Pharmaceutical companies paid out more than $250 million to some 17,000 doctors and nurses across the country in 2009 and 2010, according to a new database compiled and published by ProPublica, a non-profit investigative journalism group.
The data from seven drug makers -- who manufacture about 35 percent of the medications sold in America -- showed that nearly 400 of those doctors received payments of $100,000 or more to promote drugs, serve as medical consultants and speak at conferences.
Separately, ProPublica found records in 18 states that showed 250 of the doctors had been accused of professional misconduct, disciplined by state medical boards or didn't have the credentials to be considered specialists or researchers. The list includes some doctors ProPublica found were accused of sexual misconduct and other criminal behavior.
Does this mean doctors are on the take, prescribing medicines or treatments they might not otherwise recommend? Are doctors corrupted by the money? Not necessarily, said researchers -- but it's complicated.
Susan Chimonas, associate research scholar at Columbia University's Center on Medicine as a Profession, said the database casts light in a shadowy area.
"There are really extensive relationships between doctors and pharmaceutical companies that have been secret from the public," she said. "Now, we're getting a sense of how many there are and the incredible amounts of money that are involved."
It's not illegal for health care providers to be paid by pharmaceutical companies for certain things. Professional societies consider it unethical if a financial relationship isn't disclosed in certain situations. But experts say it should always be disclosed in order to maintain a relationship of trust with patients.
Despite that, some experts say that if a doctor has taken money from a drug company, it doesn't necessarily mean the doctor's ability to serve patients was compromised.
"If there's a relationship at all, it's an inverse relationship," said Dr. Rick May, vice president for clinical consulting at HealthGrades, a health care rating organization. "If you're a drug company, you're at risk if you form relationships with bad physicians since they're representing you."
"Doctors tend to be scrupulously honest, have professional ethics and little tolerance for bad colleagues," said May.
"Only a small percentage of physicians get in trouble," said Arthur Levin, the director of the Center for Medical Consumers, a non-profit consumer advocacy group in New York. "But I expect that there are a lot of doctors out there that have problems, but have kept out of discipline system. That could be based on agreements to stop doing something, to leave the field entirely, etc."
May and Levin advised people to check with state medical boards or watchdog groups in their states to see if a doctor has any sanctions, but May cautions against jumping to conclusions about medical malpractice litigation.
"Some physicians will have judgments against them, but they may be frivolous lawsuits and the insurance company advised the doctors to settle to eliminate the need to defend the suits," said May.
When checking whether a doctor has malpractice suits against them, consumers should compare their records to other doctors in the same specialty.
"If one doctor has 10 malpractice suits against him or her in 10 years and other doctors in the same area have only two, then there's clearly a problem," said Levin.
"Don't assume the best," he said.
Levin said it might be hard for patients to believe that a person they trust so much would behave badly, but he advises people to put even more trust in their own instincts.
"Understand that their behavior is not appropriate. Think the worst and act accordingly. You should assume it's not appropriate if you don't think it is."
One of the most important things patients can do is talk to their doctors about whether they've taken money from drug companies.
"If patients are really concerned about it, ask doctors if they have a financial relationship with any pharmaceutical or device manufacturers," said May. "And doctors should be really straightforward about it," said May.
Financial relationships with drug and device companies are increasingly under scrutiny from consumers, providers, pharmaceutical companies and the government.
Pharmaceutical Research and Manufacturers of America (PhRMA), an organization representing pharmaceutical and biotechnology research companies, said it also takes patient safety seriously.
PhRMA recently adopted changes to its code of ethics. Among them is the requirement that physicians disclose financial ties if they serve on certain committees or serve as speakers for pharmaceutical committees. They also forbid sales representatives from member pharmaceutical companies from giving items such as pens and mugs to providers -- seemingly-small things that can appear to compromise a doctor's judgment.
"The best patient care requires doctors and other healthcare professionals to have the most accurate, up-to-date information possible regarding new and existing medicines," PhRMA wrote in a statement.
The new health care reform law may also help reduce the appearance of impropriety. By 2013, all pharmaceutical companies are required to report payments to providers, and the government will make that information available to consumers.
May said much of the money that drug companies give doctors can be positive.
"The vast majority of payments go to supporting physicians' research," he said. "They will also pay doctors to be speakers or attend continuing medical education events."
He said he does worry, though, when there are payments as high as $100,000.
"You always have to be a little concerned when you see doctors getting contributions like that."
The payments have gone on for years. But light is now being cast on them.
"We've made a lot of progress," said Chimonas. "When I first started looking into this six or seven years ago, there were still denials and doctors thought fancy trips were acceptable."