Reader Poll: Glaxo And $150K Cap On Fees To Docs
26 CommentsBy Ed Silverman // October 23rd, 2008 // 1:57 pm
Earlier today, we wrote how Glaxo promises to make public the fees paid doctors and medical academics, and will strictly cap the payments they can receive in the US to $150,000 a year (see here). Andrew Witty, Glaxo’s ceo, says he will impose a cap “without exception” on payments and promised to publish the amounts.
We chatted with a Glaxo spokeswoman about the cap, because we wonder if $150,000 is sufficient. On one hand, the cap is a start toward setting limits. On the other hand, this is a large amount of money that may leave the door wide open, so to speak, to continue paying big fees to just about everyone.
After all, think about the amount of money paid to Emory University’s Charles Nemeroff, who is being investigated by the US Senate Finance Committee for allegedly faling to report Glaxo payments while simultaneously taking NIH research grants. A look at the table indicates he only exceeded $150,000 in three different years, and has been one of the most widely sought after experts by industry (back story).
So what do you think?
Should The Glaxo Cap Be Lower?
- Yes (70%, 123 Votes)
- No (30%, 52 Votes)
Total Voters: 175
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atlex
Ed,
You “wonder if $150,000 is sufficient”. My question is: sufficient for what? If a KOL is getting paid a fair and equitable fee for services performed why does there need to be a cap? Certainly there should be transparency, but what does a cap accomplish? If there is a cap, why is $150K any worse than $100K or $50K or $1K? What is the right amount? I presume that you believe that the greater the amount, the more “compromised” the KOL is. But isn’t that a little like being “more” pregnant. Either you are or you aren’t.
Atlex
Nancy Fruge
I voted yes. And I think the maximum payment to academic researchers should be zero.
Arnold Relman’s take on this is that payments for collaboration between industry and academic researchers should go to the medical schools and teaching hospitals rather than to the researchers. He says, “These investigators should be well paid by their institutions, and they should have the time and resources needed to do their research, but they should not expect to be personally enriched beyond that (Improper Rewards of Research by Arnold S. Relman, The Boston Globe, July 12, 2008).”
After all, it’s all for the patients – right?
atlex
Nancy,
Should your standard only apply to academics in medicine? How about pharmacy? How about business? Should all academics be restricted to the salaries from their teaching position? How about part-time academics; should they have the same restriction?
Atlex
Ed Silverman
Hi Atlex,
Well, first, I asked Glaxo to make available someone - anyone - who was or is involved in establishing this cap in order to ask some of the same questions you posed. I was told not until they’re closer to finalizing details.
As to your point, the cap was Glaxo’s idea, not mine. But if there is going to be a cap, what is a practical level? If the purpose is to be transparent, okay, fine. But maybe everyone will fall under the cap, if Nemeroff is any guide, since he was a widely used expert. And if that’s the case, then perhaps a cap is only a publicity stunt. The concept sounds good, but serves no practical purpose because very little is likely to change.
Of course, there’s probably another reason Glaxo set the cap at this level - a rival drugmaker that pays more would leave Glaxo at a disadvantage. So Glaxo is unlikely to lower its cap, unless there’s some new voluntary lower cap that Billy Tauzin convinces all companies to announce. I think this comes down to window dressing.
Cheers
ed
Christopher
I tend to agree with atlex on this. The assumption that an academic receiving payment for ‘outside’ work will automatically be compromised - in other words, potentially invalidate his/her research - is flawed. I’m also not sure what Mr Relman’s “well paid” means. That’s rather hard to define even on geographic terms let alone based on one’s own standards of living or aspirations (or student loans…) The alternative I suppose is for a more commercially-oriented researcher to leave the institution and go into an industry position, as occasionally happens, but that seems not to be a realistic choice for many.
Doc
Let them earn whatever the market will bear - BUT they should disclose their payment amount for the lecture prior to each lecture and YTD total honorarium. Then the audience can decide how “neutral” they are.
Former pharma Marketing Exec
The other question is how much time must be spent away from the main job - i.e. taking care of patients, in order to earn this supplemental income?
First there is the junket itself - easily a few days away from the practice, then there is all the planning of said junket, then there is the de-briefing of the junket.
Then there are all the annual conferences, well a doc has to keep his/her accreditation up don’t they?
It makes logical sense to cap the activity if only to improve service to patients, which is what this is all about anyway isnt’ it?
On the other hand, researchers, and teachers are on a much lower pay scale. Teachers need to show up and teach, but if they can supplement their income then go for it, as well as the researchers.
The bottom line is that this extra curricular activity should not be at the expense of their main job function.
Finally, I applaud Glaxo for at least attempting to be transparent.
But I can’t help thinking this is all one heck of a gravy train and we should all be able to hop on board. Why do we work for salaries anymore? Shouldn’t everyone get a chance to do this?
So, we have a job, and we get a salary to do it, but we also need bonuses and incentives, because good old fashioned pay with benefits just doesn’t cut with us anymore.
We are worth more!
Aren’t we all?
Thom
CEO Andrew Witty told the FT, “In the past, whatever has happened has happened, but in the future….”
Mr. Witty, I was the young bartender that was shtupping your wife when you were out of town on business. But she and I and have decided to just remain. So in the future, please don’t get jealous when you come home late at night and find my car parked in your driveway.
Thom
Oops…I made a mistake. Should have written, “But she and I have decided to just remain friends.”
p.s. she still wants to shtup.
Nancy Fruge
Staying on message…
Hello Atlex,
Good questions…why not apply the $0 cap to any physicians who care for patients? Some physicians volunteer to speak at conferences and serve on advisory committees. You can find a few good role models here (posted earlier by Sammy Sucra):
http://www.nytimes.com/2008/04/15/health/15conf.html
Best,
Nancy
Atlex
Nancy,
Again, why? Why should physicians not get compensated for their time and effort. Yes, there are some who would volunteer their time. But why should physicians not get compensated for educating other physicians. Transparency about payments is great; then patients can choose.
Atlex
PharmaLiterate
There are some very good points here but there are deeper underlying problems.
(1) Yes, someone giving a talk at a speaking event should disclose if he/she has a financial relationship with the maker of a drug being discussed. Absolutely, that should be happening and it is unacceptable that it’s not. But how much discloser. Certainly, if the physician had been engaged on one very high level important advisory board, that’s fairly simple. But if the physician has worked for the manufacturer and has done a full range of speaking engagements and consultant arrangements up to the $150,000 cap or more for many years, how can it be enough to say “I have worked as a consultant for such and such.” Can we call that “disclosure.” So we need to think about the nature of the disclosure. Is it enough to genuinely help the audience understand how deep the connections may be.
(2) Some of the notes above also mentioned prescribers. Absolutely, if my mother had cancer and a physician was recommending a certain medicine that came with all sorts of toxicities but a chance of some benefit I think I would want to know if her physician had earned $150,000 in speaking fees from the maker of the drug. Why on earth is that controversial.
(3) But even beyond the speaker and the prescriber there are deep concerns. What about the high level Opinion Leader type who is sitting on or maybe even chairing Guideline writing committees that could influence the prescribing behavior or hundreds or thousands of prescribers. The financial influence on the top level Opinion Leaders is substantial and that may be where the biggest threat lies. These are the folks who are hitting the caps. These are the folks that the companies are courting from 20 difference angles — speaker fees, consultant fees, CME grant money, research grants, sponsored research payments . . . There is so much money and its coming from so many different places most companies cannot even calculate it on a per Opinion Leader basis. But again, anyone who thinks that Nemeroff is some kind of exceptional circumstance has their head in the sand. On the contrary, he is simply an example of a major issue. It sounds like Martin Leon will be the next. It will unfold. The money and influence will be revealed. My guess is that it will be surprising and scary. But again people will try to say it was an exception.
I have never really liked our Congress, a bunch of corrupt do-nothings. But these investigations into financial connections are actually having an impact. Congress is sending a message to the federal agencies that they need to start doing their jobs. And hopefully universities are going to be thinking about the practices of their own Opinion Leaders. Any university receiving NIH grants that is not doing a serious internal review of financial connections is negligent. I hope Congress presses forward and forward. Because at the end of the day, as the true level of some of these financial ties is revealed the practices will be reigned in. They cannot be defended.
Doug Bremner MD
The purpose of compensation of KOLs is to drive sales of products. Information cleaned about the scientific aspects of the drug or different approaches to the market is icing on the cake. It is human nature to follow the lead of early innovators. This can be seen in everything from the adoption of a new kind of corn in Guatemala to the adoption of a new drug for diabetes.
1. Greenhalgh T, Robert G, MacFarlane G, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly 2004;82(4):581-629.
2. Berwick DM. Disseminating innovations in health care. JAMA 2003;289:1969-1975.
This behavior is even more pronounced in medicine, which is taught as a sort of apprenticeship, i.e. adopt the practices of the ‘master’, and doctors continue to look to the leaders in their field for new information about changes in their field.
Pharmaceutical companies know this and they turn this to their advantage by staying on the good side of KOLs. You can see that from anonymous posts to previous threads on this site from pharma execs.
Matt
Unfortunately, it’s not just about staying on the good side, but “virtual bribes.” When a company is paying a KOL hundreds of thousands of dollars a year, they’re not just staying on the good side. They want the KOL to talk up their product and act in their benefit whenever they have the opportunity to do so. I’ve worked in Big pharma. Many times the commercial people specifically target KOLs with the most influence on guidleine committees, within scientific organizations, and on boards. They want to “convert” the KOL from neutral to strongly supportuve. It’s the way of the industry. It doesn’t belong in Big Pharma, but it’s what you get when business people run the whole show. I thin $150,000 is way too high. The companies should let the public know when they’re spending 1/10th that much on an MD in a given year!!
atlex
Doug,
As a pharma “exec” I respectfully disagree with the emphasis you put on the use of KOLs. Certainly, influencing KOLs is critical for product utilization. They do impact the views of other physicians. Importantly, though, most of the top KOLs tend to work with a wide array of competitive companies. Equally as important to this relationship between KOLs and pharma is their critical input during the development stages of products (Phase II and III). Not only do they help a pharma company determine what type of evidence is most important to produce to ensure that the product can prove its clinical value. This can help make the development process far more effective and efficient. Moreover, these KOLs are often the lead researcher in the pivotal trials.
In a world where senior business consultants get paid as much as $800-$1000 an hour (yes, that’s what the senior partners at McKinsey, BCG and other places get), the top level KOLs, who offer the most value to pharma, deserve to be compensated fairly.
Atlex
Sarah at GSK
Ed - In the US, I think we can all appreciate the concept of being fairly compensated for work that has been completed. Independent healthcare professionals provide legitimate and important insight and expertise into medical care that helps us meet patients’ needs, and they should be fairly compensated for that work. That said, we also believe that a limit on compensation paid to individual physicians is appropriate, and believe that our compensation cap strikes the appropriate balance. We also believe this level is consistent with the caps set by our peer companies. Finally, it’s important the cap not be confused as an average; the number of health care professionals who have approached this cap in 2008 is very small. GSK is also committed to making information about physician payments publicly available in the US. We are urgently undertaking a review our internal processes to determine the best way to efficiently report this information. We will be putting a process in place to ensure this information can be reported as soon as possible, and we’ll provide more detail when our plans have been finalized.
Ed Silverman
Hi Sarah at Glaxo,
Thanks for writing in. Always happy to have some official input over here.
And I appreciate your points. I don’t disagree with fair compensation. I offered the poll to get a sense of what others think of this move. I think it’s an interesting idea, but would still like more details, which hopefully will be forthcoming sooner than later. So please keep us all posted.
Cheers,
ed
Doug Bremner
Calling KOLs “independent healthcare professionals” casts them as some kind of entrepreneurs that are part of the private marketplace, when in fact they are professors at universities; if they weren’t not as many people would listen to them.
atlex
Doug,
Not wanting to speak for Sarah, but I think she meant independent from GSK. In other words, GSK can get the opinions of its internal scientist and physicians any time, but the opinions of “independent” scientists and physicians are invaluable.
Atlex
Justice in MI
Most universities now have “conflict of commitment” policies which impact both the amount of time and, in some intances, the amount of income that can be generated through commitments outside of their specifically academic roles.
Given the fact that industry is, in part, relying on the university “brand” - and not simply the KOL’s particular expertise - it seems to me appropriate that the university has a claim in the way that “brand” is being utilized.
From that perspective, to view academic medical researchers essentially as independent contractors, making arrangements with companies and being “fairly compensated,” misses the point. That point is, indeed, what “independent” means. It may also get to some of the differences between being in a profession and being in a business.
As long as researchers have an academic affiliation, a place where they teach and do research, are provided benefits and office space, and evince at least some fidelity to the values of that institution (veritas, for example), they are not “independent.”
keeping them honest
Was Charles Nemeroff “independent” while giving hundreds of talks for Glaxo at the same time as he directed the Emory-GSK-NIMH Initiative, that focused on 5 Glaxo drugs? Was he “independent” when he pimped the off-label use of Glaxo’s drug paroxetine (Paxil) for posttraumatic stress disorder? Just like in the infamous Cyberonics affair, Nemeroff fronted for Glaxo as lead author of a made-for-marketing review article pimping Paxil in PTSD. On that occasion he used unpublished data of a colleague to say something uniquely favorable about Paxil but he did not bestow co-authorship on the colleague. And, Glaxo paid for the article to be written by a third party. The article was little more than paid advertising. And, Doug Bremner was a co-author on that piece of sh*t.
The article is Post Traumatic Stress Disorder: A State-of-the-Science Review, by Charles B. Nemeroff, J. Douglas Bremner, Edna B. Foa, Helen S. Mayberg, Carol S. North, and Murray B. Stein, in Journal of Psychiatric Research 40 (1): 1-21, 2006. When will co-authors like these wake up to the fact that operators like Nemeroff are toxic?
Doug Bremner
I guess the “keeping them honest” troll is back here writing anonymously, of course, I am not really sure what point he is trying to make here, other than that he doesn’t like Charles Nemeroff. I wasn’t the one that said KOLs should be considered “independent”. That said I would have to disagree with the adjective he applies to an article I was an author of, however I have already covered this topic in detail on my web site here for those who are interested:
http://www.beforeyoutakethatpill.com/2008/10/disclosures-and-seroxat.html
Lisa Van S
Dr. Bremner,
Do you know, or have you worked with Sally K Laden, of Science Therapeutics Information, Inc? Check Out her Editorial work on Paxil Study 329. Says an awful lot about her integrity
http://paxilharmschildren.com/doc/gsk.gif.pdf
Doug Bremner
Lisa: your link isn’t working, but no I don’t know her, and I have read study 329 and the followup articles and letters, and I disagree with the reply letter written by the authors of the original paper stating, to paraphrase, that it is OK to change the primary outcome after the fact if you are not the FDA (it’s not).
Lisa Van S
Dr. Bremner,
Try This
http://www.paxilharmschildren.com/doc/gsk.gif.pdf
keeping them honest
Typical of Bremner to see my earlier comment in self-referential terms. As for defending the article his name went on, readers can track it down to decide for themselves if it is a piece of sh*t.