Doctors' Ties to Drug Makers Are Put on Close View

Dr. Allan Collins may be the most influential kidney specialist in the country. He is president of the National Kidney Foundation and director of a government-financed research center on kidney disease.

In 2004, the year he was chosen as president-elect of the kidney foundation, the pharmaceutical company Amgen, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins, according to records examined by The New York Times. In 2005, Amgen paid Dr. Collins at least $25,800, mostly in consulting and speaking fees, the records show.

The payments to Dr. Collins and the research center appear in an unusual set of records. They come from Minnesota, the first of a handful of states to pass a law requiring drug makers to disclose payments to doctors. The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products. Patient advocacy groups and many doctors themselves have long complained that drug companies exert undue influence on doctors, but the extent of such payments has been hard to quantify.

The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state's licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.

Doctors receive money typically in return for delivering lectures about drugs to other doctors. Some of the doctors receiving the most money sit on committees that prepare guidelines instructing doctors nationwide about when to use medicines. Dr. Collins, who received more money than anyone else in the state, is among a limited number whose payments financed research.

In dozens of interviews, most doctors said that these payments had no effect on their care of patients.

Dr. Collins said his sole focus was the health and well-being of patients. "Just because I might do consulting work doesn't mean I don't press the agenda of the public health," he said.

Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said interactions between drug companies and doctors were beneficial. "In the end, patients are well-served when technically trained pharmaceutical research company representatives work with health care professionals to make sure medicines are used properly," he said.

There is nothing illegal about doctors' accepting money for marketing talks, and professional organizations have largely ignored the issue.

But research shows that doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs -- whether or not they are in the best interests of patients. ...

Dan Whelan, an Amgen spokesman, said the company paid the Minneapolis Medical Research Foundation "to conduct sophisticated research and data analyses that have enhanced the understanding of health care delivery" for kidney patients.

But Dr. Daniel Coyne, a kidney specialist at Washington University, said he was troubled by the payments.

"Amgen's funding for Dr. Collins's MMRF is another huge financial connection to individuals at the National Kidney Foundation," Dr. Coyne said. "The foundation's recent pro-industry anemia guidelines -- and the revisions due next month -- have to be viewed with great skepticism."

Dr. Coyne recently wrote an editorial in an influential journal decrying guidelines written last year by the kidney foundation that encourage doctors to use more of Amgen's drugs to treat anemia in kidney patients despite studies showing that increased use led to more deaths. ...

•	Doctors' Ties to Drug Makers Are Put on Close View The New York Times, Wednesday, March 21, 2007 Byline: Gardiner Harris and Janet Roberts

	Story also ran in 3 others:  Tuscaloosa News (AL), Free Internet Press (NY) and Free Internet Press (NY)