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York County docs, entities received hundreds of thousands of dollars from drug companies
[March 16, 2013]

York County docs, entities received hundreds of thousands of dollars from drug companies


YORK, Pa, Mar 16, 2013 (York Daily Record - McClatchy-Tribune Information Services via COMTEX) -- The trick to inserting a birth control implant into a woman's arm is to keep the angle flat.

"It needs to be put in very superficially under the skin," said Dr. William M. Unwin, a York County obstetrician and gynecologist.

You don't want to insert the small, flexible plastic rod, known as Nexplanon, too deeply, because that could cause complications for removing it later.

The process can take less than a minute and the implant lasts for three years. A woman can have it removed at any time and become pregnant as early as the first week afterward, according to the product's website.

"It is a great alternative," Unwin said. "It is a great long-term contraception, particularly for young women." For years, Unwin has taught other doctors and medical professionals how to insert and remove such implants. Last year, he led three training sessions, including one in Allentown -- each three hours long, he said. And he received $3,000 in speaking fees from Merck, according to a ProPublica database.



The investigative news outlet recently updated its Dollars for Docs database to include more than $2 billion in payments from 15 drugmakers for promotional speaking, research, consulting, travel, meals and related expenses from 2009 to 2012.

The practice is legal, and drug company officials say physicians are the best people to teach their peers about new and effective treatments, according to ProPublica. But critics of the practice, like Dr. Sidney Wolfe, a physician and director of Public Citizen's Health Research Group, a consumer advocacy organization, say it taints the doctor-patient relationship.


"It's fairly pervasive," said Wolfe. "...Patients should be educated to know that the decisions that their doctors make to prescribe drugs to them might be heavily influenced." In Unwin's case, he considers the money he receives a relatively small amount, given the travel and time commitment involved. And he said there are other products that he wouldn't speak about while being paid by drug companies.

The money Unwin received is relatively small compared to payments for some other health care professionals.

Some York County doctors had multiple payments disclosed in the tens of thousands of dollars range.

Money The combined prescription drug sales of the companies included in the database amounted to about 47 percent of the U.S. market in 2011, according to ProPublica.

The Patient Protection and Affordable Care Act of 2010 will require all pharmaceutical and medical device companies to begin publicly reporting this data beginning in 2014, according to ProPublica. The first report will cover August to December of this year.ProPublica reported that the database shows that 22 doctors have made more than $500,000 since 2009 giving talks and consulting for drugmakers. Half of the top earners are from a single specialty, psychiatry.

The database includes $97.14 million worth of payments in Pennsylvania. That figure does not include some of Valeant's payments and all of Allergan's payments, because the companies use ranges to report.

Searching for payments over $250 in the York area yields more than 160 disclosure payments. A similar search for Hanover yields almost 50 results.

Not counting payments listed in ranges or payments below $250, there is about $880,000 worth of disclosure payments for individuals and entities with a York County mailing address.

The ProPublica database notes that some companies list different addresses for the same individual, because professionals may have practices in multiple locations or because they provided different addresses for payment. The about $880,000 figure for York County only counts disclosures payments where a York County mailing address was listed.

The database includes multiple disclosed payments above $10,000 from AstraZeneca for Neal Gilbert Ranen of the York area. Strategic Health Institute of the York area, where the listed practitioner is Wanda D. Filer, received three disclosed payments from Merck for speaking: $12,625 for 2009; $29,625 for 2010; and $21,200 for 2011.

Ranen, Filer and some others who received some of York County's larger payments could not be reached for comment.

Some physicians with current or former ties to WellSpan Health are listed in the database.

WellSpan Health spokesman Barry Sparks said Wellspan-employed physicians are required to seek approval from a group of WellSpan leaders before accepting an engagement where they will receive an honorarium funded by a pharmaceutical company.

"We're extremely conservative in approving such requests," Sparks said. "We only do it when there's a compelling educational purpose." That policy does not apply to independent doctors who have admitting privileges with Wellspan.

An instructor Unwin said there have been good studies to show that incentives to physicians may impact what treatments and drugs physicians choose to prescribe.

And he said he wouldn't feel as comfortable speaking about birth control pills, for instance, as he does about the Nexplanon implant.

There are many types of birth control pills on the market, he said. He said there are differences between them and some may be better for certain patients, but they work equally well at preventing pregnancy.

But he said that's not the case with Nexplanon.

He said the training that he gives is required by the U.S. Food and Drug Administration for any medical professionals who want to do the implants. There are different types of intrauterine devices, which are placed in a woman's uterus for birth control, available in the United States. But Unwin said Nexplanon is the only product of its kind available here.

He doesn't see himself as pushing the sales of the birth control implant.

"My role is, as an instructor, to teach physicians," Unwin said. "...I'm not convincing anyone to use this product." Research The ProPublica database draws a distinction between research payments and ones for speaking and consulting.

The news outlet notes that the figures listed for research do not reflect the actual compensation, if any, received by the physician listed as the principal investigator.

Those payments for clinical studies may include costs associated with patient care and supplies, as well as the time spent by health care professionals treating patients and managing the study, according to ProPublica.

Here are some of the top research payments in York County listed in the Dollars for Docs database: --- $163,441 to Drake P. DeHart of Red Lion by Eli Lilly for January to December 2011. Payment for: Research related payments. He declined to comment through a representative in the office.

--- $84,615 to York Hospital by Merck, for January to September 2012. Listed practitioner: Kevin John McCullum of York.

McCullum is the director of non-invasive cardiology at York Hospital. He said drug companies provide reimbursement to the health system for expenses related to studies, and none of it flows directly to him.

"To date, I've received zero dollars for any of the research that I've participated in," he said.

The Dollars for Docs database doesn't list him as receiving any speaking, consulting or other payments.

He said there are safeguards in place to ensure the independence of the research.

He said he participates in the research because he's interested in discovering "new therapies that will either prevent people from ever developing heart disease or reduce their risk of heart disease." --- $16,316 to York Hospital, which is part of WellSpan Health, by AstraZeneca for January to September 2012. No listed practitioner.

WellSpan Health spokesman Barry Sparks said clinical trials benefit community residents by giving them access to specific treatments and interventions that wouldn't be available otherwise or would require travel to a larger medical center.

"Physicians involved in the clinical trials also may apply what they've learned in the studies to treating other patients," Sparks said.

Speaking and consulting Here are some of the top speaking, consulting and other payments for York County listed in the Dollars for Docs database: --- $64,850 to Neal Ranen of York by AstraZeneca, for January to December 2010. Payment for: speaking. Ranen could not be reached for comment.

--- $62,100 to Neal Gilbert Ranen of York by AstraZeneca, for January to December 2011. Payment for: speaker fees.

--- $51,800 to Neal Gilbert Ranen of York by AstraZeneca, for January to September 2012. Payment for: speaker fees.

--- $29,625 to Strategic Health Institute of York by Merck, for January to December 2010. Payment for: speaking. Listed practitioner: Wanda Diane Filer. Filer could not be reached for comment.

--- $24,900 to Neal Gilbert Ranen of York by AstraZeneca for January to December 2011. Payment for: speaker fees.

--- $21,200 to Strategic Health Institute of York by Merck for January to December 2011. Payment for: speaking. Listed practitioner: Wanda D. Filer.

--- $16,700 to Robert Tuliszewski of Hanover by GlaxoSmithKline for April to December 2009. Payment for: speaker. He said he spoke about a drug called Avodart that is prescribed to shrink enlarged prostates. Tuliszewski, who is retired, said he was considered a local expert, and said he spoke mainly to families, physicians and internists.

"It was an educational session talking to them about the disease process and how to manage it," he said. In his opinion, he said, Avodart was "the best drug to manage the disease process. That's what it was all about." --- $16,600 to Puneet Gupta of Spring Grove by AstraZeneca for January to December 2010. Payment for: speaking. Gupta's office referred questions to Memorial Hospital. Josette Myers, a spokeswoman for the hospital, wrote in an email that Memorial's agreement with its physicians "includes a code of conduct which prohibits accepting compensation from vendors and suppliers. Dr. Gupta no longer accepts paid speaking engagements with pharmaceutical companies." --- $12,625 to Strategic Health Institute of York by Merck for July to December 2009. Payment for: speaking. Listed practitioner: Wanda Diane Filer.

--- $11,500 to Kurt K. Thomas of Hanover by Eli Lilly for January to December 2011. Payment for: Educational programs. "Expert-led speaker programs designed to educate patient and other health care professionals," reads the database. He could not be reached for comment.

--- $11,500 to Kurt K. Thomas by Eli Lilly of Hanover for January to December 2011. Payment for: Patient education programs. "Contracts with credentialed educators to help inform patients and their caregivers on the proper use of Lilly medications," reads the database.

Here are some top honoraria payments The ProPublica database says that Cephalon did not break out its payments into individual categories, but the company reimbursed health care professionals for speaking and consulting. In those cases, the payment was listed as for "honoraria." --- $101,650 to James McMillen of Dillsburg by Cephalon for January to December 2009. Payment for: Honoraria. He could not be reached for comment.

--- $13,800 to Asit Upadhyay of York by Cephalon for January to December 2009. Payment for: Honoraria. He could not be reached for comment.

Notes on the data from ProPublica "Some records include both the practitioner listed by the company and the entity receiving payment. If only one name is listed, it represents both the listed practitioner and payee. For instance, some payments made to a university research lab will list the university as the entity receiving payment, and an individual researcher as the practitioner.

"Companies are continually updating their data, so the most recent additions may not be included in our database.

"A physician on the list may be getting money from other companies that have yet to disclose payments.

"Practitioner names and addresses (city/state) are listed as the companies released them and may vary. For instance, some companies include a middle initial, and others do not. Some companies also list different cities for the same individual. This may happen because professionals may have practices in multiple locations or because they provided different addresses for payment." ProPublica says that although much of the money went to physicians, the database also includes research payments to institutions. Payments to other practitioners, including nurses and pharmacists, are also included.

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