Are you wondering what kind of information will be gleaned about pharmaceutical company-physician relationships once the Physician’s Payment Sunshine Act takes effect in 2013? That’s the year when drug companies will have to start publicly reporting all payments and gifts they dole out to doctors who conduct “educational” speeches and seminars that promote proprietary pharmaceuticals.

In their recent “Dollars for Docs” project, reporters from the investigative news organization ProPublica offer a sneak preview of what kind of money we’re talking about. Reporters from the group probed the “labyrinthine websites” of seven Big Pharma companies that are already reporting this kind of data and discovered that between 2009 and 2010 these firms paid a whopping $257.8 million to about 17,700 providers for giving “educational” talks and seminars to colleagues about certain medications. Charles Ornstein, a reporter for ProPublica told NPR  “In our database we found that there were 384 doctors who, over the course of just the past 18 months, have received at least $100,000 from the drug companies that have reported so far.”

The ProPublica reporters compiled a single, searchable database that allows patients to search for their personal physician or other doctor in their state and see if they receive industry payments, how much they pull in, and in some cases, what drugs they are promoting.  Creating this database required reporters to dig through often-vague and disparate data from Eli Lilly, Pfizer, AstraZeneca, GlaxoSmithKline, Merck & Co., Cephalon, and the Johnson & Johnson companies, who together represent about 36% of the US pharmaceutical market. That’s a substantial portion, but because there are more than 70 drug companies operating in the US, the data might represent just the tip of the iceberg.

Besides ferreting out Pharma payments to doctors, ProPublica investigators went farther; digging deeper and running detailed searches on individual practitioners to find out whether they were licensed or had disciplinary actions taken against them. The most surprising finding: “A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.”

For example, “In 2001, the U.S. Food and Drug Administration ordered Pennsylvania doctor James I. McMillen to stop ‘false or misleading’ promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

“Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.

“Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.”

ProPublica partnered with five other organizations; NPR, the Boston Globe, the Chicago Tribune, PBS and Consumer Reports to use these data as the source for a range of stories which can be accessed here.

Of the seven big Pharma companies that provided this information on their websites, five did so as part of settlements they made with the FDA after they were found to be promoting name-brand drugs for off-label uses. Typically in these cases, consultant doctors (often armed with company-authored “research papers”) would meet with their colleagues and “educate” them about how a drug could be used for the off-label indication. In the last three years, pharmaceutical companies like Novartis, Pfizer and Cephalon have had to fork over nearly $7 billion in penalties and settlements of these charges.

There are several conclusions to be drawn from the ProPublica investigation. The first is that Pharma payments to doctors to promote proprietary drugs—usually the newest and most expensive pills that may cost more than alternatives without being substantially more effective—are widespread and seem to show no sign of slowing. One reason is that many hospitals and individual physicians have barred traditional drug reps from their premises and have banned gifts. But company-funded doctors can freely stroll the halls of the hospital, setting up lectures, dinners and other outings with colleagues to share information about proprietary drugs. The fact is, the strategy works: According to this ProPublica piece, “Glaxo’s drug to treat enlarged prostates, Avodart — locked in a battle with a more popular competitor — is the topic of more lectures than any of the firm’s other drugs, a company spokeswoman said. Glaxo’s promotional push has helped quadruple Avodart’s revenue to $559 million in five years and double its market share, according to IMS.”

In the past, drug companies have tried to tap into physicians at the most prestigious medical and academic centers. For example, the Boston Globe found that Harvard doctors and researchers were particularly prized by the industry. “Doctors and researchers affiliated with Harvard Medical School collected 45 percent of the $6.3 million given to Massachusetts doctors in 2009 and 2010 by [the] seven pharmaceutical companies,” most of it for talking to colleagues about the company’s drugs and which diseases they treat, according to the paper.

But many of these medical centers, including Brigham and Women’s, Massachusetts General and McClean Hospital in Boston, have instituted bans on their practitioners making company-funded speaking appearances. Harvard is following suit early next year. Enforcement is not always complete, but many doctors who saw their incomes well-supplemented by speaker fees have agreed to stop or left the centers. The Globe article mentions Dr. Brent Forester, a geriatric psychiatrist at McLean, who was one of the Massachusetts physicians paid the most last year. He “made $73,100 for giving nearly 40 talks for Eli Lilly to colleagues about the antipsychotic Zyprexa and the antidepressant Cymbalta over dinners in restaurants and in doctors offices. He has resigned from speakers bureaus to comply with the new rules, but said he ‘never felt like a spokesperson for the company at all.’”

“It was an opportunity to educate primary-care doctors about the treatment of psychiatric conditions,’’ Forester said.

That may be so for Forester and plenty of other physicians who truly believe they are providing a needed service for their busy colleagues who might not be able to keep up-to-date on the latest therapies. But the public doesn’t buy it. As part of the “Dollars for Docs” project, Consumer Reports conducted a nationally-representative survey of 1,250 adults and found that more than 75% said they would be “very” or “somewhat” concerned about getting the best treatment or advice if their doctor were accepting drug-company money. And 70 percent felt that doctors should tell patients about these payments if they intend to prescribe medications from one of those companies.

“Let's be honest: The purpose of these talks is to influence doctors to buy a company's drugs,” Eric Campbell, an associate professor of health policy at Harvard Medical School tells the Chicago Tribune.

With more academic institutions and top-tier hospitals banning speaker fees and other promotional payments, drug companies will increasingly have to resort to using less prestigious shills—like the 250 doctors in the ProPublica investigation who had sanctions filed against them or the others who were not board certified in any specialty. Private physicians without academic affiliations are another option. Perhaps companies should be required to conduct background checks on their paid practitioners and make these kind of data available on their websites as well.

For now, when the Physician’s Payment Sunshine Act is enacted in 2013, companies will have to report names, addresses, the amount of the payment, the date of the payment, and the precise nature of the "service" provided by the doctor. Not only that, but if the payment was for a promotional talk, the company will have to disclose the name of the drug the doctor was promoting. Hopefully, this information will be presented in an easy-to-search format, like the new (but limited) ProPublica database. To compile their database, reporter-investigators spent hours pouring over vague and confusing data from company websites and then went even further to cross-check this information with the backgrounds of individual physicians receiving payments. A patient shouldn’t have to go to such extreme measures just to find out if their doctor has a conflict of interest in providing quality care.