It’s clear that Dr. Biederman, Wilens, and Spencer did not disclose the majority of their drug company payments to Harvard University. Their motivations were unclear. In yesterday’s posting, I proposed a kind and gentle possibility—namely, that they made honest mistakes, and really believed that most of the payments were not relevant to their NIH grants. Most of those who commented yesterday did not find this explanation exactly…shall we say…convincing. They may well be right.
As I have read more about this scandal, I think the more likely explanation is that these doctors felt embarrassed about accepting so much drug company money. On some level, they likely made conscious decisions to hide these payments. If true, this is a serious ethical breach, and all three of them may be in bigger trouble professionally than I originally thought.
As I’ve gone through the list of payments posted publically in the Congressional Record (click here and then type “Biederman” in the search box), it’s clear that the majority of money received by these doctors did not come directly from drug companies, but indirectly from various third party companies. And this is likely the key to the mystery of why the doctors assumed they could ethically hide these payments.
As I described last year in this New York Times op-ed, much of the continuing medical education (CME) industry in the United States is a legalized money laundering operation. Rather than paying doctors directly to give accredited CME courses (which is illegal), drug companies pay third party companies to create the courses. The checks are actually written by the education company, but the ultimate source is clearly the sponsoring pharmaceutical company. The drug industry has gravitated to this form of marketing because they realize that doctors are more likely to believe information in CME courses than information from drug reps.
The Harvard scandal represents the perfect storm of this money laundering operation. It appears that the vast majority of the money eventually reported by the Harvard Trio, a combined $4.2 million over 7 years, was drug company money that was laundered and processed to seem like it wasn't drug company money. And this, I suspect, is why it was so easy for the doctors to rationalize not disclosing it.
The most glaring example comes from Dr. Wilens disclosures. Senator Grassley posted slightly more than a third of Wilens’ payments ($612,303 out of a total of $1.6 million). Only $69,915 of this (11%) came directly from drug companies. Most of the money ($542,388) came from various third pary companies, many, possibly all of which, are CME companies.
Here’s the breakdown of Wilens’ indirect drug company payments:
1. TVG (pharmaceutical marketing company): $42,000
2. J.B. Ashtin (medical communication company): $14,500
3. Phase 5 (marketing research and strategy company): $194,250
4. Medlearning (medical education communication company): $70,000
(Here is an example of a CME newsletter Wilens wrote for Medlearning)
5. Promedix/Advanced Health Media (speaker program management): $163,750
6. Primedia (former administrator of MGH Psychiatry Academy CME programs): $32,000
7. Veritas Institute for Medical Education (medical education communication company): $25,388
None of this "soft" money was reported in Wilens' forms.
As a sad post-script, the Physician Payments Sunshine Act, a financial transparency bill which is likely to be passed by Congress, would allow essentially all such soft money to go unreported, because of a CME exemption tacked on to appease the pharmaceutical industry. It's likely that companies are already making plans to funnel even more of their promotional money through these opaque third party companies.
And so it goes....