Dollars For Docs: The Top Physicians In Big Pharma's Pocket

The list includes a big-name cancer specialist with a thick resume of peer-reviewed research, but also doctors whose qualifications as experts remain a mystery.

Self-promoters who boast of their persuasive skills are mixed in with physicians who refuse to discuss the nature of their promotional work.

Dollars for Docs is part of an ongoing investigation into the influence of drug company payments on patient care. Our list of 43 doctors earning more than $200,000 is based on reports from seven companies that have publicly disclosed such payments to date—GlaxoSmithKline, AstraZeneca, Eli Lilly and Co., Pfizer, Cephalon, Merck & Co. and Johnson & Johnson. ProPublica plans to continue updating the payments data as additional companies reveal them.

So, what kind of doctors are pharma's handpicked stars?

• Fewer than half are formal educators affiliated with academic medical centers or prominent leaders in their medical societies. The rest are a mix of physicians with limited credentials or about whom little could be gleaned despite searches of research publications, academic websites and professional society leadership lists.
• Five of the 43 are from Tennessee—more than any other state, even though it's the 17th-largest by population. New Jersey, Texas, California, New York and Michigan each had three.
• Eleven of the 43 have board certification in the small field of endocrinology, a hotly competitive area because of the multibillion dollar market for diabetes drugs. Eight physicians, the next-largest subgroup, hold no advanced certification, despite speaking on specialized diseases and treatments.
• Only three of the top earners are women—all endocrinologists, one each from Louisiana, Tennessee and New Jersey.
• More than half worked for two or three companies. One Tennessee diabetes physician worked for five. Seven earned money solely from Glaxo.

The ranks of the top earners—and their pay—are almost certainly much greater, as more than 70 drug firms haven't publicly reported all their speakers and consultants. Because these data are from only a handful of companies, it's unclear how closely they resemble the industry's physician sales force overall.

In the medical world, there's much debate about whether physicians should be paid to promote the products of drug firms at all. Critics of such talks say companies are using doctors as celebrity spokespeople, exploiting their prestige to deliver what is essentially a drug sales rep's pitch.

Drug companies "spend the money because it puts a veneer of respectability upon the marketing," said Dr. Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. "It's using luminaries to market drugs, and they fully understand what they're doing."

One of Nissen's colleagues at the clinic, endocrinologist Adi Mehta, earned at least $202,600 from three companies. Mehta said in a statement that he feels "passionately" that such speaking educates his peers, the same rationale drug companies use to defend their reliance on practitioners. The prestigious clinic does not prohibit participation in pharma speakers' bureaus.

ProPublica sought out many of the best-compensated speakers to learn more about their backgrounds, motivations and opinions on the influence of the money on their practices.