Pfizer Reveals (Almost) All Payments to Physicians

Pfizer recently published its list of physician payments it made during the last half of 2009 (Q3 and Q4). The list, which is presented on this web page using javascript, includes these categories of payments:

• Professional Advising
• Expert-Led Forums
• Research, including Phase I-IV clinical trials and investigator-initiated research
• Meals, business travel expenses and educational items that are greater than or equal to $25 in value, and where the aggregate amount paid to an individual health care professional is greater than or equal to $500 in a calendar year.

Pfizer is the only pharma company to reveal how much it pays healthcare physicians and/or institutions for research. GSK and Merck, whose payments I analyzed in a recent Pharma Marketing News article ("Pharma Begins to Reveal Payments to Physicians"), only revealed payments for educational activities (speaker fees) and consulting. Neither Merck nor GSK revealed payments related to clinical research, or travel and entertainment expenses. None of these companies included payments for continuing medical education (CME) activities.

I asked Pfizer last Wednesday for the data in Excel format, but so far they haven't sent it to me, although they said they are looking into it. Meanwhile, Eric Milgram, author of Pharma Conduct Blog gave me his copy of the data in Excel format. Eric has looked into which physicians and organizations got paid the most. I looked at how the money was distributed on a state-by-state basis and by category of payment.

For my analysis, I used these categories:

• Pfizer Research (Pfizer Sponsored Research)
• Speaking (Expert-Led Forums)
• Consulting (Professional Advising)
• Travel & Meals (Business Related Travel and Meals)
• IIR (Investigator-initiated Research)
• Unknown
• Educational Items (ie, tchtockes given away by sales reps)

The breakdown is illustrated in the following pie chart (click on it for an enlarged view):

Payments for educational items totaled only $12,275 out of a total of $35,436,797. This is too small to be picked up in this chart, which round to the nearest whole percent. Keep in mind that Pfizer is only reporting items with a value of $25 or greater and that the new PhRMA physician marketing code limits "gifts" to physicians (ie, the code prohibits distribution of non-educational items such as pens, mugs and other “reminder” objects typically adorned with a company or product logo). "Educational" items are supposed to be for the education of patients or healthcare professionals and should not exceed a value of $100. Such items include anatomical models that physicians may use to show patients what their insides look like.

It could be that Pfizer is giving away lots of educational items worth less than $25 and therefore not reporting this expense, but I doubt it. The physician gift (educational item) industry is essentially dead.

How much is spent on marketing vs research activities? "Consulting" fees may be paid for either type of activity, but most often physician consultants are paid by the marketing department to help it position the product with physicians. Let's say 75% of Pfizer's consulting fees were for marketing purposes.  Investigator-initiated research (IIR) is also often just a marketing ploy designed to get key physicians to prescribe more of the product. Let's put 50% of that into the marketing bucket. Travel and meals is a substantial category. Let's also say 50% of that goes to the physician marketing consultants. Pfizer has an "unknown" category that totals $899,688. Let's say 25% of that should be in the marketing bucket. And all of the $12,275 worth of "educational" items I consider marketing related.

The total amount of payments Pfizer made to physicians for marketing purposes in the 2nd half of 2009 was $17,390,969 or 49.1% of the total ($35,436,797). This is the first time I have been able to analyze how much a pharmaceutical company pays for physician marketing versus research. Of course, this does not include direct-to-consumer marketing expenses or research that is done in Pfizer's own labs or by research contract organizations. The latter could be a huge research expense.

The other analysis I did was a state-by-state breakdown, which is shown in the following bubble chart (click on it for an enlarged view):

Each bubble's size is proportional to the amount of money physicians/institutions in that state received (for a comparison with GSK and Merck, see "Why Does GSK Prefer New York Physicians & Will Governor Patterson Ruin It for Them?").

The five states receiving the most money from Pfizer are represented by red bubbles. North Carolina (NC) is one of the top five states receiving money from Pfizer. This was primarily because Duke University received over $1 million for research. That represents about 44% of all the money Pfizer paid physicians and other institutions in that state.