Merck & Co. paid doctors and nurses a total of $3.7 million this summer to give talks to colleagues about the drugmaker's products and other health topics, Merck disclosed Monday.
Amid growing criticism of industry influence over which treatments doctors choose for their patients, the company posted a database on its Web site listing speaking fees paid to 1,078 doctors, researchers, nurses and other health professionals. It covers July through September, and Merck — the second major drugmaker to disclose payments to doctors — plans to update it regularly.
"There's been a tremendous amount of misunderstanding" about the relationship between industry and doctors, said Dr. Richard Pasternak, Merck's head of scientific affairs. "This shines a light on it."
The 1,078 speakers gave a total of 2,493 talks and were paid $1,548 on average. The top earner got $22,693, and dozens of doctors received more than $10,000.
"We think what we're doing is just fine," Pasternak told The Associated Press in an exclusive interview.
He said Merck's programs are balanced and some cover strategies for improving care, such as understanding patients from different cultures. Many focus on new research or overall care for a particular disease for which Whitehouse Station, N.J.-based Merck sells a drug.
Some media and members of Congress have denounced what they see as excessive influence by drug and device makers over doctors, who in the past were openly wined and dined by companies trying to curry favor.
Guidelines bar expensive gifts, trips
Industry guidelines since January have barred providing expensive meals, trips and gifts. They state that company-funded presentations to doctors should include only a modest meal and limit speakers' payments to "reasonable" compensation for their time and travel expenses. Major universities and hospitals now are reviewing their own rules for what industry payments staff doctors can accept and must disclose.
Meanwhile, the Physician Payments Sunshine Act, sponsored by Sens. Charles Grassley and Herbert Kohl, would require drug and device makers each year to report details of all payments to doctors on a public, government Web site. The bill, which sets fines up to $1 million for knowingly not reporting payments, was folded into the health reform bill approved last week by the Senate Finance Committee.
Merck's disclosure comes after Eli Lilly & Co. on July 31 posted a "faculty registry" of payments to doctors and others for doing medical lectures or advising the company. Pfizer Inc. and Glaxo Smith Kline PLC have promised to make similar disclosures.
"Steps taken toward greater transparency help to build public trust. The fact that these initiatives are happening proves the reform movement has gained real traction," said Grassley, R-Iowa.
Dr. Robert Califf, vice chancellor at the Duke Clinical Research Institute, thinks industry must help teach doctors how to best use drugs or other medical products. But Califf, who has given many talks over his career, said industry has grabbed too much influence, partly by having high-profile doctors give talks or pressuring younger doctors into giving talks "to say certain things or not say certain things."
'A step in the right direction'
Califf said disclosing payments to physicians is "a step in the right direction," but that medical schools and professional medical societies should take a bigger role in teaching doctors about new products.
Dr. Steven Nissen, head of cardiology at the Cleveland Clinic and an industry critic, said disclosures aren't enough.
"They don't pay this kind of money unless they're getting marketing out of it," he said, adding that paid speakers "become an employee and an agent of the pharmaceutical industry."
Merck's top speaker in the last quarter, Dr. James Kemp, a former president of the American Academy of Asthma, Allergy and Immunology, sees it differently.
"I'm not a salesman," said the retired San Diego pediatric asthma specialist. "I feel clean and I feel Merck is clean."
Kemp, who presented 11 talks for Merck and gives speeches for other drugmakers, said the presentations help doctors and the compensation is not excessive, given that he's away from home for a couple days for each talk. Kemp said sometimes he doesn't even mention Merck's drug, although the slides he uses — provided by Merck — usually mention its drug and its risks.
"Of course, doctors feel more favorable to a sponsor's drug," he said.