It comes from the world's leading pharmaceutical companies and leads to a mental health clinic in Granada Hills, an anesthesiologist's office in Santa Monica, and to a cardiologist with practices in Glendale, Pasadena, and Long Beach.
In fact, hundreds of physicians, psychiatrists, and medical school faculty members across California are on the payroll of major drug companies, earning tens of thousands of dollars for speaking to other medical professionals at events held by industry leaders that make drugs such as Advair, Cymbalta, Viagra and Zoloft.
From 2009 to 2012, California doctors who participated were paid $242 million - the highest in the nation - by major drug companies for research, speaking, consulting, trips and meals, according to a new database released Monday by ProPublica, an independent, nonprofit news organization.
The disclosures have been listed on the websites of some drug companies for several years, but a federal mandate will require it for companies by 2014.
Analysts from ProPublica gathered names of physicians, the amount they were paid, and the services they rendered - data listed on websites of 15 of the largest pharmaceutical companies, which make up 47 percent of the U.S. drug sales.
The data shows that speaking about diseases for a drug company has become a lucrative moonlighting gig for
those in the medical profession locally and across the nation.But while the practice of speaking is not illegal, it raises the question of conflict of interest: Is the drug being given to you because you need it, or because the doctor writing out the prescription is paid by Big Pharma?
"Pharmaceutical companies used to take doctors to dinner, but that was banned years ago," said Dr. Arthur Chanzel Jeng, an infection control specialist at UCLA-Olive View Medical Center in Sylmar.
"Now they must provide some educational content."
Jeng was paid $80,500 by Pfizer last year for several speaking engagements. As an infection control specialist at Olive View, he and others in his field are concerned about drug resistant diseases and the limited number of antibiotics. Drug companies have little incentive to produce new antibiotics, he said, so if they do, physicians in his field want to know more about the drugs. That's why he agrees to speak.
"We (speakers) provide education when a new antibiotic does get released," he said. "There needs to be education among doctors on how to use this new antibiotic."
Jeng said Pfizer is never mentioned by name at the events. Internal monitors attend the engagements to make sure, because of past litigation against the company. He also said he does not feel pressured to administer medications solely made by Pfizer.
"A lot of the lectures are in university settings. It's part of our job description," he said. "We don't take samples."
Olive View is part of the Los Angeles County Department Health Services, and has its own policy on pharmaceutical influences, said hospital spokeswoman Azar Kattan.
"The Department of Health Services has a very formal process for selecting the drugs that we prescribe or use for our patients," Kattan said.
She said a committee establishes a list of drugs that can be used. If a physician wants to recommend a drug that is not on the list, he or she must receive permission from the committee.
"Part of the reason we have this process is we take potential conflict of interest very seriously, so we try to be very careful in how we select the drugs we use," Kattan said. "If we identify noncompliance by a physician, we would investigate it and take appropriate action."
Guidelines on what physicians can and cannot accept are also published by the California Medical Association. But the trade group declined to address the issue directly.
"Generally speaking, our policy supports that disclosure and transparency are both beneficial," said Molly Weedn, spokeswoman for the CMA.
At UCLA, faculty, staff, and trainees all can continue to be part of "Speakers' Bureaus" or similar programs sponsored by industry, but:
"Faculty, staff, and trainees always should strive, however, to ensure that their talks or public presentations are free of any commercial influence," according to UCLA guidelines. "In addition, they need to consider whether an industry-sponsored activity creates an appearance of impropriety and strive to avoid any activity that may create the appearance of a conflict of interest. Transparency and disclosure are an essential factor when participating in these programs."
But a look through ProPublica's database shows that Dr. Donald Tashkin, Medical Director of the Pulmonary Function Laboratory at the David Geffen School of Medicine at UCLA, was paid $181,670 last year by companies such as Merck, Novartis, Pfizer, AstraZeneca.
Since 2009, there were 39 disclosures listing his name, 17 for speaking engagements, according to ProPublica. Tashkin has authored papers on the effects of marijuana on lungs. Since 2009, he has earned $453,195 from drug companies.
Tashkin did not return calls, but UCLA officials at the school said Tashkin may be an exception to their guidelines.
"Dr. Tashkin, as an emeritus faculty member, is not subject to the same set of policies and reporting requirements as is a full-time, active faculty member," said Dale Tate, spokesman for UCLA Health Sciences.
"His reporting requirements depend on a number of variables including time spent at the David Geffen School of Medicine."
The database also shows that about half of the top earners are from a single specialty: psychiatry, according to findings by ProPublica.
"It boggles my mind," Dr. James H. Scully Jr., chief executive of the American Psychiatric Association, told a reporter from ProPublica, referring to the big money paid to some psychiatrists for what are billed as educational talks.
Paid speaking is "is perfectly legal, and if people want to work for drug companies, this is America," said Scully, whose specialty has often been criticized for its over-reliance on medications. "But everybody needs to be clear - this is marketing."
Southland physicians in private practice also received large sums of money last year:
Dr. Harry Balian, a cardiologist who lists offices in Glendale, Pasadena and Long Beach, earned $69,625 last year or $165,034 since 2009 in speaking fees paid by Eli Lilly, Johnson & Johnson, Novartis, Forrest, and Pfizer. Balian is the Medical Director of the Cardiocath Lab and Special Procedures at Glendale Adventist Medical Center.
Dr. Konstantinos Tripodis, medical director at the Hillview Mental Health Center, earned $71,000 last year, but $283,545 since 2009 for speaking paid for by Pfizer, Novartis, Eli Lilly, AstraZeneca and Merck. He lists office addresses in Granada Hills, Pacoima, Thousand Oaks and Newbury Park.
And Dr. Gerald Sacks, an anesthesiologist from Santa Monica, earned what appears to be the most in California: $718,100 since 2009.
None of these physicians returned telephone calls or emails to discuss how, if any, conflict of interest arises in their work.
Disclosure required under health reform
Last month, the Centers for Medicare and Medicaid Services issued a final ruling on the physician payment sunshine provisions of the Affordable Care Act, President Obama's health reform legislation set to take full effect in 2014.
The provision requires manufacturers of drugs, devices, biologicals, and medical supplies to report annually to CMS any payments or transfers of value made to physicians and teaching hospitals.
The manufacturers must begin collecting payment data on Aug. 1, 2013, and the database will be made public in September 2014.
Some of the biggest companies already disclose such data on their websites, but the industry is concerned about giving information to CMS because many technical questions remain.
"It's not yet clear what they will report on the website," said Marjorie Powell, senior assistant general counsel for Pharmaceutical Research and Manufacturers of America, the leading trade association for research-based pharmaceutical companies.
"One of the concerns we still have is there will be masses of information and the companies feel it's very important that everybody understand the relationship between pharmaceutical companies and doctors," she said. "The only way the companies do the research is to have physicians work on clinical trials.
"It's worrisome that things won't translate properly."
But while medical schools and teaching hospitals welcome the disclosures, some say the information should be considered carefully by the public.
"One of the most important pieces of disclosure is having context around transparency, which is the only way for true transparency," said Heather Pierce, senior director of science policy at the Association of American Medical Colleges.
A list of names and dollar amounts does not tell the public the whole story of why a doctor was paid by a pharmaceutical company, she said.
"There is no additional information of where they are speaking, what they are speaking about and who they are speaking to," Pierce said. "It's an important distinction that a financial interest is not necessarily a conflict of interest."
But others say even listing reasons why a doctor was invited to speak doesn't go far enough for different reasons.
"For savvy consumers who find the (ProPublica) database, you can check to see if your doctor is being paid to recommend your medication," said Jaime Court, president of the Santa Monica-based Consumer Watchdog, a national nonprofit organization that works to protect taxpayers from special interests.
Court said there should be a registry with pharmaceutical agents' names, along with who they visit and the kinds and amounts of samples and gifts handed out.
"The phamarceutical industry is a hospitality industry for the medical profession," Court said. "Most of the hospitality is unknown.
"Just because a doctor is not in the database doesn't mean they are not being influenced by a company," he said. "We want to know the prescriptions we receive are the best for us, not for a gift exchange."
He said disclosure is like sunlight brightening the dark, but cautioned it isn't always enough.
"Sunlight is like a disinfectant, but it doesn't always do the job," Court said. "You really have to dig."
susan.abram@dailynews.com, 818-713-3664, @sabramla
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