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Doctors Prescribe More of a Drug if They Receive Money From Pharma Company

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by Hannah Fresques for ProPublica

Doctors who receive money from drugmakers related to a specific drug prescribe that drug more heavily than doctors without such financial ties, a new ProPublica analysis found. The pattern is consistent for almost all of the most widely prescribed brand-name drugs in Medicare, including drugs that treat diabetes, asthma and more.

The financial interactions include payments for delivering promotional talks, consulting and receiving sponsored meals and travel.

The 50 drugs in our analysis include many popular and expensive ones. Thirty-eight of the drugs have yearly costs exceeding $1,000 per patient, and many topped the list that are most costly for the Medicare Part D drug program.

Pharmaceutical companies have paid doctors billions of dollars for consulting, promotional talks, meals and more. A new ProPublica analysis finds doctors who received payments linked to specific drugs prescribed more of those drugs.

Take Linzess, a drug to treat irritable bowel syndrome and severe constipation. From 2014 to 2018, the drug’s makers, Allergan and Ironwood, spent nearly $29 million on payments to doctors related to Linzess, mostly for meals and promotional speaking fees.

ProPublica’s analysis found that doctors who received payments related to Linzess in 2016 wrote 45% more prescriptions for the drug, on average, than doctors who received no payments.

Key Takeaways

We studied the 50 most-prescribed brand-name drugs in Medicare for which drugmakers had made payments to doctors in 2016. The drugs include treatments for diabetes, asthma, high cholesterol, hypertension, glaucoma and more. Among our findings:

  • Of those 50 drugs, 38 cost more than $1,000 per year.
  • For 32, at least 10% of doctors prescribing the drug received payments tied to the drug from the company that made it.
  • For 46 of the drugs in 2016, doctors who received payments for the drug prescribed more of it compared with doctors who did not.
  • On average, doctors who received payments prescribed 58% more of that drug than doctors who did not.

Read our methodology for more about the analysis.

Those findings were repeated for drug after drug. In 2016, doctors who received payments related to Myrbetriq, which treats overactive bladder, wrote 64% more prescriptions for the drug than those who did not. For Restasis, used to treat chronic dry eye, doctors who received payments wrote 141% more prescriptions. The pattern holds true for 46 of the 50 drugs.

On average, across all drugs, providers who received payments specifically tied to a drug prescribed it 58% more than providers who did not receive payments.

Other research, including our own, has found a correlation between payments and overall prescribing. This new analysis expands upon past work by looking individually at a variety of popular drugs. “What clearly jumps out is how consistent the association is across drugs,” said Aaron Mitchell, a medical oncologist at Memorial Sloan Kettering Cancer Center who has studied pharmaceutical payments for oncology drugs.

Our analysis looked at the relationship in two ways: whether those who received payments prescribed more of a drug, as well as whether those who prescribed a drug received higher payments than those who did not. We found that, on average, physicians who prescribed a drug received higher payments related to the drug that same year than those who didn’t prescribe it.

For Linzess, the value of payments was more than four times higher for providers who prescribed the drug than among those who did not. For Myrbetriq, it was three times higher, and for Restasis, it was twice as much.

Holly Campbell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, an industry trade group, said it stands to reason that doctors who have interactions with a company about a drug may prescribe more of it “because they have more information about the appropriate uses for the products.”

Through spokespeople, Allergan (maker of Linzess as well as Alphagan P, Bystolic, Combigan, Lumigan, Namenda and Restasis), Janssen (maker of Invega, Invokana, Xarelto and Zytiga) and Novo Nordisk (maker of Levemir, Novolog and Victoza) described their interactions with physicians as important for sharing medical information.

Novo Nordisk added that prescribing data is not used to target physicians for speaking or other promotional interactions. Eli Lilly said in a statement that meals can take place in many contexts, including in doctors’ offices, at speaker events and at conferences, but didn’t answer other questions. GlaxoSmithKline, Ironwood, Astellas and Purdue declined to comment.

For some drugs that are household names, it was more common for prescribers to receive a payment than not to. More than half of doctors who prescribed Breo, an expensive asthma drug, to Medicare patients received payments involving the drug in 2016. This was also true for Invokana and Victoza, both of which are diabetes medications. For Linzess, nearly half of doctors who prescribed the drug had interactions with its maker.

More than one in five doctors who prescribed OxyContin under Medicare in 2016 had a promotional interaction with the drug’s manufacturer, Purdue Pharma. The company did not respond to a request for comment.

“If there are physicians out there that deny that there is a relationship, they are starting to look more and more like climate deniers in the face of the growing evidence,” said Aaron Kesselheim, a professor of medicine at Harvard Medical School and an expert in pharmaceutical costs and regulation. “The association is consistent across the different types of payments. It’s also consistent across numerous drug specialties and drug types, across multiple different fields of medicine. And for small and large payments. It’s a remarkably durable effect. No specialty is immune from this phenomenon.”

Huey Nguyen, a gastroenterologist in southern Indiana, increased his prescribing of Linzess in recent years. From 2013 to 2015, Nguyen’s Medicare patients had fewer than 60 claims per year for Linzess. In 2016 and 2017, that jumped to over 110 claims per year.

Over that time, Nguyen was a promotional speaker for Linzess. Allergan paid him $1,000 in 2013, over $4,000 in both 2016 and 2017, and $2,000 in 2018 to speak about the drug.

Though Linzess has been on the market since 2012, Ironwood and Allergan made a big push to promote the drug in 2016 and 2017. Spending on doctors reached $10 million in 2016 and nearly $8 million the following year, up from under $4 million in both 2014 and 2015.

In total, Nguyen has earned $25,000 from 2014 to 2018 related to six drugs from four pharmaceutical companies, excluding meals. In 2018, he was paid by two companies to promote competing drugs that treat irritable bowel syndrome.

ProPublica’s analysis did not set out to examine, nor did it resolve, whether industry payments change doctors’ behavior, or if patients receive inferior care from doctors who receive payments. Many factors can influence doctors’ prescribing choices. Some patients, for instance, have conditions for which only brand-name treatments are available or for which other drugs have failed.

Nguyen said promotional speaking educates doctors about how a drug works, whether insurance covers it and when not to prescribe it.

“It’s a way for the primary care physicians to have access to a gastroenterologist where they can ask one-on-one questions,” Nguyen said. “I’m more educated towards the drug, because I have to be trained to speak on it, so I’m more comfortable prescribing it.”

Experts are skeptical that interactions between companies and doctors benefit patients. “If there really were innovations and real benefits that were accruing to patients for a new treatment, it shouldn’t take so much spending by the company to get the word out,” said Stacie B. Dusetzina, associate professor of health policy at Vanderbilt University Medical Center, who advised ProPublica on the design of its analysis. “I wonder if promotion is really to try to push products that have a much less substantial benefit because they’re not gaining the market share naturally.”

Nguyen said he takes many things into account when prescribing a drug, including its approved uses, cost and side effects. “In my day-to-day practice, my patients still come first,” Nguyen said. He said the speaking engagements do not influence his prescribing, “at least not consciously. Unconsciously, I don’t know.” He sees the public disclosure of industry payments to doctors as a way to help patients be active participants in their care.

Nguyen said he works with companies for the extra compensation but acknowledged that “it’s perfectly reasonable for people to question my motives.”

ProPublica’s analysis matched doctors’ prescribing in Medicare’s prescription drug program to the industry payments doctors received. Drug and medical device companies are required to report these payments annually through the federal Open Payments program, and they are made public on a government website. More than 600,000 doctors receive payments annually. (Companies also report research payments and ownership interests, but these were excluded from our analysis.)

Some providers were paid thousands of dollars, often for promotional speaking. But the typical doctor took in much less. Most only received meals, typically worth less than $100 per year.

In 2016, ProPublica found a relationship between the total dollar value of a doctor’s interactions with drug and device companies and the overall percentage of brand-name drugs he or she prescribed.

Other research has found correlations between industry interactions and prescribing for certain classes of drugs, including opioids, urology drugs, oncology treatments, inflammatory bowel disease treatments and heartburn medication. In one study, brand-name prescribing for certain classes of drugs was associated with receiving as little as a single pharmaceutical industry sponsored meal. A study of prostate cancer treatments did not find evidence of a connection.

Brand-name drugs are more expensive than generic options, both for patients and for Medicare. A recent report from the Department of Health and Human Services found that Medicare Part D and its beneficiaries could have saved almost $3 billion by switching from brand-name drugs to generics.

Linzess is an expensive drug, costing Medicare and patients an average of about $1,500 annually. A common alternative is the laxative Miralax, available over the counter as generic polyethylene glycol, which costs less than $200 annually if taken every day. Nguyen said he recommends Miralax to many patients, but that wouldn’t show up in Medicare’s data because Medicare doesn’t cover over-the-counter drugs. He said he often prescribes Linzess to patients who have tried Miralax and not seen the symptom relief they hoped for.

For brand-name drugs that have good generic alternatives, “every time a doctor prescribes one of these brand-name medications, it’s extra money transferred from the Medicare program to the manufacturer,” said Michael Barnett, assistant professor of health policy at Harvard T. H. Chan School of Public Health. “Medicare spending is out of control. And drug costs are one of the major reasons.”

Drug cost can have major consequences, not just for Medicare balance sheets but also for patients’ well-being. “The newest, latest drug is often not any better than the old drugs” that treat the same condition, Mitchell said. “But the new drugs are always more expensive. That really hurts patients’ pocketbooks. You’ve got physicians prescribing more expensive drugs and patients who aren’t taking them as a result. A generic medicine that’s cheaper that a patient does take is a whole lot more effective than an on-brand, expensive medicine that they don’t take.”

Summary: Pharmaceutical companies have paid doctors billions of dollars for consulting, promotional talks, meals and more. A new ProPublica analysis finds doctors who received payments linked to specific drugs prescribed more of those drugs.

ProPublica is a nonprofit newsroom that investigates abuses of power.

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21 Workers Test Positive for Coronavirus at Rock n Roll Ralphs

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Workers protest outside Ralphs in Hollywood where 21 have tested positive for coronavirus

HOLLYWOOD (KTLA) — Workers rallied Friday outside a Ralphs store in Hollywood where 21 people have tested positive for the coronavirus.

The group called on the store to take more aggressive action when staff test positive for the virus, and to ramp up efforts to protect the grocery store employees, who are considered essential workers on the front lines of the pandemic.

They said they speak for thousands of workers who are afraid they aren’t getting enough protection as the virus continues to spread countywide, infecting more than 24,000 as of Friday.

The Ralphs at 7257 W. Sunset Blvd. has had an outbreak involving several workers who tested positive for the virus, according to the Los Angeles Department of Public Health, which lists businesses and […]

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‘Stay Put, Order In’ and Dine With Friends on Zoom, Says Mayor

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WEST HOLLYWOOD — WeHo is home to some of the best restaurants in the world and our community members are used to gathering around restaurant tables and enjoying meals together. Now, there’s an opportunity to, instead, gather around kitchen tables at home and enjoy a meal (or many!) while supporting our local restaurants.

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Mealtime is a wonderful opportunity to connect with friends, family, and loved ones using virtual teleconferencing technology, while partaking in your favorite delivered or takeout food.

City Encourages Residents to Support Local Restaurants During Safer At Home Orders

Many West Hollywood restaurants remain open and are offering takeout, curbside, and delivery meals, which are sensitive to social distancing during the emergency. The City of West Hollywood and the West Hollywood Chamber of Commerce have teamed up to offer a directory of “Stay Put, Order In” eateries in West Hollywood, which is accessible by visitingwww.weho.org/coronavirus (click the “Stay Put, Order In” link!) or www.wehochamber.com/dinein. This list is updated daily.

“We need to start hanging out together, and talking, and seeing each other again. So, why not plan to #WeHoDinnerConnect this week – maybe Saturday at 8 p.m.? Or Sunday at 7 p.m.? Or even just 15 minutes of screen-to-screen gossip,” said Mayor D’Amico. “And you don’t have to cook a thing… local restaurants have meals and menus tailored to take-away choices and they’re ready to send food over to your house or make arrangements for you to pick it up.”

If picking up food, remember to wear face coverings, which are required to enter essential businesses.

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Amoeba Music Won’t Reopen Original Sunset Boulevard Store

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Amoeba Music won’t be reopening its original Sunset Boulevard store

HOLLYWOOD (TimeOut) — In a statement posted to its Instagram account on Monday, Amoeba announced that it would not be reopening its nearly two-decade-old flagship on Sunset Boulevard. Instead, the indie record shop will divert all of its resources to opening its new shop on Hollywood Boulevard, which they still hope to have ready in the fall.

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It is with a very heavy heart that we announce that the massive impact from COVID-19 has forced Amoeba Hollywood to remain closed until we can hopefully move to our new location this fall. We are devastated. We know you are too. We never envisioned not being able to give the store the send-off it deserves, to give you all a chance to say goodbye. But we are facing too many mitigating circumstances. This is not the end of Amoeba! We are moving to a new location at 6200 Hollywood Blvd in the fall and we feel fortunate that this plan was set into motion long before COVID-19. There are so many unknowns and uncertainties for a business like ours right now. The only thing we do know for certain is that we intend to survive. We want to continue to be there for our amazing customers and our incredible staff in our new location long after this pandemic disappears. The only way we can keep Amoeba Hollywood alive in the future is to make this difficult decision now. Thank you ALL so much for your support during this time and over the years. We have the best customers in the world, as evidenced by the tremendous outpouring of support for our GoFundMe. Your generosity is going to help cover health care for our employees at all three stores, and generally help Amoeba continue while we all must remain closed. We miss you all and cannot wait until we can be together again. Please read our full statement online at https://amoeba.com/moveupdate

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Our original story about the store’s GoFundMe campaign appears below.

It’s become a pit stop on music-lover’s tours of Hollywood, it’s hosted concerts from Patti Smith and Paul McCartney, and it’s weathered the Great Recession and the transition from CDs to MP3s to all things streaming. But with Amoeba Music’s future more uncertain now than ever, the massive independent record store is turning to its devotees for nearly half a million dollars to try to stay afloat.

In an essay on GoFundMe, Amoeba cofounders Dave Prinz and Marc Weinstein recount […]

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