Thread by @charlesornstein

1/ For 10 years, my colleagues and I have been dogged by one mammoth question:

Do doctors who receive a pharma payment linked to a particular drug prescribe more of that drug?

We finally have an answer. 👇👇

2/ The answer is a resounding yes, as my colleague @HannahFresques reported today. But the backstory of how we got here is actually really interesting.

propublica.org/article/doctor…

@HannahFresques 3/ Back in 2010, @ProPublica launched Dollars for Docs, which at the time let readers see if their doctors received payments from seven drug companies that made their payments public. projects.propublica.org/docdollars/

@HannahFresques @propublica 4/ From the start, we knew that having the drug company payments wasn’t enough. We also needed access to what drugs doctors prescribed, information that is traditionally private.

@HannahFresques @propublica 5/ In 2013, @TracyWeber, @j_la28 and I convinced @cmsgov to give us data on the prescriptions written in Medicare’s Part D prescription drug program, which pays for 1 in 4 prescriptions written nationwide. (Thanks @N_Brennan)

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan 6/ We analyzed the data on the drugs doctors prescribed and created a lookup tool, called Prescriber Checkup, which allowed people to compare their doctors to peers in the same specialty and state. projects.propublica.org/checkup/

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan 7/ Our analysis gave us the first signs that the drug company payments were linked to prescribing: Some of the top prescribers of expensive, brand-name drugs had financial relationships with the drugs’ makers. propublica.org/article/top-me…

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan 8/ I found the same for the very expensive drug H.P. Acthar Gel, a drug made from pigs’ pituitary glands that treats an array of diseases. propublica.org/article/top-ac…

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan 9/ In the meantime, the federal government began releasing data on the payments made by every drug and medical device maker in the country, more than 1,700 in all. openpaymentsdata.cms.gov

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan 10/ In 2016, @ryanngro, @mtigas and I succeeded at connecting the prescribing data and the payments data and found that doctors who received payments from the pharmaceutical industry prescribed drugs differently than their colleagues who didn’t.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 11/ The more money those doctors received, on average, the more brand-name medications they prescribed.

But this analysis didn’t look at specific drugs, it looked at payments overall. propublica.org/article/doctor…

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 12/ Since then, we’ve worked to look at the connections between drug company money and a doctor’s prescribing habits in a more granular way.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 13/ Back to today! @HannahFresques examined the top 50 brand-name drugs prescribed to patients in Medicare Part D for which drug companies made payments to doctors. propublica.org/article/doctor…

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 14/ She found that for 46 of the 50 drugs prescribed in 2016, doctors who received payments related to a specific drug that year wrote more prescriptions for the drug than doctors who didn’t.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 15/ In 2016, for example, doctors who received payments related to Myrbetriq, which treats overactive bladder, wrote 64% more prescriptions for the drug than those who did not.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 16/ We also found that, on average, physicians who prescribed a drug received higher payments related to the drug that same year than those who didn’t prescribe it.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 17/ Another interesting thing: For some drugs that are household names, it was MORE common for prescribers to receive a payment than NOT TO.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 18/ More than half of doctors who prescribed Breo, an expensive asthma drug, to Medicare patients received payments involving the drug in 2016. This was also true for Invokana and Victoza, both of which are diabetes medications.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 19/ AND ... More than one in five doctors who prescribed OxyContin under Medicare in 2016 had a promotional interaction with the drug’s manufacturer, Purdue Pharma. The company did not respond to a request for comment.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas 20/ Here’s what @akesselheim said about our findings: “If there are physicians out there that deny that there is a relationship, they are starting to look more and more like climate deniers in the face of the growing evidence.”

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas @akesselheim 21/ Both companies and doctors defend their work together, saying they are providing information so that physicians can make better choices for patients.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas @akesselheim 22/ @HannahFresques’ analysis did not look at whether the pharma payments *caused* doctors to prescribe more of a drug, it simply found a correlation. Read her methodology: projects.propublica.org/graphics/d4dpa…

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas @akesselheim 23/ Here’s the payoff for the public: We’ve added a flag to our Prescriber Checkup tool. If your doctor prescribed you one of the 50 drugs we looked at, you can now see if they received a payment related to it.

Then, you can ask them about that. projects.propublica.org/checkup/

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas @akesselheim 24/ Here’s an example of what that looks like.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas @akesselheim 25/ We’re not done!

Check out Dollars for Docs: projects.propublica.org/docdollars/
And Prescriber Checkup: projects.propublica.org/checkup/
And tell us what you find! We’re listening.

@HannahFresques @propublica @tracyweber @j_la28 @CMSGov @N_Brennan @ryanngro @mtigas @akesselheim 26/ We can’t do our journalism without you. Want to receive more of ProPublica’s big stories right in your inbox as they publish? Sign up for our newsletter. go.propublica.org/bigstory-social