Doctors supplement income via drug companies

A cardiologist, endocrinologist, psychiatrist, nurse practitioner and allergist. These five medical professionals in Burbank and Glendale may have different specialties, but they have one source of income in common — drug companies.

Since 2009, 33 medical professionals in Burbank and Glendale have been paid roughly $500,000 by eight pharmaceutical companies for speaking engagements and other services, with nearly 70% of the cash spread among five practitioners, according to a database compiled by national investigative news organization ProPublica.

Eight drug companies have paid doctors across the country more than $320 million since 2009. Most doctors receive the paychecks for giving product lectures or pitching their colleagues in one-on-one meetings, sometimes over dinner at expensive restaurants. Others host teleconferences or provide consulting services.

Doctors and drug companies say the practice — which is legal and regulated by the Federal Drug Administration — helps spread valuable information about the treatment of diseases and medications.

Others in the medical community say the arrangements can raise ethical questions or affect patient trust.

Eric Campbell, an associate professor of health policy at Harvard Medical School, told the Chicago Tribune last year: “Let's be honest: The purpose of these talks is to influence doctors to buy a company's drugs.”

Drug companies have long guarded the compensation information. But in recent years a number of companies have begun to disclose the payments on their websites, some as part of legal settlements. More companies are expected to disclose payments this year, and federal law mandates that all drug and medical device manufacturers follow suit by 2013.

Topping the list locally was David Tonnemacher, a Glendale cardiologist who received $114,000 from GlaxoSmithKline, followed by Glendale psychiatrist Lukas Alexanian, who received $88,349 from Astra Zeneca and Eli Lilly.

Burbank nurse practitioner Phyllis Oreck received $58,205 from Eli Lilly. Burbank endocrinologist Minh Mach received $41,594, from Eli Lilly, GlaxoSmithKline and Astra Zeneca. Glendale allergist Cassandra Mahan received $41,300 from GlaxoSmithKline.

With nearly 1,000 local doctors registered with the California Medical Board, the overwhelming majority were not listed in the database, although they could be included in future disclosures from other drug companies.

The financial arrangements have become mired in a a series of lawsuits nationwide in which former employees alleged that the firms used fees to encourage doctors to prescribe their medications.

Local doctors dispute those accounts, saying they are in no way influenced by their financial relationships with the pharmaceutical industry.

“No matter what they do, when I am sitting in my office one-on-one with a patient, there is no way in the world you can pay me enough not to think about my patient,” said Alexanian, who received the majority of his payments for speaking about Eli Lilly’s Cymbalta, an antidepressant drug.

He added that while he has been approached by a variety of companies, he speaks only about drugs that have been effective for his patients.

“We do have to feel comfortable about the medication,” he said. “We do have to feel that the medications are effective and good medications.”

Oreck, Mahan and Mach could not be reached for comment.

Tonnemacher — who spoke extensively over the last year for GlaxoSmithKline’s Lovaza, a prescription fish oil supplement used to lower triglyceride levels — said he works only with companies he finds ethically sound.

“The trap I think comes in when a drug company tries to come in and say we need you to write so many prescriptions, and if you do we’ll let you talk for us,” he said. “I don’t work for those people. Most people, I think, who give the talks don’t do that.”

After 15 years of helping his patients aggressively target and prevent heart disease, Tonnemacher said he has become a leader in his field with the lowest hospitalization rate in the city. He said he is often approached by colleagues and pharmaceutical representatives for more information about his medication philosophies.

“From what I understand, the doctors who do most of the talks are the people who have something to share,” he said.

Local oncologist Boris Bagdasarian, who serves as medical director of cancer services at Glendale Adventist Medical Center, said that while he has been approached by a variety of drug companies, he has opted against becoming a paid speaker.

“The bottom line is, it’s too time consuming,” he said.

Still, he said he has attended some of the lectures and sees value in them as long as they are given by doctors who are true experts in their fields.

“People who are credible, who are authoritarian and leaders in their respected fields aren’t going to put their career or credibility on the line by being bought and sold by the pharmaceutical companies,” he said. “I think most of them are important in providing that information, as long as it’s well prepared, and the lecturer doesn’t put his credibility on the line.”

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