ProPublica investigation reveals drug company payments to doctors
The nonprofit journalism site ProPublica has an interesting set of stories out today detailing the amount doctors have been paid by drug companies for consulting, speaking and educational work. The stories include a searchable database to see if your doctor has been among those paid. Among the doctors being paid were more than 260 from Oklahoma.
Recruited and trained by the drug companies, the physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.
These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.
Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases “in the boonies,” he said. On a recent trip, he said, he drove to “a little bar 40 miles from Odessa,” Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.
Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are “a calling,” and he is booking them for 2011.
The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.
ProPublica notes that just because a doctor is listed, it doesn’t mean anything is wrong. But its journalism partners also took a look at some of the doctors and found a few had been disciplined by state medical boards.
We found several dozen of the top speakers did not have board certifications — which means they were not certified in their medical specialties — and then we found more than 250 doctors who had some type of sanction taken against them by a state medical board. And we just looked at a sampling of states.
Some of the discipline was really quite serious. The Ohio Medical Board, for example, voted a couple of years back to revoke the license of William David Leak, whom they accused of performing unnecessary nerve tests on 20 patients and subjecting some to an excessive number of invasive procedures. Dr. Leak is appealing the penalty, and his license is still active, but since 2009 he has received $85,000 from Eli Lilly and Co.
The disclosure of doctor payments comes from the websites of several pharmaceutical companies, some of which were compelled to start the sites as part of legal settlements. The new federal health care law will mandate similar information from all drug companies by 2013. For more on the ProPublica data, and its limitations, click here.
–Paul
More details on the latest Census poverty, health insurance and income data
The Census Bureau came out with new data yesterday on poverty, health insurance coverage and income at the national and state level.
I had a wrap-up of the highlights in today’s paper. Overall, it’s one of those “good news, bad news” reports.
Nationally, poverty rose and health insurance coverage declined in 2009, the Census said. Both are likely traced to the continuing recession.
In Oklahoma, the number of people in poverty declined to about 468,000 people, down from an estimated 484,000 in 2009. But you’d be hard pressed to find many people trumpeting the decline, especially as demand remains high at food banks and the number of people on food stamps continues to grow. (The Oklahoma Department of Human Services reports that more than 588,000 Oklahomans were on food stamps in June 2010, an increase of 19.5 percent from June 2009.)
As with any statistical report, the devil is in the details with the Census data. It’s important to note that this week’s numbers come from the Current Population Survey’s Annual Social and Economic Supplement, a long-running Census product that surveys 100,000 households each year:
The Annual Social and Economic Supplement to the Current Population Survey (CPS ASEC) is designed to give annual, calendar-year, national estimates of income and official poverty numbers and rates. It is, nonetheless, used for many other purposes, including the allocation of federal funding.
. . . The Basic CPS is used to calculate the monthly unemployment rate estimates. Supplements are added in most months; the ASEC is conducted in February, March, and April with a sample of about 100,000 addresses per year. The questionnaire asks about income from more than 50 sources and records up to 27 different income amounts, including receipt of numerous noncash benefits, such as Supplemental Nutrition Assistance (formerly known as the food stamp program), subsidized school lunches, and housing assistance.
The Census tries to caution against too many state-to-state comparisons with the supplemental data, mainly because survey sizes at the the state level are sometimes too small to be meaningful in any given year. That’s partly why I used two-year averages when describing state-level changes in today’s story.
I also touched upon an apparent anomaly with the health insurance coverage question in Oklahoma. David Blatt at the Oklahoma Policy Institute has a nice discussion of the issue here.
I called the Census yesterday for some explanation, but they needed to research the issue and couldn’t get back to me in time for the newspaper deadline. Here’s what Jessica Smith, a data specialist at the Census Bureau, said about the Oklahoma health insurance anomaly this afternoon:
We couldn’t find anything out of the ordinary with the data, but we don’t recommend people use single-year data for the CPS for single states because the sample sizes are too small.
Meanwhile, the Census will be releasing new data from its American Community Survey later this month. That survey uses a much larger sample size and a different methodology from the Current Population Survey. It will have details from smaller geographies such as counties and Congressional districts:
The American Community Survey (ACS), replaced the decennial census long-form sample questionnaire. The ACS offers broad, comprehensive information on social, economic, and housing data and is designed to provide this information at many levels of geography. During the 2000-2004 testing program, the ACS collected income data for a much larger sample than the CPS ASEC (about 800,000 addresses per year). Beginning in 2005, the ACS sample size grew to about 3 million addresses. As with the decennial census long form, the ACS relies heavily on questionnaire responses mailed in by respondents. These estimates are collected on a rolling basis every month throughout the year, and the questionnaire asks about eight types of income received in the previous 12 months. For example, those interviewed in January 2010 were asked about income received in the January to December 2009 period, and those interviewed in December 2009 were asked about the December 2008 to November 2009 period.
So, don’t be surprised if the American Community Survey data coming out Sept. 28 has a little different picture of the state’s economic and social well-being.
–Paul
Dueling health insurance stats
Figuring out who has health insurance coverage and who doesn’t is an ongoing challenge for policymakers.
Do you count people who went without coverage for a week or a month as being uninsured? What about the ranks of the long-term uninsured? How many of them might qualify for government programs or subsidies but just haven’t signed up?
It’s not an easy task, which is why today’s story on the numbers of uninsured might shed some light on the issue. The Census Bureau’s American Community Survey, a wide-ranging sample of 3 million households each year, asked a health insurance coverage question for the first time last year. For a look at how the question was asked, check out page 8 of the survey form.
Our analysis of the Census’ ACS estimates showed that about 22 percent of Oklahomans under 65 went without health insurance coverage when they were surveyed last year. That put Oklahoma at No. 5 in the nation for the percentage of residents younger than 65 without health insurance.
Of course, it didn’t help matters that the Census just two weeks ago put out another survey that had information on the uninsured from its long-running Current Population Survey. That survey showed an estimated 15.9 percent of Oklahomans of all ages were without health insurance in the CPS’ 2-year average from 2007 to 2008. (For more discussion of that survey data, see the Oklahoma Policy Institute posting here, and the thoughts from our editorial page here. The journal Health Affairs also has a more detailed discussion of the CPS health insurance estimates here.)
David Blatt, policy director for the Oklahoma Policy Institute, said that no matter which Census survey policymakers use, “I think the true numbers lie somewhere between those estimates. Whatever the number, we have a heck of a lot of Oklahomans without health insurance coverage.”
Researchers are hopeful that the bigger survey sample of the American Community Survey will provide more accurate figures in the future. Here’s how the University of Minnesota’s State Health Access Data Assistance Center, or SHADAC, puts it:
The ACS is a great development for health services researchers, but as with all surveys, it will have its problems. In summary, the greatest advantage is that the ACS will be a regular source of health insurance coverage for local areas. The timely releases will fill a significant information void. The biggest limitation is format of the health insurance item is and the ability of respondents to recognize what type of health insurance coverage they have. Some error is always expected in survey research, and we have yet to see how it will compare to other surveys.
In the meantime, here’s a look at some of the latest uninsured estimates from the Census’ American Community Survey for the Oklahoma counties and Congressional districts covered under the latest 2008 survey data:
Finally, NPR has a nice set of interactive maps using the same data:
–Paul
Mapping swine flu cases
With yesterday’s first confirmed case of the H1N1/swine flu in Oklahoma, that takes to 41 the number of states affected by the worldwide outbreak, according to the Centers for Disease Control and Prevention.
A number of maps tracking the H1NI flu outbreak are already widely available, but the New York Times had an interesting story about how several universities are using data models to predict future infections.
You can see some of the maps by Northwestern University here. (Caution: these are from the “worst-case” scenario.) Researchers there compiled data using several sources, including one that approximates human interactions from the circulation of dollar bills across the country.
Here’s one of their maps:
Meanwhile, researchers at Indiana University came up with many of the same conclusions when they predicted the course of flu infections.
Here’s one of the IU maps:
While we’ve all heard the calls for basic hygiene (vigilant hand-washing; covering your mouth with a tissue when coughing and sneezing) to help curtail the outbreak, this was an important point from one of the professors interviewed in the New York Times article:
But one thing remains true: “People have a very weird perception of large numbers,” (Dirk Brockmann) said. “If you have 2,000 cases of flu in a country of 300 million, most people think they’re going to be one of the 2,000, not one of the 299,998,000.”
(Don’t forget to check out our in-depth Know-It page on the flu.)
–Paul
Search for city stimulus requests
The latest “wish list” of infrastructure projects from mayors across the country was released over the weekend, and 10 Oklahoma mayors have requested $1.7 billion in funds from the economic stimulus package making its way through Congress.
You can read today’s story here.
Also, we compiled more than 220 projects requested in Oklahoma into a database that’s on the Your Right to Know page. You’ll find the link under “Data.”
(I blogged about an earlier version of the list last week.)
–Paul
State restaurant inspections online
With the latest news out of Mayes County that a likely food-borne illness has killed one and sickened dozens of others, you might be curious about how your local restaurants fare in food inspections.
You can look them up by county and/or name at the state’s Food Service Establishment Inspections site. (The link is also under the “Data” section of our own Your Right to Know page.)
While officials haven’t yet figured out what caused the recent illnesses, they also haven’t ruled anything out. The Country Cottage restaurant in Locust Grove was last inspected on Aug. 23, according to the online data. At that time, inspectors found nine violations.
–Paul
Hospital care stats
USA Today has a good story today on the latest mortality statistics of hospitals across the country.
You can search for local hospitals by ZIP code here on the Centers for Medicare & Medicaid Services Web site, although I found USA Today’s interactive map a little easier to use.
A word of caution, though: These mortality stats are just for Medicare patients in the areas of heart attack, heart failure and pneumonia. The stats are from 2006 and 2007.
–Paul
