tuyguntn
Are there any similar open dataset but for retail? Want to know user behavior,
which products are popular, items bought together and so on.

------
cenal
If anyone is currently conducting medical or scientific research and would
like to be part of a new beta for a platform that should make your lives
easier let me know.

My email is lane (at) myire dot com

------
etrautmann
The author's implication that the majority of these payments are shady or
illegitimate is bizarre. I don't know much about it, but performing research,
paying for hospital space, and paying licensing fees to doctors who have
invented novel devices all seem like healthy aspects of a medical system
working as it should. Perhaps I'm being naive?

~~~
tmshu1
Hey etrautmann! Author here, thanks for reading! I agree with you, most
payments do seem to be for legitimate purposes (sorry if it seemed like I
implied otherwise). But I believe that some types of payments--e.g. industry
paying for research--creates incentives with potential negative effects--e.g.
on the quality of research; whether these incentives _actually_ do result in
negative effects is another question that others have done research on.

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enlightenedfool
My friend had a cyst on the eyelid. His eye doctor changed 3 antibiotics for a
period of 3 months. Didn't work. Finally he insisted the doctor to surgically
drain it. That worked and it should have been done in the first place. The
doctor should have known it. The whole medical system in the US is organized
crime.

~~~
northern_lights
Obviously. This one doctor erring on the conservative side and not immediately
taking a sharp instrument to your friend's eyelid proves that all doctors are
corrupt and/or stupid, and the whole system is a scam.

Or _maybe_ doctors generally know what they're doing and can, on average,
perform their profession better than a random guy on the internet.

~~~
enlightenedfool
I'm convinced it's a scam based on my own experiences in U.S.A and the third
world. I got a throat infection in India. I went to the pharmacy, took
antibiotics for $2. It's done. If that happens in the US, I'm forced to first
visit the doctor, pay $250. Then pay some $30 for the antibiotic and even
before that have to pay the insurance company hundreds of dollars anticipating
these things. Another recent one is spine issue. I paid $4 for orthopedic
consultation and $50 for MRI. Check what it costs in US. I have several such
experiences. So I'm not a "random guy on the internet". I know what I'm
talking about.

~~~
pjc50
It's a scam, but not because you didn't get your preferred treatment first
time but because you're required to pay ridiculous amounts for the service in
the first place.

(The equivalent experience in England&Wales would be free, apart from $10
prescription charge for each prescription, which is waivable for quite a lot
of categories of people with low income)

~~~
arethuza
No prescription charges in Scotland or Northern Ireland:

[http://www.bbc.co.uk/news/uk-12928485](http://www.bbc.co.uk/news/uk-12928485)

~~~
pjc50
True, good point.

