Is your Doc in bed with Big Pharma?

[vertigo]

Here's a way to find out, at least for the US:

http://projects.propublica.org/docdollars/

Some of the very well-known HIV doctors have received quite a bit of $$$.  Not necessarily bad, but certainly worth knowing.

[buginme2]

Some of the very well-known HIV doctors have received quite a bit of $$$. 

Like who and how much?

[vertigo]

Ann, sorry for posting in the wrong forum.  I had a feeling later that you would move it, and sure enough you did.

Bug, here's just a quick addition of some of the docs I follow.  Based on 2009-2012 pharmaceutical company earnings from the ProPublica website:

Joel Gallant:  $30,000 (formerly Johns Hopkins, now hosts a great tumblr Q&A)
Paul Sax:  $66,000 (NEJM Journal Watch blog)
Peter Shalit: $284,786 (Author: "Living Well, The Gay Man's Essential Health Guide")
Benjamin Young: $523,617 (TheBody.com)

ProPublica says their data is based on reports from 15 pharmaceutical companies, totaling 43% of the US market.  So actual earnings could be much greater than reported.

How much is appropriate, and how much is egregious?  Honestly, I don't know.  But it's a good resource, I think.  By way of comparison, my personal doctor is listed for all of $17 in this time period.  Maybe that's just because he doesn't contribute much to research.  But it also gives me confidence he doesn't have a vested interest in any particular therapy.
 
These are just the docs I pay attention to.  I'm actually grateful that they either publish or post online.  But still, based on just partial data this suggests that a lot of $$$ is changing hands.

[mecch]

How much is appropriate, and how much is egregious?  Honestly, I don't know.  But it's a good resource, I think.  By way of comparison, my personal doctor is listed for all of $17 in this time period.  Maybe that's just because he doesn't contribute much to research.  But it also gives me confidence he doesn't have a vested interest in any particular therapy.
 
These are just the docs I pay attention to.  I'm actually grateful that they either publish or post online.  But still, based on just partial data this suggests that a lot of $$$ is changing hands.

After Dr. Young's impressive career bio, there is this disclosure on The Body:

Disclosures

Dr. Young has received consulting or speaking fees from Bristol-Myers Squibb, Gilead Sciences, Merck & Co., Monogram Biosciences and ViiV Healthcare. He has received research funding from Gilead Sciences and ViiV Healthcare. (Disclosures were last updated October 2013.)

Any big researcher, like Dr. Young based on the bio, with hands in many fields is going to have funding from all over the map. 

[eric48]

Of course knowing who gets what is useful info

Figuring out why is also interesting.

One may consider that writting a book earns you more
Also training doctors in developping countries (so that they use more of the modern drugs) pays more than running a blog

Every time a patient is put on $tribuild, GSI franchise expands by half a million dollar (depends how you do the maths, and everyone is free to do the computation, but it is in that range...)

Eric
 

[Ann]

Ann, sorry for posting in the wrong forum.  I had a feeling later that you would move it, and sure enough you did.

No problem. It was the hiv-doc aspect that got it moved. OT is for anything but hiv related stuff.

[mikeyb39]

This is cool.  My doctor received 2 checks from Pfizer for about 1200.00 in 2010 and one 500 check from Johnson/Johnson.

Nothing in the past couple years.   Nothing from the ones you would think.  Interesting

[mikeyb39]

No wonder he kept pushing that pill Lyrica a couple of years ago.  hmmmmm.

[Jeff G]

I just sent an email to my friend who is a doctor and asked him why he took $359 from a drug company on a specific date . I am of course just messing with him but I'm expecting a phone call at some point today LOL .

He has been known to go into a rant now and then about how much drug reps make off so little work . Those drug reps are the ones you see pop into your doctors office with a big black leather bag and gets to go right back and see the doctor that you have been waiting to see a hour after the actual appointment .

I cant remember the specifics but I think he told me that if a drug rep can talk 6 doctors into prescribing a drug the rep can make up to 6 figures in a little over a year in commissions . This is another reason why our healthcare is so expensive and I personally think its deplorable and morally corrupt .   

[zach]

i love my cannabis pharmacist, she's good people

[AusShep]

Mine gets about 150k a year, almost all for research.  What I found more interesting was drilling down to the Medicare claims, to see how much of each medication your doctor prescribes to Medicare/Medicaid patients, and how that ranks with others in his speciality.

[bocker3]

Not necessarily bad, but certainly worth knowing.

I would say that, based on how this thread is titled, you DO think it's bad.

Without knowing the why and lacking any research into prescribing habits (and more importantly, CHANGES in prescribing habits), I'd say this is analogous to a political sound bite.  i.e. meaningless because there is no way to interpret intent or action, FACTUALLY.  But it does allow one to use it as a way to buttress an already held belief.

M

[Jeff G]

I would say that, based on how this thread is titled, you DO think it's bad.

Without knowing the why and lacking any research into prescribing habits (and more importantly, CHANGES in prescribing habits), I'd say this is analogous to a political sound bite.  i.e. meaningless because there is no way to interpret intent or action, FACTUALLY.  But it does allow one to use it as a way to buttress an already held belief.

M

http://www.youtube.com/watch?v=OfAC77jWgzs

[eric48]

Benjamin Young: $523,617

search query, by author name, into pubmeb : hiv Young B[Author]

No items found.

Eric

Modified because the query is not relevant: he did publish some work, but, the query, as used, did not pick up. Sorry

[vertigo]

I would say that, based on how this thread is titled, you DO think it's bad.

No doubt I titled the threat to get some clicks.  I suppose I could have picked a more boring but emotionally neutral headline.  But honestly, no, it's not necessarily bad.  I mean, we're all in bed with Big Pharma, because the pills are keeping us alive.  But it could be bad.  I would say there is a qualitative difference between money received for research, and that for speaking, travel, meals.  Don't you think those things could influence someone's judgement?

Without knowing the why and lacking any research into prescribing habits (and more importantly, CHANGES in prescribing habits), I'd say this is analogous to a political sound bite.  i.e. meaningless because there is no way to interpret intent or action, FACTUALLY.  But it does allow one to use it as a way to buttress an already held belief.

Oh snap!  So any sunlight is too much?  Move along here, nothing to see!

Jeff G, great link LOL.  Thanks!

Eric, search "Benjamin Young" in All States.

[mecch]

No doubt I titled the threat to get some clicks.  I suppose I could have picked a more boring but emotionally neutral headline.  But honestly, no, it's not necessarily bad.  I mean, we're all in bed with Big Pharma, because the pills are keeping us alive.  But it could be bad.  I would say there is a qualitative difference between money received for research, and that for speaking, travel, meals.  Don't you think those things could influence someone's judgement?

This doc does all this:

Dr. Young is the author of more than 60 journal articles, reviews and book chapters relating to HIV and its treatment. He is a principal investigator with the U.S. Centers for Disease Control and Prevention's HIV Outpatient Study (HOPS), a massive ongoing analysis of the health of HIV-positive people throughout the U.S. A member of the HIV Medicine Association, the International AIDS Society and the American Academy of HIV Medicine, Dr. Young is also actively involved in educating health care professionals and community groups throughout the world on HIV-related subjects. He has devoted the past six years to training HIV physicians in Eastern Europe and Central Asia, where he witnessed a coup d'etat and a polio epidemic.

And yet we, who know nothing about his relationship with pharma companies, what he presents to them, what dialogue is going on, etc etc etc, are supposed wonder about undue and therefore somehow unfortunate big pharma influence? 

Theres a list of drugs out there, any HIV doc worth his salt knows the newest and best drugs, which drugs suit which treatment needs, etc. All those drugs come from so-called big pharma. 

Why don't you come up with some real journalism and meaty information if you think there is something interesting for people to know or reflect on, about money, doctors, patients, big pharma and HIV. 

The calculator and the info it spits out is just info....  What are we supposed to do with that info? 

(This is like those people who rattle off the price of flying around the POTUS on Air Force One, like its somehow scandalous but we aren't sure how or why...)

[eric48]

Hi Vertigo, I take your estimates as is.

Some posters are in the opinion that Doc doing research work should somehow get compensated

So... I was looking into the research contributions...

Latest article is an editorial and I will let the reader make their own opinion about the research value

Unplanned antiretroviral treatment interruptions, genetic barrier, and development of resistance

One  segment of interest is where he emphasizes :
the importance of homogeneous terminal half-lives in any combination

(The scientifically inclined may want to comment, but, IMHO, this is one point Stribild is not good at...)

mentionned Affiliations are :
International Association of Providers of AIDS Care, Washington, DC, WA,
USA and Josef Korbel School of International Studies, University of Denver, Denver, CO, USA

http://www.iapac.org/Contact01.html
see : Vice President/Chief Medical Officer

http://www.du.edu/korbel/
... invites students from around the globe to think beyond the Beltway with innovative interdisciplinary programs.

Most importantly, the public is gaining access to previously unavailable knowledge such as:
http://projects.propublica.org/docdollars/

This transparency may be good, may be not... It is new

I believe this is a very valuable effort, not only for US patients, but for other countries where patients are less protected

It was definitively worthwhile that you posted this

Eric

[Piscean]

My Dr. took only $247, almost all for meals. Interesting seeing how he is the first and longest practicing HIV specialist in the city. His practice treats 1000's with HIV and has since the first days of the epidemic.

[vertigo]

Theres a list of drugs out there, any HIV doc worth his salt knows the newest and best drugs, which drugs suit which treatment needs, etc. All those drugs come from so-called big pharma. 

You're right.  And I didn't start this thread to pick on Dr Young.  I read his answers at TheBody and appreciate the work he does there.  But let's broaden this conversation beyond HIV, since while that is what unites us on this forum, we're all consumers of the broader spectrum of health care.  Most of it is not as demonstrably necessary as HIV meds.  Google "disease branding" if you want some examples of how drug companies can medicalize common human conditions, and then market their solution to both doctors and consumers.

The calculator and the info it spits out is just info....  What are we supposed to do with that info? 

What are you supposed to do with "just" info?  I would say that you should evaluate it and decide if it is relevant to you.  Same as all the other info in your life.  Sounds like you've made that call in this case, which is fine.  But if my doctor were pushing me to take a certain drug and I knew that he had taken a lot of money from the manufacturer, that info might be relevant to me.

Why don't you come up with some real journalism and meaty information if you think there is something interesting for people to know or reflect on, about money, doctors, patients, big pharma and HIV. 

Sometimes knowing where the money is going is the catalyst for real journalism.  This is not an HIV story, but a recent example of a highly prominent doctor who was getting paid by chemical manufacturers to tell lies:

http://articles.chicagotribune.com/2014-03-13/news/ct-flame-heimbach-met-20140314_1_flame-retardants-burned-babies-heimbach

[OneTampa]

My GP got $300 (Lunch).

My HIV Specialist got $12,000 (Research).

Interesting.

[pittman]

Why don't you come up with some real journalism and meaty information if you think there is something interesting for people to know or reflect on, about money, doctors, patients, big pharma and HIV. 

The calculator and the info it spits out is just info....  What are we supposed to do with that info? 

(This is like those people who rattle off the price of flying around the POTUS on Air Force One, like its somehow scandalous but we aren't sure how or why...)

The difference is that you can pretty easily enter into a conversation with your doctor at your next visit and just ask them about it while I don't have generally find myself in the presence of the president of the United States.

If any of my doctors had been listed for anything more than a few meals, or maybe an occasional conference (they were not) I'd be asking them about their pharma relationship.

[tednlou2]

I didn't find my HIV doc.  Makes me wonder why he isn't so important.   

I did find my brother-in-law, who is a doc.  He got $65 for meals over 2011-2013.

The interesting thing about Dr. Young, since he was mentioned, is that many of the big dollar amounts came from speaking.  There were $40,000, $50,000, $65,000, $77,000 and several others.  I didn't take out my calculator, but it seemed he got way more in speaking fees than research.  If he were my doc, I would wonder why $77,000 to speak?  Doesn't Bill Clinton only pull in $100,000? Lol.  Were each of those big dollar amounts for one speaking engagement?  If it were for several speeches over the course of the year, then I could understand.  I am sure they are flown first class and put up in a nice hotel.  Those expenses could add up quick.  Although, I'm not sure whether these figures include things like flights, hotels, meals, etc or whether they pay that separately.  I would assume it must include all expenses?? 

I'm not suggesting there is something wrong.  I know he does so much work in HIV and then takes time to answer questions online.  I would just be curious why all those large speaking fees.  I read his questions sometimes and haven't noticed him pushing certain meds over others.  I can certainly see how those suspicious that "big pharma" wouldn't want to bring a cure to light would really get paranoid.

Btw, I thought Dr. Gallant was much more in demand than Young.  I know more would know Gallant's name over Young.  Or, perhaps I just think more would know him over Young.  I noticed Gallant didn't have all those huge speaking fees.  It would be interesting to know why.

[bocker3]

Since when does getting paid for something, speaking, research, etc mean someone has to be doing nefarious things??  AND -- what business is it of mine (or anyone) how much a doctor makes??  If you feel your doctor is the type to take money in a quid pro quo way, then move on - find someone new.  This thread insinuates that a doctor who takes money from pharma becomes their pawn. 
Information is good and helpful, but partial information that is combined with comments to plant seeds of doubt or to suggest, UNSUBSTANTIATED, conduct is exactly what we get every election season in our political ads.
Do some doctors push drugs because they get money -- most assuredly.  I doubt it is most.  And let's be clear, a doc may get money from Pharma company A and "push" their drug, not because of money, but because he/she thinks it is the best drug for their patient.
I think I get the intent of this post (I'm assuming positive intent here), but the set up stinks!  It is reminding me of all the horrible primary ads I'm seeing right now from Cantor.

Mike

[eric48]

Btw, I thought Dr. Gallant was much more in demand than Young. ...  It would be interesting to know why.

Regardless of who does what and why, any conference will have sponsored talks. Usually introducing new meds, etc.

Depending on the conference rules this talk will either be given by a company's staff member or an external consultant

There is absolutly nothing wrong or hidden about this. Most of the times, the room is empty, anyway...

Moreover some docs do publish stats and clinical experience that they have had by themselves: it is certainly taking some of their time

Doing conferences in Eastern Europe or central Asia, where the use of modern meds is limited and likely to grow will be beneficial for the attending doc, the supplier and (may be) patients

Doing conferences in Eastern Europe or central Asia will earn you more than running a blog on Tumblr, but, on the other hand you have to go there

Docs are required to disclose Financial relationship but not the extend of that relationship

Eric

[geobee]

Whatever "big pharma" is paying Dr. Lalezari, it's not enough.  The guy's a rock star.

Maybe I'm feeling a little cranky, but I really don't like the way this post is framed.  It suggests that there is some undue influence, that doctors don't act independently. 

I say go big pharma.  Thanks for the medication.  And, one day, I'll thank them for the cure.  It ain't going to come out of grandma's home remedy cabinet.

[intaglio]

Mine gets about 150k a year, almost all for research.  What I found more interesting was drilling down to the Medicare claims, to see how much of each medication your doctor prescribes to Medicare/Medicaid patients, and how that ranks with others in his speciality.

Where did you find this info? Link?

Nevermind. Found it under Prescriber Checkup at the top.

[mecch]

Whatever "big pharma" is paying Dr. Lalezari, it's not enough.  The guy's a rock star.

Maybe I'm feeling a little cranky, but I really don't like the way this post is framed.  It suggests that there is some undue influence, that doctors don't act independently. 

I say go big pharma.  Thanks for the medication.  And, one day, I'll thank them for the cure.  It ain't going to come out of grandma's home remedy cabinet.

I agree in general with your perception of this thread. 

However, what about this proposition. 

A personal politics about so called "Big Pharma" doesn't have to be black and white.  All cheers, or all ridicule and suspicion.

As for HIV and medicine, anyone around in the 80's and 90's has many reasons to be angry and distrustful about "big pharma" and HIV.   

Anyway, I think its great to have transparency, just wished there were more info, so I could read perhaps some argument about the situation in the USA, specifically, in 2014, with big pharma and HIV treatment....    Are doctors being "persuaded" to prescribe one big-pharma product, instead of another big-pharma product?

I think this perspective (a historically formed critical stance about big pharma) is at least part of the reason that AHF made the argument against PrEP......  It was finally a pretty big disservice to today's community, but the gesture might be comprehensible in the context of the entire epidemic..... 

[bufguy]

Great website...My Doc received almost $125,000 in 2012 all from ViiV....I don't feel conflicted because he prescribes Atripla for me and calls it the gold standard. Atripla is produced by Gilead.

[vertigo]

I've taken some flack on here for how this post was framed, and I think the criticism is legit.  Four decades immersed in American capitalism sometimes leaves me a bit cynical about people's responses to financial incentives.

For the record, I don't think most doctors are in the tank for the pharmaceutical companies.  HIV doctors, in particular, are probably not in it for the money.  This link shows that their pay is at the bottom relative to their peers:

http://www.medscape.com/features/slideshow/compensation/2014/public/overview?src=wnl_edit_specol&uac=36307HK#2

However, HIV docs who do want to boost their income will probably turn to pharma to do so.  As the link points out, doctors who manage chronic diseases earn less than doctors who perform expensive procedures, for example orthopedists or dermatologists.  As a patient, I think knowing how much my doctor receives from the drug companies is relevant.

[bocker3]

I've taken some flack on here for how this post was framed, and I think the criticism is legit.  Four decades immersed in American capitalism sometimes leaves me a bit cynical about people's responses to financial incentives.

For the record, I don't think most doctors are in the tank for the pharmaceutical companies.  HIV doctors, in particular, are probably not in it for the money.  This link shows that their pay is at the bottom relative to their peers:

http://www.medscape.com/features/slideshow/compensation/2014/public/overview?src=wnl_edit_specol&uac=36307HK#2

However, HIV docs who do want to boost their income will probably turn to pharma to do so.  As the link points out, doctors who manage chronic diseases earn less than doctors who perform expensive procedures, for example orthopedists or dermatologists.  As a patient, I think knowing how much my doctor receives from the drug companies is relevant.

relevant how??  I'm not asking to be argumentative -- I am curious as to what this info tells you about your doctor?  what action does it drive?

Are doctors being "persuaded" to prescribe one big-pharma product, instead of another big-pharma product?

It is possible that a "big pharma" is being "persuaded" to pay a doc to come speak because he/she is a big proponent of one of their drugs.  Meaning, the money may follow the doctor's choice rather than money causing a choice.

I do agree that more info would be beneficial, for now all we know is how much someone got from whom.  Useful to start a discussion with the doc, perhaps, but not for much else.

Mike

[Joe K]

I've taken some flack on here for how this post was framed, and I think the criticism is legit.  Four decades immersed in American capitalism sometimes leaves me a bit cynical about people's responses to financial incentives.

For the record, I don't think most doctors are in the tank for the pharmaceutical companies.  HIV doctors, in particular, are probably not in it for the money.  This link shows that their pay is at the bottom relative to their peers:

http://www.medscape.com/features/slideshow/compensation/2014/public/overview?src=wnl_edit_specol&uac=36307HK#2

However, HIV docs who do want to boost their income will probably turn to pharma to do so.  As the link points out, doctors who manage chronic diseases earn less than doctors who perform expensive procedures, for example orthopedists or dermatologists.  As a patient, I think knowing how much my doctor receives from the drug companies is relevant.

Why can't you just be honest and say that you think that many doctors can be influenced, as to which drugs they prescribe, by payments from the drug companies?  All this semantic gymnastics, when you keep saying they are not influenced, but then again, if they want to make more money they are influenced, makes little sense, especially when applied against HIV specialists.

Over the decades, I have met hundreds of HIV specialists and with the exception of a few, none of them would ever consider offering drugs that were not in the best interest of the patient.  It's just not in their DNA.  They didn't become infectious disease specialists to get rich, they did it to make a difference and through the decades they have made great strides in treating our illness.

HIV drugs are not even in the top 10 prescribed drugs in the US.  Atripla, comes in at 15th, with Truvada at 22nd and their overall sales are dwarfed by the sales volumes of the top 10 drugs sold. (http://www.drugs.com/stats/top100/2013/sales).

Information like this can be useful, if it is presented in context, but we have no context to help us understand what these numbers mean.  As an indicator, the data may be useful, but certainly not to be used to "assume" that our doctors are doing anything unethical.

Joe

[mecch]

What are you supposed to do with "just" info?  I would say that you should evaluate it and decide if it is relevant to you.  Same as all the other info in your life.  Sounds like you've made that call in this case, which is fine.  But if my doctor were pushing me to take a certain drug and I knew that he had taken a lot of money from the manufacturer,   that info might be relevant to me.

Do you think this happens in the USA?

[tednlou2]

How many here think political contributions have an impact on what the candidate proposes and then how they vote in office, but do not think docs couldn't be persuaded?  Persuaded to push testosterone, when the patient doesn't need it?  Etc, etc. 

I don't think there is some huge conspiracy.  I do have to say I do wonder why Dr. Young got so much money in speaking fees.  Those are huge amounts.  Makes me want to learn whether there is a legitimate reason for such huge payments.  I know he flies to various countries.  Still seems like a lot, especially if it doesn't include travel, hotels, and meals. 

[vertigo]

OK, in reverse order...

mecch: Yes, I think sometimes it does.  Another area where I think conflicts of interest exist is between doctors and the medical device industry, i.e. which artificial joint your surgeon might choose to implant.  That financial info has yet to be disclosed.

Joe K:  I'm not trying to be dishonest or disingenuous.  And I appreciate your defense of HIV specialists, most of whom are indeed excellent people and not in it to get rich -- as we both agree.  Just because a doctor takes money from drug companies doesn't necessarily mean there must  be adverse influence, I don't think I ever said that.  But it could be the case.  Why couldn't it?  I've met a lot of doctors -- most good, a few indifferent, one bad -- and they are all humans susceptible to varying incentives.

bocker: I've tried to explain why I think this info is relevant, perhaps not successfully.  But here's a question for you: do you think it would be better if this information was not disclosed at all?  Granted, this is partial data and given without complete context.  But how else is transparency likely to occur, other than in discrete increments?  Also, I think your last line is actually kind of a big deal:

I do agree that more info would be beneficial, for now all we know is how much someone got from whom.  Useful to start a discussion with the doc, perhaps, but not for much else.

That in and of itself is a big step forward, if a patient is motivated to have a conversation with a doctor on the subject.  Or it could be a tipoff to get a second opinion from another provider.

OK guys, I don't want to be the jerk who always has to get the last word in, so I'm going to bow out of this thread.  Thanks for the dialogue.  As on many issues, my own opinions are not fixed, and comments -- both positive and negative -- help to inform my thoughts on a subject.  FWIW, the comments thread on the ProPublica site contains a rather similar back & forth, with some aggrieved doctors complaining of scare mongering, and other commenters arguing for more sunlight.

I hope that some folks have found the initial link to be interesting and worthwhile.

[Joe K]

Joe K:  I'm not trying to be dishonest or disingenuous.  And I appreciate your defense of HIV specialists, most of whom are indeed excellent people and not in it to get rich -- as we both agree.  Just because a doctor takes money from drug companies doesn't necessarily mean there must  be adverse influence, I don't think I ever said that.  But it could be the case.  Why couldn't it?  I've met a lot of doctors -- most good, a few indifferent, one bad -- and they are all humans susceptible to varying incentives.

I wasn't saying you were dishonest, just confusing in how you presented the subject.  The topic would probably be clearer if we talked about it as two separate issues, doctors influenced by money from pharma AND what data would help us see where this might be happening.  Your opinion is valid, I was just questioning of what use the data is, when we simply have no context against to judge what it shows.

Joe

edited to add:  With all the changes from the ACA, hospital consolidations, multiple physician practices, how can we even begin to track all the ways that money can find its way to a doctor?  Is being paid to be a board member, or consultant to a drug company or hospital group, any different from getting fees for seminars.  So many ways to transfer money, with so few tracking mechanisms.

[bocker3]

bocker: I've tried to explain why I think this info is relevant, perhaps not successfully.  But here's a question for you: do you think it would be better if this information was not disclosed at all? 

I have no big issue with the info being disclosed.  I'd prefer more context and I don't like it presented in a thread that is titled to suggest nefarious actions.  It smacks of negative advertising that has overtaken our political discourse (actually -- lack of discourse).

Mike

[bmancanfly]

vertigo,
Thanks for posting this info.  I found it very interesting and will definitely be a conversation starter with my doc.  He has received a substantial sum (high six figures)  a large portion of which is speaking fees.  While this proves no wrong doing,  it does make me question possible conflicts of interest.

Doctors are human beings and potentially guilty of the same avarice and greed as the rest of society.   Viewing them as anything less would be living life with blinders on. 

[eric48]

I think this is a very good initial post and I repeat my thanks to Vertigo

That being said, I discussed things with Doc yesterday, such as cost of meds and stuff...

Our clinic is not doing too well financially... Doc is bit disgruntled about the all thing : here is the way I understand things

Say, there are 12 patients a day at $ 50/visit. That is $ 600/day $: 120000 /year on which you have to pay rent, secretaries, expenses, etc. So it would not work without gvt support.

At ca. 12 patients a day and 2 visits per year and 200 working days that's 200 x 12 /2 yearly scripts = 1200 patients/year worth of treatment

Let's take Atripla as price standard at ca. $ 10.000 / year
The induced sales volume is $ 12 Million / year

The manufacturing cost for Atripla estimated from MSF report is $100 Per patient year therefore $ 120.000

If you look at a HIV doctor as being the point of sales for HIV drug manufacturers an HIV clinic is worth $ 10 million/year of gross margin to the manufacturers ...

$120.000 for the point of sales and 12 million for the rest of the supply chain...

That's a very unusual business pattern

Eric

[mecch]

Yet doctors in industrialised countries, and probably in many developing countries, prescribe from a list of drugs manufactured by many different companies.

No doctor or clinic is prescribing a high volume of one drug, I would guess.

Also - the funds that pay for the drugs are not mixed with the funds that pay the doctor, in a lot of cases.

Also - how many doctors in rich countries charge 50 USD (equiv) a half hour.....

I dont see the point of the calculus.

[bmancanfly]

There are lots of ways that it can become a very slippery ethical slope for a doctor looking to firm up his bottom line.   Not suggesting anything necessarily nefarious (although that is not unheard of)  but the slow erosion of the separation between a profit making business and medical ethics.  Even if it is just the appearance of conflict of interest.

Certainly worth bringing it out into the open by publically revealing the exchange of dollars between docs and pharma.

[wolfter]

Perhaps I'm viewing this entire thread from a different prospective.  I personally would not care how much my doctor rec'd from any outside force.  I have ultimate faith in his decisions and have rec'd the greatest care possible.

I didn't click on the link to even check if he receives outside funding.  I own my care and the doctor is but a mere a link in that chain.  If I was ever to question his morales and/or motives then I'd probably consider a different doctor.

greg

[bocker3]

Perhaps I'm viewing this entire thread from a different prospective.  I personally would not care how much my doctor rec'd from any outside force.  I have ultimate faith in his decisions and have rec'd the greatest care possible.

I didn't click on the link to even check if he receives outside funding.  I own my care and the doctor is but a mere a link in that chain.  If I was ever to question his morales and/or motives then I'd probably consider a different doctor.

greg

I am with you Greg -- as I feared with this thread, we have folks looking at their docs as guilty until they prove themselves innocent.
Honestly, if I had this little faith in my doctor's desire to treat my properly and look out for my well being, I'd find another.  I discussed with my doc what drugs to go on -- and I didn't go with his initial thought either.
Personally, it's no more my business where my doctor gets his income from than it is for him to ask where I get my income from!!

Mike

[tednlou2]

John Oliver chose this issue, when he returned for a new season of "Last Week Tonight."  In that segment, he discussed how the ACA required tracking of money docs get from pharm.  So far, that site only has the last 5 months of 2013. 

I looked up Dr. Young again.  In those last 5 months, he received about $100,000.  Much of that came from ViiV, which makes Triumeq.  As has been pointed out, we don't know what he does for that money.  Perhaps nothing is amiss.   However, I have noticed he favors Tivicay and Epzicom and Triumeq over other drugs like Stribild.  In his forum, he has said he is concerned with the Cobicicstat boosting and how he's not sure altering normal liver function is good.  On the possible heart attack risks with abacavir, he has said that is settled and there is no risk. 

Dr. Gallant has said there is no issue with "altering normal liver function" with Cobicicstat.  He also said the heart attack risk with abacavir has definitely not been settled.  He said we should have the final answer here in the next month or so.  I can see how this can make some wonder whether money is influencing those views.  Perhaps he would still have those views, regardless.  When I saw how much he got in just 5 months from ViiV, it did make me question the advice he gives.  I don't think that's bad to question.  He's not my doc, but he does give advice to many online.  Dr. Gallant received $352 in those last 5 months. 

http://youtu.be/YQZ2UeOTO3I

https://openpaymentsdata.cms.gov/physician/323941

[buginme2]

I checked to see how much my doctor gets from pharma and its zero . Although my doc is employed at the university so I wonder if they don't allow it???

I checked a popular hiv doc that has a private practice in the city.  He's super popular and hard to get an appointment with. He gets tens of not hundred of thousands from pharma.


I bet his patients get better drugs than I get.  Uhh

[mecch]

I checked to see how much my doctor gets from pharma and its zero . Although my doc is employed at the university so I wonder if they don't allow it???

I checked a popular hiv doc that has a private practice in the city.  He's super popular and hard to get an appointment with. He gets tens of not hundred of thousands from pharma.


I bet his patients get better drugs than I get.  Uhh

I would like to understand better your argument or your fear, underlined above.

Why would they get "better drugs" than you? Isn't what you get determined by what your insurance will pop for? How is what the insurance will pay in any way related to how much the prescribing doc pockets directly from pharma?  A doc isn't deciding insurance reimbursements.  Please explain?

[eric48]

The point made by Tednlou is all too obvious

When you read their respective online contributions, it is all too ovious that these are some times pro domo arguments. So times I wonder who really write those

And the argument against the other drug are fallacious

Those taking these medications are ,then, caught in between and that raises anxiety without real reason to

Incompetence and corruption...

This is not unique to HIV

You have this obvious corruption in many other fields that include cardiovascular primary (preventive) interventions

Cholesterol sham, we call it now

This is a shame...

Needsless to say those doctors are never going to remind you that Generic ARVs are doing a wonderful job worldwide

And while you guys are struggling to keep inssrance and jobs, your competitors in eastern europe or south east Asia spend much less on medication and primiums, the cost less to their employers and at the end your job is being relocated there

[Miss Philicia]

Somehow I missed this thread and the opening link -- my doctor's is wiping the floor! So much money I can't even add it all up quickly. Just one speaking engagement for Johnson & Johnson got him $18,000 in 2010.

But the thing is -- he's the executive medical director for our HIV clinic, and it's the largest clinic in the city, and Philadelphia is the 5th or 6th largest metro area in the country.

Some of the payments are for speaking while most are for research and they payee was actually the clinic, it just also lists it for his name.

Not sure what the point of all of this is. "IN BED WITH BIG PHARMA OMGNOES!"

[eric48]

My doctor is not listed...

And I don.t really care

My concern is that some doctor are being funded by Big Pharme, which is OK with me

AND are sitting at guidelines boards : they take part in the voting of recommendations

Usually new drugs stay one or 2 years in the alternate section, but, 2 recently introduced drugs made it to ´recommended ´ section remarkdly fast

[intaglio]

Propublica's recent article disclosing the challenges it faced parsing Pharma payments to doctors.

[eric48]

Interesting read

Vested interest are not exclusive to the HIV meds market

It really takes a lot of effort to untangle the web that leads to such high cost for antivirals,that, sa shown here, do not cost that much to make

www.tinyurl.com/HPC-MSF

It also takes time and careful reading to identify the kind of bias or tendancy to push one argument or another

Tednlou ´ remark remains pertinent, and, I had come to a similar observation myself

Sadely enough, some people think it is wise to echo such hidden advertizing
Most of them just do it in good faith

Incompetence and corruption...