Minnesota Law Sheds Light on Drug Companies
A groundbreaking Minnesota law is shining a rare light into the big money that drug companies spend on members of state advisory panels who help select which drugs are used in Medicaid programs for the poor and disabled.
Those panels, most comprised of physicians, hold great sway over the $28 billion spent on drugs each year for Medicaid patients nationwide. But aside from Minnesota, only Vermont and Maine require drug companies to report payments to doctors for lectures, consulting, research and other services. 
An Associated Press review of records in Minnesota found that a doctor and a pharmacist on the eight-member state panel simultaneously got big checks - more than $350,000 to one - from pharmaceutical companies for speaking about their products.
The two members said the money did not influence their work on the panel, and the lack of recorded votes in meeting minutes makes it difficult to track any link between the payments and policy.
But ethical experts said the Minnesota data raise questions about the possibility of similar financial ties between the pharmaceutical industry and advisers in other states.
“In the absence of disclosure laws, there’s certainly no way to know,” said Jack Hoadley, a research professor specializing in Medicaid at Georgetown University in Washington. “There are a lot of physicians in general who have at least some contract or grant funding out of pharmaceutical companies, and additional (who) do speaking engagements.”
The AP began looking at the records in mid-June. Soon after, the Minnesota Medicaid Drug Formulary Committee began considering a conflict-of-interest policy that would require members to disclose such financial relationships and recuse themselves from voting in some cases. The committee is expected to act on the policy next month.
John E. Simon, a psychiatrist appointed to the panel in 2004, earned more than $350,000 from drug companies between 2004 and 2006. Pharmacist Robert Straka served from 2000 to 2006 and collected $78,000 from various drug makers during that time.
Both men, and the committee chairman, said the payments did not influence their work with the committee.
But state officials said they would examine the panel’s past actions for any bias tied to the payments, and they will start screening appointees to more than two dozen advisory councils for similar links to the drug industry.
They will also require the Drug Formulary Committee to begin recording how each member votes at its meetings.
___
The Minnesota advisory panel’s recommendations to the state Human Services Department are almost always followed. The committee guided $240 million in spending on drugs for 202,000 patients last year. That’s slightly less than a third of all the state’s Medicaid patients - mostly disabled and mentally ill people whose medical bills are paid directly by the state.
The top drugs for Minnesota Medicaid patients covered by the panel’s advice in recent years have been schizophrenia treatments from Eli Lilly & Co. and AstraZeneca PLC - Lilly’s Zyprexa from 2000 to 2004, followed by AstraZeneca’s Seroquel in 2005 and 2006. About a third of the drugs on the state’s preferred drug list are made by companies that paid Simon, Straka or both.
A medical ethicist said state drug advisers should not take pharmaceutical companies’ money because of the power the panel exercises over the poorest, most vulnerable patients.
“This is a high-stakes committee,” said Dr. Arthur Caplan, chairman of medical ethics at the University of Pennsylvania School of Medicine. “If you’re going to have your hand on that tiller, you don’t want to think that anybody is trying to push it.”
Some other states have taken tough measures to guard against that. Nevada bars anyone from serving on its Pharmacy and Therapeutics Committee who is in any way paid by or affiliated with a corporation that makes prescription drugs.
“It’s as clean as we can get or we can dream up,” said Charles Duarte, the state’s Medicaid administrator.
In Idaho, committee members can be fired on the spot for failing to disclose a conflict of interest.
___
Here’s what the Minnesota records show:
Simon, a Minneapolis psychiatrist, earned $354,700 from companies including Eli Lilly and AstraZeneca from 2004 to 2006 in honoraria, speaker’s and consulting fees, and other payments ranging from $500 to $93,012. His stint on the formulary committee began in June 2004.
Simon said he continues to speak about new medicines for pay, giving talks an average of every week or two. He said the engagements let him share his expertise with primary care doctors and other health care workers who care for mentally ill patients.
Simon said his work for drug companies - primarily Eli Lilly, which has paid him nearly half a million dollars since 1998 - has not posed a conflict of interest because the antipsychotics, antidepressants and dementia drugs he promotes have never been discussed by the panel.
He declined to name the drugs, citing confidentiality agreements. If those drugs came up for discussion, he said, he would disclose his connections and abstain from voting.
Simon said he should be able to vote on drugs made by the companies that pay him, as long as they don’t come from the neuroscience or psychiatric divisions that pay him. But, he said, he would not oppose a stricter standard.
“There’s absolutely no record of my biasing in favor of one company or another or any of them,” Simon said. “I figure the preferred drug should be the one that cuts the best deal with the state.”
Spokesmen for Eli Lilly and AstraZeneca said their companies’ relationships with Simon had nothing to do with his role on the panel.
Lilly spokesman Phil Belt said Simon even voted against Lilly products, including a growth hormone and an insulin.
“It just wouldn’t be appropriate to assume or imply that our relationship with him is in any way a product of or influenced by his role on the Drug Formulary Committee,” Belt said.
Straka, a University of Minnesota pharmacy professor, earned $78,100 in honoraria and other fees from 2000 to 2006, including $36,745 from Schering-Plough Corp. and $24,623 from Merck & Co. He served on the panel from September 2000 to March 2006.
Straka said he was paid for educational talks usually arranged by medical groups who lined up the sponsors. He said he routinely discloses his ties with drug makers and did so as a formulary committee member, both verbally and in writing.
“I have no problem with the issue of fully disclosing things. I do that all the time,” Straka said.
But a public records request by the AP turned up no information about Straka making such disclosures. Nor do such statements appear in the committee’s minutes going back to February 2001. Other committee members and staff interviewed by AP could not recall him disclosing compensation from drug makers.
The information about Straka’s earnings might not have come out at all, because drug companies are not required to disclose payments to pharmacists under the Minnesota law. Many did so anyway in his case, with some listing him as an “M.D.” in their reports.
___
Dr. William Korchik, the panel’s chairman, said he supports disclosure of committee members’ relationships with drug companies, “whether it’s stock, research or speaker’s fees.”
Korchik said he didn’t know the extent of the financial relationships until contacted by AP. But Korchik defended the panel’s work, saying the ties did not bias a group that works mainly by consensus.
“This whole thing may be an issue of appearance of conflict, but I really feel comfortable that the committee has not been hoodwinked,” he said.
Al Heaton, a pharmacist who has served on the committee since the early 1990s, is the only panel member mentioned in the last six years of minutes for disclosing a potential conflict of interest and abstaining from a vote - on bone drugs he had gotten funding to research years earlier.
“I think that’s important to know,” said Heaton, the director of pharmacy at Blue Cross and Blue Shield of Minnesota.
“An individual may be perfectly honest and totally objective, but finding it out afterward, then you always wonder were they or were they not?”
Copyright © 2007 The Associated Press.
It is no big surprise that the panel members have taken payments from pharmaceutical companies and voted accordingly. It is a shameful surprise that only Minnesota, Vermont and Maine require disclosure. The larger states that we expect to be keeping an eye on their state panel appointees are MIA. But if their citizens force them, all states will require accountability. Let’s get to it!
Conflicts of interest and corruption are to healthcare what flies are to cow manure.
As far as I’m concerned the pharmaceutical industry in the US has long ago crossed the line between advocacy for health and sheer greed. It’s a given when the motivation is profit instead of innovation and overcoming disease.
The article states, “Lilly spokesman Phil Belt said Simon even voted against Lilly products, including a growth hormone and an insulin.” Hmm, Guess even tho the Committee didn’t record votes Lilly was keeping track!
And should we be still afraid of terrorism when we have such disgraces here, in our belly.???
You will take health care away from the pharmaceutical and insurance industries when you pry it from their cold, dead hands.
I believe what the pharmceutical says, just as I believe oil and profits don’t enflueance the Bush crime family oil profiteers to the death and distruction in Iraq. America is in good Satan’s hands. We kill for profits the price is our soul.
Missing link: not one member of the panel approving drugs is poor or disabled. {sigh} the US is still assuming someone without an identifiable “problem” is a better judge of what is needed rather than the people who know what is neeed…and use electronically opening doors and typing keyboards and huddles in American football and umpire signals in baseball and curb cuts. Who the hell are these NON-poor, NON-disabled, NON-elderly to tell us just what it is that’s good for us?! A certain blind, mute woman in US history had the same question once: a socialist and anti-war freak, a pro-union person whom the FBI kept files on. Helen Keller.
I had the same thought, PrincessKauai. I also found it interesting that the timing of the honoraria fees coincided with their terms on the formulary committee. Good work by Martiga Lohn of the Associated Press.
Nietzsche, I’m afraid you’re right. We may need a revolution to gain our right to single payer health care. Among other rights being denied us by Congress. I’m still telling everyone I know about the National Initiative.
Need a law that says a drug company can only charge one price for any drug. The increasing tendency in this country to have an infinite number of prices benefits people with influence, money, and power. Creates a situation where bribes are a great advantage and the poorest people pay the highest price.
Doctors should not be allowed to invest in any medical business except their own practice. Drug companies should be strictly forbidden for anyone who has the authority to prescribe.
Is it any wonder why some Americans go to other countries to get their prescription medicines??
“….the lack of recorded votes in meeting minutes makes it difficult to track any link between the payments and policy.”
Someone should donate a copy of “The Complete Idiot’s Guide to ROBERT’S RULES” to the state of Minnesota.
Anyone checking to see if state by-laws were followed in these meetings?
If a company pays you a half million dollars to talk about thier drugs, it is a bias. Dr. Simon there is an elephant in your office.
What’s even more surprising surrounding this greedy business between the drug companies and Doctors is whether these drugs are any good. Of course, the drug companies can come up with new drugs all of the time and pass them off to the mentally ill who have no other choice but to either take these last installments or do without. They ( the indigent and mentally ill have no voice). So we are left without answers as to whether or not these latest psycho drugs do the patients any good. Talk about blind adherance to the gospel truth coming from the so called experts. And these quacks get paid for pushing such nonsense.
What is even more disturbing is the price of vitamins are going up? I have heard a lot of drs and pharmacists are recommended vitamins and supplements. I hope this doesn’t happen. People often have to experiment and find vitamins that work for them.
I like wellness centers they work to keep you out of the hospital and preventitive care.
Why doesn’t insurance and the gov. write you a check when you do not utilize the system. My car insurance issues a check every year I do not get into an accident. Car insurance is going down and not up? Why? You cannot say it is because people do not sue. I live near Philadelphia the biggest sue-happy in the world where everyone is having dinner at their mom’s and their car is stolen.
When will the government and health insurance take personal responsibility and admit the price is really so high because of the waste on administrative costs. The administrative costs are not keeping people out of court.
Hello all,
This one aspect of danger is just the tip of the iceberg…the iceberg being the combined chemical, drug and processed foods industries. Please get and read: The Hundred Year Lie by Randall Fitzgerald, paperback. The information will be overwhelming at first, but you can begin to make better choices for yourself and family, one step at a time.
PAX
#
Hey claudius August 22nd, 2007 8:39 pm
You say,”Is it any wonder why some Americans go to other countries to get their prescription medicines??”
What has been going on in our country makes me ask, “Is it any wonder why more americans do not go to other countries to live?”
There are people that observational information about pychotropic information. Most of the developmental centers have exhustive data. Most of the people there are committed and have extensive medical histories that include this type of medication. With the institute of human rights intervention many have been taken off these medications and many centers have been closed through legal challenges. Ugh, there is a history that will make you want to vomit. After so many years the truth comes out, how mentally retarded children were used for nuclear experimentation.
AS A MEDICAID RECIPIENT I FEEL TOTALLY AT THE MERCY OF THE MERCILESS.