Are some doctors becoming sales reps for drugmakers?

Several weeks ago, Eli Lilly became the first pharmaceutical company to disclose its financial ties to doctors. The heralded move by the big drugmaker, which is best known for selling the Prozac antidepressant, came after protracted pressure from politicians and consumer advocates, who argue that the relationships between these companies and some physicians may easily be undermined by money.

At issue is the notion that some doctors—wittingly or not—are now extensions of marketing campaigns, because they receive sizeable fees for speaking to other physicians about the attributes of specific drugs. The practice has prompted growing concern that the influence doctors wield as paid speakers may unfairly sway prescribing decisions and, therefore, affect the practice of medicine.

Responding to such criticism, Lilly created a new section on its website that contains a long list of payments to doctors for speaking to other physicians, patient education, and advising the drugmaker about clinical trial practices. And in keeping with a newfound industry religion, Lilly execs made sure to utter the "T" word—transparency—to describe their commitment to informing the public of its activities.

“Lilly has been a leader in our industry about being transparent about our business practices,” says Lilly CEO John Lechleiter, in a video on the Lilly site in which he explains what doctors get paid for by the drugmaker. "Among the things they do is speak to their peers about our medicines, presenting information Lilly provides to help their colleagues learn about treatment options for patients.”

And they are paid rather well. During the first three months of 2009, Lilly paid $22 million to nearly 3,400 doctors and other health care professionals. However, some fared better than others—22 doctors received between $50,000 and $70,000. Not coincidentally, 15 of the biggest recipients were psychiatrists; Lilly sells the Cymbalta antidepressant and the Zyprexa antipsychotic drugs.

Last month, Merck followed suit and posted its own list of payments on its website. These totaled about $3 million in this year’s second quarter and revealed an average payment of $1,548 for each speaking engagement. But unlike Lilly, the Merck list failed to include consulting fees or other reasons doctors were paid. Nor was there a distinction between fees and expenses for attending meetings.

The differences highlight a drawback in the voluntary efforts being made by drugmakers to mend their tarnished images and regain public trust. Although the pharmaceutical-industry trade group issued a new policy earlier this year on payments and gifts given to doctors, drugmakers are still free to interpret the rules as they wish. As a result, disclosures may yield inadequate comparisons.

“I’m highly suspicious of the stuff that companies are putting on the Web,” says Eric Campbell, an associate professor of medicine at Harvard Medical School, who has studied the issue of gifts and payments given to doctors by drugmakers. “The information is voluntary and unaudited. We don’t know what the truth is. We just know what they say and how they choose to define things.