Drugmakers' deep pockets linked to decision-makers

ST. PAUL, Minn. - A groundbreaking Minnesota law is shining a rare light onto the big money that drug companies spend on members of state advisory panels who help select which drugs are used in Medicaid programs for the poor and disabled.

Those panels, most composed of physicians, hold great sway over the $28 billion spent on drugs each year for Medicaid patients nationwide. Yet only three states - Maine, Vermont and Minnesota - require drug companies to report payments to doctors for lectures, consulting, research and other services.

A review of Minnesota records found that a doctor and a pharmacist on the eight-member state panel simultaneously got big checks - more than $350,000 to one - from drugmakers for speaking about their products.

Both said the money did not influence their work on the panel, and spokesmen for the drug companies said their payments had nothing to do with the members' roles.

The lack of recorded votes in meeting minutes makes it difficult to track any link between payments and policy.

But ethical experts said the Minnesota data raise questions about the possibility of similar financial ties between the pharmaceutical industry and advisers in other states.

"In the absence of disclosure laws, there's certainly no way to know," said Jack Hoadley, a research professor specializing in Medicaid at Georgetown University in Washington. "There are a lot of physicians in general who have at least some contract or grant funding out of pharmaceutical companies, and additional do speaking engagements."

The Associated Press began examining the records in mid-June, shortly before the Minnesota Medicaid Drug Formulary Committee started considering a conflict-of-interest policy that would require members to disclose such financial relationships and recuse themselves from voting in some cases. The committee is expected to act on the policy next month.

John E. Simon, a psychiatrist appointed to the panel in 2004, earned more than $350,000 from drug companies between 2004 and 2006. Pharmacist Robert Straka served from 2000 to 2006, and collected $78,000 from various drugmakers.

Both men, and the committee chairman, said the payments did not influence their work with the committee.

But state officials said they would examine the panel's past actions for any bias tied to the payments, and they would start screening appointees to two dozen advisory councils for similar links.

They will also require the Drug Formulary Committee to record how members vote.

The advisory panel's recommendations to the Minnesota Human Services Department are almost always followed. The panel guided $240 million in spending on drugs for 202,000 patients last year - slightly less than a third of all the state's Medicaid patients.

The top drugs for Minnesota Medicaid patients covered by the panel's advice in recent years have been for schizophrenia - Eli Lilly & Co.'s Zyprexa, from 2000 to 2004, and AstraZeneca PLC's Seroquel, in 2005 and 2006.

About a third of the drugs on the state's preferred list are made by companies that paid Simon, Straka or both.

A medical ethicist said state drug advisers should not take drugmakers' money because of the power the panel exercises over the poorest, most vulnerable patients.

"This is a high-stakes committee," said Arthur Caplan, chairman of medical ethics at the University of Pennsylvania School of Medicine. "If you're going to have your hand on that tiller, you don't want to think that anybody is trying to push it."