One in three Minnesota psychiatrists has received funding from drug manufacturers in the past five years, including seven past presidents of the Minnesota Psychiatric Society, two state drug policy advisers and 17 faculty psychiatrists at the University of Minnesota.
While drug company funding is hardly limited to mental health providers, a review of the latest Minnesota public data shows a much higher proportion of psychiatrists receiving money for research, lectures and consulting than other medical specialties.
Drug companies reported $2.1 million in contributions to Minnesota psychiatrists in 2006, up from $1.4 million in 2005.
It's arguable whether the money influences how doctors prescribe drugs or how doctors on
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influential advisory boards recommend how and when drugs should be used. The psychiatrists who take the money see it as a necessity in a system that needs more education about mental illness and shortchanges mental health research.
Health policy advocates believe the drug companies are getting a return on their investment regardless of whether the doctors know the money is influencing them.
"They wouldn't keep doing it - piling on more and more dollars - if they didn't think it was successful," said Joel Albers, a St. Paul pharmacist and health economist.
From 2002 through 2006, the nation's drug manufacturers reported $73 million in gifts, grants and reimbursements under Minnesota's one-of-a-kind reporting law. Payment records
for 2006 were released earlier this summer and have been added to a Pioneer Press database at twincities.com
that allows readers to search by name for doctors, nurses or institutions that have received money.
The state's reporting system is imperfect, as drug companies apply different criteria for the types of payments they must disclose. Some include scientific grants that are in doctors' names but actually go to their research institutions. Others include only the meals, gifts and perks Minnesota lawmakers were targeting when they passed the reporting law a decade ago.
The tally nonetheless is a crude indicator of the involvement and influence of the drug industry in medical care nationwide, especially in areas like psychiatry that rely heavily on some of the nation's most expensive drugs.
Such lawmakers as Sen. Chuck Grassley, R-Iowa, have been scrutinizing the Minnesota data and proposing federal laws to either disclose or restrict the money drug companies give doctors. Locally, the Minnesota Department of Human Services is considering tighter restrictions on members of its drug formulary committee, who advise the state on which drugs are most effective and offer the best value.
One committee member, Dr. John Simon, has received more than $570,000 since 2002 from six drug companies, according to state reports. Most of that was from Eli Lilly, whose antipsychotic drug Zyprexa is the most costly each year for Minnesota's fee-for-service health program for the poor and disabled.
While the committee offers guidance on numerous medications, its advice on mental health drugs is crucial. More than 200,000 Minnesotans are enrolled in the fee-for-service program, and 80 percent of them take at least one psychiatric medication.
Simon said pharmaceutical companies pay him to speak at conferences and clinics about their drugs or about the conditions treated by their drugs. While the situation hasn't occurred, he said, he would abstain from any committee votes involving drugs he has been paid to discuss.
He did vote in December 2004 for an unrestricted state policy with respect to Strattera, a nonstimulant drug Lilly makes for attention deficit disorder. Upon reflection, he said, he should have abstained or acknowledged his funding from Lilly before voting. However, he said, he also cast votes advising restrictive policies on Lilly drugs that regulate insulin and cholesterol.
"I certainly don't need to take care of the pharmaceutical companies," said Simon, who was appointed to the formulary committee by the Minnesota Psychiatric Society. "They're big boys and can take care of themselves by other means."
"Most of the psychiatrists who are really good," he added, "have ties to industry."
State records show 187 psychiatrists received $7.4 million from drug companies from 2002 through 2006. Twenty-eight received at least $50,000 during that period, while others received smaller amounts for gifts or speaking engagements. The median amount received was $2,700, which is three times the median amount of $900 for other types of doctors who received payments.
The state psychiatric society is reviewing literature and research on drug company influence and plans to offer members training on how to avoid conflicts, said Dr. Jeff Hardwig, society president.
"Does drug company marketing affect our practice? I think the answer must be yes," said Hardwig, a northern Minnesota psychiatrist with no drug company ties. "Practicing psychiatrists must be aware of how that might influence them and be on guard against undue influence."
Simon said psychiatrists are getting a greater share of drug company money because primary care doctors need more education about mental illness and how to treat it: "Go into your family practice clinic and complain about chest pain and see what they say, and then go in and complain about bipolar disorder and see what they say."
Former pharmaceutical executives said drug companies are interested in teaching doctors about treatment standards, because that will increase the number of doctors who act on that information and prescribe their pills. However, they said, pharmaceutical companies usually start by hiring doctors who are frequent prescribers of their drugs.
Psychiatric drugs are unique. If patients have success with certain medications, their doctors aren't likely to switch them, even when cheaper alternatives are available. That increases the stakes for drug companies to make sure their drugs are tried first.
It also makes decisions by formulary committees and other advisory boards particularly important. If Minnesota's formulary committee votes to restrict how a certain drug is prescribed, the state usually follows that recommendation.
A spokesman for industry trade group PhRMA said earlier this year that the money reflects valuable research and education that is advancing medicine. The group has questioned the relevance of the state database, because it mixes research grants with gifts and other types of unrelated payments.
Dr. David Adson, of the University of Minnesota, reportedly has received more than $560,000 since 2002 from drug companies. However, Adson said, most of that money is for research grants that pass directly to the university.
Like Simon, Adson has a state advisory role: He is the clinical leader of a program that notifies doctors whenever their prescriptions for antipsychotics and other psychiatric drugs are out of step with clinical standards.
Top psychiatrists are in demand, so it isn't surprising to find them giving paid lectures or conducting drug-company research while also serving on advisory committees, said Al Heaton, pharmacy director for Blue Cross and Blue Shield of Minnesota. But Heaton, who also serves on the state formulary committee, said those connections need to be disclosed upfront.
"It's better to have it kind of come out from under the rock, and people can create their own opinions and judgments, versus if it's not disclosed, and then you find out after the fact," Heaton said. "Then you just assume it was bad."
The psychiatric society nominated Simon to the state formulary committee because of his expertise and credentials, Hardwig said, but is considering whether it should ask him to step down.
Simon told the society this week he would do so if asked, to avoid even the appearance of a conflict.
MaryJo Webster contributed to this report. Jeremy Olson can be reached at 651-228-5583 or firstname.lastname@example.org.
Search the database at twincities.com to see if your doctor received payments from pharmaceutical companies.