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ProPublica’s Dollars for Docs is a free public database that contains information on the payments doctors and teaching hospitals have received from the pharmaceutical/health product industries. If you have ever wondered about the potential influence of big money on your physician or the medical profession as a whole, Dollars for Docs—last updated at the end of 2019—sheds some light on the contentious matter.
This valuable endeavor from the nonprofit has not only provided some justification for the concerns and anger of many Americans over the nation’s costly health care system, but it has also shed light on the companies, individuals, and organizations that have given and accepted the largest sums of money.
It’s important to note that money, dinners, events, and other ‘favors’ do not necessarily or always result in doctors and teaching hospitals ‘selling out.’ For example, the medical professional could have researched the product and believes it to be the best, whether it is a drug or a medical device.
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Medical Payment Data Overview
A 2018 study published by the Journal of the American Medical Association (JAMA) concluded that the U.S. spends “nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes.” The reasons for the high spending totals relative to other countries, the study argues, is not due to “…social spending and health care utilization in the United States…: but the “prices of labor and goods, including pharmaceuticals and devices, and administrative costs.”
Evidence Suggesting Dollars for Doctors is a Real Issue
As it pertains specifically to healthcare industry payments to medical professionals, 48% of U.S. physicians received a total of $2.4 billion in payments in 2015 alone. Compared to the total spend of the U.S., perhaps it doesn’t sound like much or enough money to actually influence medical professionals. Nevertheless, there exists evidence that small favors have at least associative effects on the drugs doctors prescribe.
A study examined if and how pharmaceutical industry-sponsored meals influence physician prescriptions of brand-name drugs. The researchers tracked the results of four drugs: rosuvastatin; nebivolol; olmesartan; desvenlafaxine. From their findings, they concluded that “physicians who received a single meal promoting the drug of interest, with a mean value of less than $20 [for the meal], had significantly higher rates of prescribing” for all four brand-name drugs over their generic competition.
|Drug name (brand name ver.)||Generic prices||Brand-name prices|
*cheapest prices chosen from GoodRx, as of October 2020
Dollars for Docs Origins: The Physician Payments Sunshine Act
On September 6, 2007, Senators Charles Grassley (R-IA) and Herb Kohl (D-WI) introduced the Physician Payments Sunshine Act. This bill marked the first attempt to bring much-needed transparency, or ‘sunshine,’ to the healthcare industry at large, not just in a handful of states. Unfortunately, support in the new legislation was lacking, failing to effect any reform.
Nevertheless, the Physician Payments Sunshine Act experienced a revival as a part of the Affordable Care Act (ACA) in 2010. Both passed successfully, establishing a disclosure requirement for any form of payment between the healthcare industry and medical professionals. Via the Open Payments Program, the Centers for Medicare and Medicaid Services (CMS) has the responsibility of ensuring medical companies are reporting their payments to medical professionals and teaching hospitals.
In short, the enactment of the ACA (and more specifically, the Physician Payments Sunshine Act) made it possible for ProPublica to create Dollars for Docs.
A Quick Look at Dollars for Docs
As of the most recent update to Dollars for Docs (late 2019), ProPublica has tracked and documented $12 billion in disclosed payments from 2,191 companies to over a million individual physicians and about 1,200 teaching hospitals.
Below, we have extracted the top five spenders from ProPublica’s data and the three drugs/treatments each spends the most on respectively.
Breakdown of Dollar for Docs’ Top 5 Spenders
Genentech, Inc.—$478 million worth of payments made; 1,620 physicians receiving payments; 37 teaching hospitals receiving payments
- Rituxan (non-Hodgkin’s lymphoma medication): $52.3 million
- Herceptin (breast cancer treatment): $34.1 million
- Avastin (treatment for colon, ovarian and other cancers): $29.6 million
Zimmer Biomet Holdings Inc.—$109 million; 23,982 physicians; 364 teaching hospitals
- Persona (knee implants): $20.7 million
- IT VITE XLPE LINERS (hip implants): $13.6 million
- E1 (hip replacement): $13.4 million
Stryker Corporation—$91.9 million; 22,332 physicians; 688 teaching hospitals
- Accolade (joint replacement): $20.7 million
- Trident (joint replacement): $13.6 million
- Triathlon (knee replacement system): $13.4 million
Boston Scientific Corporation—$82.2 million; 39,116 physicians; 146 teaching hospitals
- General Therapies: $44.9 million
- Watchman (atrial fibrillation treatment): $4.16 million
- SQRX pulse generator (spine treatment): $3.93 million
Allergan Inc.—$73 million; 96,336 physicians; 126 teaching hospitals
- Botox: $23.3 million
- Vraylar (schizophrenia treatment): $9.68 million
- Natrelle (breast implants): $8.11 million
Dollars for Docs, Corruption in the Healthcare Industry?
Dollars for Docs exposes one possible way where the pharmaceutical industry legally but perhaps unethically attempts to boost their profits by providing favors for doctors and teaching hospitals. That being said, we should not be so quick to definitively claim that there is a causal relationship between our nation’s high medical expenditures and the healthcare industry’s financial relationships with those in the medical field.
With more digging from you, the citizen investigators, the payment data compiled in Dollars for Docs may mean very little when physicians actually prescribe mention. But then again, this remains just one potential area where the economy gets rigged.
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Beyond Dollars for Docs…
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