Pfizer Details Payments to Doctors

Pfizer, the world’s largest drug maker, said Wednesday that it paid about $20 million to 4,500 doctors and other medical professionals for consulting and speaking on its behalf in the last six months of 2009, its first public accounting of payments to the people who decide which drugs to recommend.

Pfizer also paid $15.3 million to 250 academic medical centers and other research groups for clinical trials in the same period.

While other pharmaceutical companies have disclosed payments to doctors, Pfizer is the first to disclose payments for the clinical trials. The disclosure does not include payments outside the United States.

A spokeswoman for Pfizer, Kristen E. Neese, said most of the disclosures were required by an integrity agreement that the company signed in August to settle a federal investigation into the illegal promotion of drugs for off-label uses.

Dr. Freda C. Lewis-Hall, Pfizer’s chief medical officer, characterized the disclosure and Web site as part of “a march to disclosure” that the company started in 2002.

Pfizer is the fourth major drug company to make such disclosures, following Eli Lilly, Merck and GlaxoSmithKline. All four Web sites are searchable by the names of doctors or organizations, but all are set up in ways that make it difficult to download and analyze the entire database.

“All of them are welcome, but none of them is a replacement for a single national database,” said Allan Coukell, director of the Pew Prescription Project, an initiative of the Pew Charitable Trust.

Beginning in 2012, drug and medical device companies will be required to disclose payments to doctors of more than $10, with the first report available in 2013. The Physician Payment Sunshine Act was passed as part of health care reform. Some states also have disclosure laws.

Ms. Neese said the disclosures included elements not required by the federal agreement, like payments to academic centers and to nurse practitioners and physician assistants.

The reporting also goes beyond the Sunshine law, Pfizer said, by not imposing a delay of up to four years on financial support for clinical trials. Pfizer plans to report the payments without the delay.

Dr. Marcia Angell, former editor of The New England Journal of Medicine and a writer on conflicts of interest, said, “If they’re doing that — it would amaze me if they did, but if they are — that’s great.”

Dr. Angell said the Pfizer amounts seemed low although she had no specific knowledge. “I can’t help but think something has escaped,” she said.

Pfizer’s disclosure met with skepticism from one specialist on conflicts of interest in medicine.

“I think it’s a good thing to do, but I put absolutely no trust in what drug companies voluntarily disclose to the public when those things are unaudited,” said Eric G. Campbell, lead author of a 2007 study of physician-industry relationships published in The New England Journal of Medicine.

Professor Campbell, who is director of research at the Mongan Institute for Health Policy at Massachusetts General Hospital and an associate professor at Harvard Medical School, said drug companies were trying to get ahead of a rising tide of public opinion for disclosure.

The payments to doctors covered fees, travel and meals worth $25 or more and totaling $500 or more during the six-month period, Pfizer said.