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Pharma Paid Physicians $6.5B in 2014 – Looking into the Open Payments Dataset
- afarrell 11y agoHere 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 11y agoGreat perspective from someone on the ground, thanks for sharing!
- hodwik 11y agoThe 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
- r00fus 11y agoNow what do those "speaking engagements" actually entail? For example, Hillary Clinton has not disclosed the speeches she's made despite making millions in speaking fees for wall street firms and others.
- Zigurd 11y agoWhat are you implying. Next thing you'll be saying her daughter really isn't qualified to work for a hedge fund. How rude.
- refurb 11y agoI 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 11y agoThe 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.
- BogusIKnow 11y agoThanks for the insights, it's always amazing who reads and comments on HN.
- refurb 11y agoThe 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.
- chm 11y agoThere are outliers (Genentech, Stryker, Medtronic, DePuy, etc.) when looking at the share of "Royalty or License" payments. And what the graph doesn't show is how these companies are related. Who owns who? Who's independent and who isn't?
- niels_olson 11y agoPharma 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 11y agoThat isn't what this article is about
- niels_olson 11y agoYes, 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.
- enlightenedfool 11y agoMy 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.
- et2o 11y agoYeah, this anecdote definitely proves that.
- rayiner 11y agoAntibiotics are cheap. A three month supply may well be cheaper than even simple surgical drainage.
- FireBeyond 11y agoThe doctor's obligation is not to "find the cheapest possible treatment" (especially one where the over prescription of generic antibiotics is more problematic than beneficial), especially if the patient is informed.
- rosser 11y agoIn the individual case, it's dubious to suggest that surgery is a less conservative option than antibiotics. Yes, antibiotics are woefully over-used (though the overwhelming majority of their use — something on the order of 80% — is in livestock), but the physician's obligation to their patients is to treat their presenting problem, and in the way that is least harmful. Typically, that's taken to mean more conservative approaches first.
- northern_lights 11y agoObviously. 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.
- noondip 11y agoSee whether your doctor has received drug company money - https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/
- chimeracoder 11y ago> 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 11y agoPrecisely. 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.
- tuyguntn 11y agoAre there any similar open dataset but for retail? Want to know user behavior, which products are popular, items bought together and so on.
- Fede_V 11y agoMy 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.
- dopamean 11y agoThis sounds like the same thing you often hear about Congress. People like their congressman but think the others are doing a poor job.
- danieltillett 11y agoIsn't this the same as the rest of the population's opinion about advertising? Everyone thinks advertising works on other people, but not them.
- amelius 11y agoI 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.)
- cenal 11y agoIf 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
- tuananh 11y agoIf you want to read more on this topic, i highly recommend you to take a look at Bad Pharma book by Ben Goldacre (https://drive.google.com/open?id=0B5lnD5gfVd69ZmkwMktvbjNEcmc https://drive.google.com/open?id=0B5lnD5gfVd69ZmkwMktvbjNEcm...).
- maaarghk 11y agoHas it been released into the public domain or is that a pirated ebook?
- scardine 11y agoIn 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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- frak_your_couch 11y agoShameless 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-part-4.html http://blog.caseystella.com/pyspark-openpayments-analysis-pa...) and Benford's Law analysis (http://blog.caseystella.com/pyspark-openpayments-analysis-part-5.html http://blog.caseystella.com/pyspark-openpayments-analysis-pa...)
- tmshu1 11y agoSuper 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 11y agoHey, 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 11y agoNo worries! Gotcha, that is indeed very helpful! I appreciate it, will be in touch if I have more questions in the future :)
- etrautmann 11y agoThe 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 11y agoHey 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.