Posted: Apr 17, 2014 9:53 PM
Updated: Apr 18, 2014 8:15 AM
WESLACO - Some Rio Grande Valley doctors get thousands of dollars in cash, and other forms of payment, from pharmaceutical companies.
The totals climb into six figures for some. The payments are not illegal, but medical ethicists, and even the federal government, say they do raise serious questions about the potential for conflicts of interest.
The concerns come from the fact that doctors prescribe a certain medication while at the same time, and perhaps without the patients' knowledge, receiving payments from the company that manufactures that medication.
CHANNEL 5 NEWS dug into payments to Valley doctors from 2009 to 2012. The investigation revealed the top three Valley doctors getting the most money from drug companies.
The doctors involved did not want to speak about the issue.
Eli Lilly, Pfizer, Glaxo-Smith-Kline a dozen others drug companies pay thousands to doctors.
"They said this is how you make a buck in this pharmaceutical industry," said Dr. Howard Brody, director of the Medical Humanities Institute at the University of Texas Medical Branch in Galveston.
Brody said pharmaceutical companies spend $56 billion each year marketing new drugs. Doctors get money, dinners, trips and tickets to high-profile sporting events, among other things.
"It's creating serious problems about professional responsibility and integrity," Brody said.
The companies list payments on their websites. Eli Lilly has what's called a corporate integrity agreement with the U.S. Inspector General. The company makes the anti-depressant Cymbalta to medicines for diabetes and erectile dysfunction.
Other companies' websites also show their payments, which are dozens of pages long.
"It's the public and the doctors, sort of being bombarded by this marketing. I think we're seeing more and more evidence that this is causing more harm than benefit," Brody said.
Companies have to release the information under the government's new health care law.
The non-profit investigative organization ProPublica put together a database on the issue. It shows two billion dollars in payments to U.S. doctors going back to 2009. The information can be accessed by entering a doctor's name.
Topping the list, by far, was McAllen psychiatrist Dr. Jose Igoa. He was paid $275,026 in more than 30 payments for speaking, meals and travel from 2009 to 2012. The money was paid by companies like Eli Lilly, Johnson and Johnson, AstraZeneca and Pfizer.
CHANNEL 5 NEWS tried to contact Dr. Igoa several times, by phone and in person, to find out what the payments are for, and about potential for conflicts of interest.
Igoa never returned requests for comment.
"I really think you'll find this spread out pretty much across the board in all the medical specialties," Brody said.
Brody said he believes there is a conflict of interest when doctors get payments from drug companies and prescribe those companies' medications to patients.
"It's almost all on a subconscious level," he said.
"To think about, if I don't prescribe enough drugs they're not going to hire me next year, which is in fact what happens, that's huge," Brody said.
Second on the list was Edinburg rheumatology Dr. Jorge Zamora-Quezada.
Payments from 2009 to 2012 reached $102,077. Most of the money came from Eli Lilly and Pfizer. The money, according to the companies, was for speaking, meals and travel.
Zamora did not return requests for comment.
Dr. Lorenzo Pelly of Brownsville was third on the list. Records show Pelly received $85,531 during the same time period as the others, 2009 to 2012. Most of the money was paid by Eli Lilly for speaking at events.
CHANNEL 5 NEWS asked Pelly several times over the course of a month to sit down for an interview. A news crew found him at his office in Brownsville.
At first, he seemed to act as though he did not know what the news crew was talking about. The news crew mentioned the payments he received and asked if they represented a conflict of interest.
Pelly said the payments do not represent a conflict of interest. Pelly said he is part of a national speakers bureau for the pharmaceutical companies.
"I don't get paid to prescribe medications. I am an expert in that field," Pelly said.
Pelly said he would not speak about medications if he did not think they were good for his patients.
The American Medical Association takes no position on what they call "industry's choice" to provide physicians with compensation for what are said to be genuine and legitimate services.
"If you want to advance medical science, there are very good ways to do it that don't involve filling my pockets with all this cash," Brody said.
The Department of Health and Human Services says on its website that payments from manufacturers to physicians and teaching hospitals can also introduce conflicts of interest that may influence research, education and clinical decision-making in ways that compromise clinical integrity and patient care.
Brody said that in recent years the medical industry has begun to re-examine the wisdom of payments from pharmaceutical companies to doctors.
Brody blames an old system, not individual doctors. He stops short of calling for a new law to prevent the practice. He hopes doctors will make positive changes on their own.
In December, Glaxo Smith Kline announced it would no longer pay doctors to speak on behalf of its products. The company still claims that patients benefit when doctors work with the pharmaceutical industry. They said the collaboration provides better insights into patient needs.
Eli Lilly says it is required to work in partnership with doctors to meet regulations for the approval of medicines and the proper education of prescribers.