Ties that bind

Report: Twenty-eight doctors in North Carolina received more than $1 million from drug companies

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This article was revised on Nov. 18, 2019, to correct the amounts received by two Greensboro doctors, which had been incorrectly listed as much higher.

Twenty-eight doctors in North Carolina, including one from Greensboro, received more than $1 million each in speaking fees and other payments from pharmaceutical and medical device companies from 2014 through last year, according to data by ProPublica's Dollars for Doctors project.

Twelve of those doctors practice in the Charlotte area. Eight are from the Triangle area.

For years, the relationship between doctors and drug and medical device companies has raised conflict-of-interest concerns and may make some patients nervous that those payments could influence the doctor's treatment plan.

But some experts say those ties are necessary.

The two Greensboro physicians who received the most are affiliated with Cone Health. Dr. Daniel R Bensimhon, who works in the Advanced Heart Failure Clinic at Moses Cone Hospital, collected about $1.044 million between 2014 and 2018. Dr. Mohamed K. Mohamed, who specializes in medical oncology at the Cone Health Cancer Center at Wesley Long, got $875,142 during that same time period.

Cone Health declined to make the doctors available for an interview, but said in a statement that it had adopted policies to ensure ethical interactions between their physicians and the health care industry:

“Relationships between physicians and the health care industry, such as pharmaceutical and medical device companies, help foster innovations that improve the quality and safety of patient-centered care. While Cone Health supports and encourages genuine scientific and educational collaboration, Cone Health and Cone Health Medical Group expect exemplary conduct on the part of their employed and affiliated physicians in the workplace and the community.”

Jona Hattangadi-Gluth is an associate professor at the University of California San Diego School of Medicine who has studied industry payments to physicians. She said those payments aren't necessarily a bad thing.

"Medicine as a field wouldn't evolve and treatments and therapies and devices wouldn't evolve without a close collaboration between industry and physicians," Hattangadi-Gluth said.

However, there's still evidence that industry payments may influence doctor behavior, she said.

A 2016 ProPublica analysis of federal data showed doctors who accepted money from pharmaceutical companies prescribed a higher percentage of brand name drugs than doctors who didn't.

ProPublica is a nonprofit newsroom that focuses on investigative journalism.

Data on which doctors are receiving money from drug and medical device companies is available through the Centers for Medicare and Medicaid Services' Open Payments program.

The program was created as part of the Affordable Care Act, and collects and publicizes information on the financial relationships between physicians and the health care industry.

The ProPublica Dollars for Doctors program uses that information to make an easily searchable database. Patients can look up their physicians by name on the website to see how much money the doctor takes from drug and device companies — and from which companies.

"I think we'd like to believe that all physicians are going to be completely objective and only use the drug or device that has the most data, that is the most evidence-based," Hattangadi-Gluth said. "But I think there's evidence certainly that higher payments or certain payments from certain companies are affecting behavior. We know it affects behavior."

Top earners

The North Carolina doctor who received the most money from drug and device companies was Kimberly Livingston of Raleigh, with a total of $3.9 million from 2014 to 2018, according to the ProPublica database. Second most was R. Williams of Durham, at nearly $3.1 million.

The top earning Charlotte-area doctor — and fourth in the state — is William Hodges Davis, a foot and ankle specialist at OrthoCarolina, who made $2 million from drug and device companies over those five years, according to the database.

The Observer asked to speak to doctors through Atrium Health and OrthoCarolina but none was made available. Other doctors could not be reached.

Payments from drug and device companies include consulting fees, honoraria, gifts or entertainment, but do not include royalty or research fees. ProPublica excluded royalties from the database reviewed by the Observer because royalties are payments that compensate doctors and inventors for intellectual property.

The ProPublica database shows that 101 North Carolina doctors received at least $500,000 in the past five years. Those doctors received a combined $94 million during that time.

Of that group, 33 are from the Charlotte area, and another 38 are from the Triangle.

What's more, according to Dollars for Doctos, 35 doctors statewide received at least $500,000 from drug or medical device companies for services other than consulting — typically, for promotional talks about a product. But in some cases, drug companies have used this label for other types of payments.

Ties that bind

Most of the Charlotte- or Triangle-area doctors listed as top earners in the Dollars for Doctors project are affiliated with a larger hospital system or medical group.

Atrium Health had the biggest portion of doctors on the Charlotte-area list. Thirteen of the 33 Charlotte-area doctors who received at least $500,000 from drug or medical device companies, excluding royalties, are Atrium physicians, according to the hospital system's website.

"Due to the talent of Atrium Health physicians, members of the healthcare industry often seek their expertise, whether that is to educate fellow physicians, improve patient therapies or otherwise contribute to cutting edge treatments," Atrium said in a statement.

Physicians are required to disclose relationships with health care companies and get approval to avoid conflicts of interest, Atrium said.

Certain specialties are more likely to interact directly with the health care industry, Hattangadi-Gluth said. In her research, she's found that surgeons tend to receive more money from drug and medical device companies, especially in specialties like orthosurgery and neurosurgery, she said.

Six of the Charlotte-area doctors on the list are OrthoCarolina physicians, according to the OrthoCarolina website.

OrthoCarolina is proud of the cooperation between drug and device companies and its physicians, spokeswoman Logan Kureczka said in a statement.

"Innovation and development of new and improved products and techniques cannot occur without involvement of physicians," Kureczka said. "... OrthoCarolina is proud that a number of our providers are recognized as innovators in delivery of orthopedic care."

All payments from drug and medical device companies to OrthoCarolina physicians are reviewed by a compliance committee of OrthoCarolina's governing board each year, Kureczka said.

"Avoidance of conflict of interest in patient care is a critical part of our compliance program," she said.

Two of the 33 are Novant Health physicians, according to Novant's website.

"Novant Health's physician-led conflict of interest process requires physicians to disclose when they are paid by pharmaceutical or medical device companies," a Novant Health spokesperson said in a statement. "This policy helps maintain the integrity of Novant Health's decision making related to what drugs or devices are used on our patients."

Patient benefits

In the Triangle, 16 of the 38 doctors who received $500,000 or more from drug and device companies were listed as providers with Duke Health on the hospital system's website.

Duke Health requires physicians to report industry relationships, the health system said in a statement.

Four of the 38 were listed as providers on UNC Health's website.

UNC Health reviews physician relationships with health care companies to make sure the financial relationships do not interfere with patient care, the system said.

"When conducted ethically and transparently, interactions with vendors can result in benefits to our patients, support our research and contribute to improved training," UNC Health said in a statement.

Hattangadi-Gluth said it's important to keep the field of medicine objective.

While it's not a bad thing that doctors work with drug and medical device companies, she said, it's important that patients are now able to see how much money their doctors make from those companies — and if they make money from drugs or devices they recommend.

"We know that pharma and the evolution of therapies rely on physicians interacting with them, and being involved in drug development and device development," Hattangadi-Gluth said. "So it's not necessarily something that's bad, it's something now that's documented."

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Staff writer Nancy McLaughlin contributed to this story.

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