A new federal plan will require drug and medical device companies to report all payments to U.S. physicians in 2013. The danger? As Minnesota found, some information may be incorrect.
Long before the rest of the country cared, Minnesota took aim at the pharmaceutical industry.
In 1993 it passed a novel law: If drug companies paid any of the state's health providers to push their pills, the money had to be publicly reported.
Two decades later, the federal government is poised to follow suit, promising a new era of openness.
But a ProPublica analysis of drug company disclosures in Minnesota provides a cautionary lesson: The information submitted may not be accurate.
To vet Minnesota's reports, ProPublica compared them to its Dollars for Docs database, a compilation of speaking fees and consulting payments reported by seven drug companies since 2009.
Cases like that of St. Paul pain specialist Todd Hess turned up. Minnesota's website shows that Hess received $364,828 last year from four companies -- far more money than any other physician.
But that understated what at least one of the companies reported on its own website. Eli Lilly and Co. told Minnesota it had paid Hess $67,353 in 2009 to give speeches in favor of its pain pill Cymbalta. On its website, however, the company reported paying Hess $74,050.
The Minnesota official charged with overseeing the data said he hadn't known about the discrepancy -- and wouldn't unless someone flagged him. The Minnesota law provided no resources to audit their accuracy, said Cody Wiberg, executive director of the state pharmacy board, which collects the information.
Experts who study physician-industry relationships say the accuracy of this information is important. Based on the disclosures, patients or employers may wrongly believe a physician has greater, or lesser, ties to a drug company.
ProPublica found multiple other examples.
Pfizer, for example, told Minnesota that it paid Dr. Randy Schapiro $1,770 last year. But on its website, Pfizer reported spending $43,827 on him in the second half of 2009 alone.
And Wyeth, now a Pfizer subsidiary, reported payments to individual doctors that actually went to their institutions for clinical research. It reported paying $500,000 to transplant surgeon Arthur Matas, for example, when the money really went to the University of Minnesota, according to Matas.
Minnesota records show that Matas personally received just $6,190 in 2009 -- for consulting for Bristol-Myers Squibb and speaking to the Mexican National Transplant Congress on behalf of Genzyme.
Representatives of Wyeth, Pfizer and Lilly said they were unaware that their reports contradicted one another until contacted by ProPublica.
Wyeth submitted a revised report to Minnesota removing Matas and more than a dozen other physicians because the payments did not go to them personally. Pfizer has submitted a revised report listing Schapiro's pay last year as $96,889 -- more than 50 times what it initially said. A Pfizer spokeswoman said her company found internal problems that led to the inaccurate report. A Lilly spokesman said his company also would amend its Minnesota report.
Hess and Schapiro, like other Minnesota physicians interviewed, said they were unaware of the discrepancies and hadn't looked at the latest disclosures. They said the media make a bigger deal about potential conflicts of interest than patients do.
"If it's cleaned up, then I don't personally have any problems with people seeing the numbers," said Schapiro. A specialist in multiple sclerosis, he is now retired and living in Colorado but still does speaking and consulting.
Schapiro said the doctors paid by pharmaceutical companies are "leaders in their fields," and patients should want to see their physician among them. "If their doctor is not on the list," he said, "maybe they should look for a different doctor."
Hess, the St. Paul pain physician, said his patients aren't concerned about his speaking fees. The media is lumping together educational speaking with the excesses of the past, he said, when drug companies showered physicians with gifts and free trips. "This is a mountain-molehill thing," he said. "I know the problems of the past. I know what Pharma has done to change those."
Minnesota's experiment began in the early 1990s as an answer to complaints to the state attorney general.
Patients were calling, concerned that their doctors were steering them to high-cost medications. Physicians were reporting pressure from the pharmaceutical companies and the "bonanza" of trips, fancy dinners and other inducements, recalled Matt Entenza, then an assistant attorney general and later a legislator.
After a pitched battle with industry lobbyists and physicians, the Legislature adopted the disclosure plan.
Years later, however, lawmakers learned that the drug company reports had been simply filed away. Only after researchers and others pressed to see them were they put on the website of the state's pharmacy board in 2006.
Wiberg, the board's executive director, said his agency was an unusual choice as the home of the disclosures. The pharmacy board oversees drugs, pharmacies and pharmacists, not money or physicians.
Today, the state posts reports covering about 900 physicians, nurse practitioners, physician assistants and veterinarians, and includes payments from companies of every size. It does not put them in a searchable database, however, and requires users to click through the individual reports of 80 companies to find their doctors.
ProPublica has combined Minnesota's 2009 reports into one database.
The federal law, known as the Physician Payments Sunshine Act, is more expansive than Minnesota's effort in some respects. The act covers both drug companies and medical device manufacturers, while Minnesota's law is limited to pharmaceuticals. It also calls for a searchable database, which will make looking up a doctor easier.
But as in Minnesota, the federal law does not require auditing. It does allow for fines if a company reports incorrectly or not at all.
Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has studied Minnesota's disclosure law, said he was surprised to learn of the discrepancies. He said the companies are quickly learning that there's an intense interest in how much they pay physicians.
"You just hope that going forward they do a better job," he said.
ProPublica is an independent, nonprofit newsroom in New York City that produces investigative journalism in the public interest.