Dr. Walter Peppelman is near the top of the list of Harrisburg region doctors in terms of money received from drug or device companies. However, he said the payments are royalties for medical devices he invented or helped invent. Further, he is prevented from profiting when he recommends or installs one of those devices.
Research shows that doctors on the payrolls of drug or medical device companies are likely to prescribe that company's product -- even if it's not the best option for the patient, says Eric G. Campbell, director of research at the University of Colorado's center for bioethics and humanities.
Drug and device companies know this. It's one reason they collectively pay doctors and teaching hospitals about $3 billion a year.
Until recently, patients had no way of knowing what payments their doctor might be receiving. But now the government publishes that information, enabling patients to find out who is paying their doctor, how much, and for what.
ProPublica has built upon that, creating a searchable database to make it easier for patients to perform checkups on their doctors. ProPublica's database enabled PennLive to compile the following list of 37 doctors in the Harrisburg region who were each paid more than $100,000 during the most recent three-year period.
But first some important perspective. Not all such payments are bad. Much depends on the doctor and the circumstances.
Penn State Health Milton S. Hershey Medical Center has numerous doctors listed is having received $100,000 or more from drug or device companies between August, 2013 and December, 2016. However, the medical center says it enforces policies to prevent such payments from influencing decisions impacting medical care and patients.
Photo credit: Mark Pynes | mpynes@pennlive.com
A payment might be made to cover the cost of research by a doctor or hospital. That's considered necessary and good. Or the doctor might be sharing knowledge of real-life medical situations with companies working on treatments and cures. Medical ethics experts say it's good for doctors be involved with such "consulting" work. Or a doctor might have invented a medical device, and is receiving royalties or licensing fees.
That too, when done correctly, is considered ethically sound.
Penn State Health Milton Hershey Medical Center, for example, wants its doctors to be "thought leaders." There, a doctor receiving payments from a company, or having an equity interest worth more than $5,000, must disclose it.
If a doctor with a financial interest in a company wants to use that company's product within Penn State Health, the doctor must disclose the financial tie and can't be involved in the decision. Doctors speaking on behalf of companies must present their own information, not company- or industry-prepared information.
"We want to make sure it's education, not marketing," says Dr. Neal Thomas, the director of medical center's conflict of interest program.
Dr. Walter Peppelman was asked what prevents the royalties he receives from device companies from influencing which devices he puts in patients.
Dr. Walter Peppelman is a Harrisburg-area surgeon specializing on the spine -- and he ranks high on the list of area physicians receiving payments from medical device companies.
That's because he helped develop various devices that have been successful in treating ailments of the spine. He receives substantial royalty payments, and is also sometimes paid for showing other doctors, including military doctors, how to install the devices.
He says his contracts with the device companies prevent him from benefitting financially when he implants a device he helped invent. Moreover, he says UPMC Pinnacle Health System, where he does the surgeries, has policies that exclude him from any decisions related to use of those devices within UPMC Pinnacle.
But there is a dark side to the spending by drug and device makers. Sometimes the doctor is essentially a marketer for a particular drug or device, simply repeating information provided by the company, typically to audiences of other doctors.
Drug companies sometimes sign up doctors to make such pitches on behalf of drugs that face competition from cheaper alternatives, said the University of Colorado's Campbell.
Campbell argues companies that produce beneficial drugs and devices don't need to pay doctors to market them. He doubts that a doctor receiving money from a device or drug company can remain fully objective.
Campbell compares it to this: If the referees for a Penn State-Ohio State football game were being paid by Ohio State to promote "good referring practices," should Penn State fans fear a close call is less likely to go their way? He contends they should.
Dr. Neal Thomas, of Penn State Health. Photo provided by Penn State
There's another important caveat about the data: it can be hard to decipher exactly what the doctor is getting paid for. According to Penn State Health's Thomas, payments that appear to go to a medical center doctor might actually go to the medical center. That's because they are intended to pay for research. While the payments are in the doctor's name, the money never touches his hand.
So what's a patient to do? The experts interviewed for this story said having the information can help patients know what questions to ask. If a patient learns his doctor is being paid by a drug company, he can do some online research see if the doctor prescribed medication made by the company. If so, the patient should ask the doctor if the drug the best and most affordable one. If it isn't, the next question is: Why not?
Here are the Harrisburg region doctors who received $100,000 or more during from August 2013 through the end of 2016, as determined with ProPublica's database.
37. Dr. Christopher J. Davis, York, addiction medicine, $100,000, mostly for promotional speaking/other related to drugs.
Many medical devices are used in the treatment of heart disease. Here is a device that can replace a damaged heart valve.
36. Dr. Paul H. McCabe, Mechanicsburg, clinical neurophysiology, $103,000, mostly for promotional speaking/other related to drugs.
35. Dr. Thyagarajan Subramanian, Hershey, neurology, $105,000, mostly for promotional speaking/other and consulting related to drugs.
Shutterstock.com
34. Dr. Carl. E. Becker, Lancaster, orthopedic surgery, $106,000, mostly for consulting and education related to medical devices.
33. Dr. Dennis R. Delp, York, optometrist, $108,000, charitable contributions from drug companies.
Shutterstock.com
32. Dr. Dmitriy Zubkus, York, critical care medicine, $109,000, mostly for promotional speaking/other related to drugs.
31. Dr. Henry E. Ostman, Harrisburg, pulmonary disease, $118,000, mostly for promotional speaking/other related to drugs.
30. Dr. Ayodele G. Ayoola, Hershey, internal medicine, $124,000, mostly for promotional speaking/other related to drugs.
29. Dr. Kofi Clarke, Hershey, internal medicine, $126,000, mostly for promotional speaking/other related to drugs.
Advocates say a good way to use the data is to check whether your doctor is receiving money from the maker of a drug or device prescribed for you. If so, you can ask if there are alternatives that might be better or more affordable.
28. Dr. Andrew Behnke, Carlisle, $132,000, mostly for promotional speaking/other related to drugs.
27. Dr. Mario D. Gonzalez, Hershey, clinical cardiac electrophysiology, $132,000, mostly for promotional speaking/other related to drugs.
26. Dr. Mubashir A. Mumtaz, Harrisburg, heart surgery, $133,000, most for travel and lodging and promotional speaking/other related to medical devices.
25. Dr. Jeffrey Pu, Hershey, hemotology and oncology, $138,000, mostly for promotional speaking/other and consulting related to drugs.
24. Dr. John S. Reid, Hershey, orthopedic surgeon, $144,000, mostly for consulting for medical devices.
23. Dr. Letitia A. Covaci, Lancaster, psychiatry, $146,000, mostly for promotional speaking/other related to drugs.
22. Dr. Allan Lipton, Hershey, medical oncology, $151,000, mostly for consulting related to drugs.
21. Dr. Kevin M. Cockroft, Hershey, neurological surgery, $160,000, mostly for promotional speaking/other related to devices.
DAN GLEITER, THE PATRIOT-NEWS
UPMC Pinnacle says it also has disclosure policies aimed at preventing payments from drug and device companies from influencing patient care. A spokeswoman provided this written statement:
"UPMC Pinnacle has a policy whereby its physicians and UPMC Pinnacle leadership are required to annually complete and sign a conflict of interest statement so that any potential conflicts will be disclosed and the individual will be precluded from participating in decisions where conflicts exist.
"This policy ensures that UPMC Pinnacle and its affiliated organizations are operated for the benefit of the community they serve, rather than the private benefit of individuals. Gifts, honoraria, expense reimbursement, free travel, etc. of more than $100 must be reported. Speaking engagement requests are submitted in advance for approval by a senior executive. The UPMC Pinnacle board of directors reviews conflict of interest reports annually."
20. Dr. Joseph F. Answine, Mechanicsburg, anesthesiology, $164,000, mostly for promotional speaking/other and non-accredited training related to drugs.
19. Dr. Leigh S. Shuman, Lancaster, diagnostic radiology, $184,000, mostly for consulting for unspecified items for McKesson Technologies Inc.
18. Dr. Gary A. Thomas, Hershey, neurologist, $207,000, mostly for promotional speaking/other pertaining to drugs.
17. Dr. Surendra Sivarajah, Hershey, endocrinologist (diabetes and metabolism), $225,000, mostly for promotional speaking/other related to drugs.
16. Dr. Rena C. Dearment, Camp Hill, internal medicine, $230,000, mostly for promotional speaking/other, related to drugs.
15. Dr. Richard B. Tenser, Hershey, neurologist, $242,000, mostly for promotional speaking/other related to drugs.
Shutterstock.com
14. Dr. Andrew Tinsley, Hershey, gastroenterologist, $262,000, mostly for promotional speaking/other related to drugs.
13. Dr. Arthur L. Williams, Harrisburg, infectious disease, $266,000, mostly for promotional speaking/other related to drugs.
Photo credit: TED S. WARREN
12. Dr. Peter A. Lee, Hershey, pediatric endocrinologist, $295,000, mostly for promotional speaking/other and travel and lodging pertaining to drugs.
11. Dr. Paul B. Seiber, Lancaster, urologist, $295,000, mostly for promotional speaking/other, related to drugs.
10. Dr. Timothy J. Craig, Hershey, allergist, immunologist, $305,000, mostly for honoraria and travel and lodging related to drugs.
9. Dr. Elisabeth B. Lucassen, Hershey, neurologist, $318,000, mostly for promotional speaking/other, related to drugs.
8. Dr. Chandra P. Belani, Hershey, hematology and oncology, $382,000, mostly for promotional speaking/other and consulting related to drugs.
7. Dr. Neal G. Ranen, York, psychiatrist, $411,000, mostly for promotional speaking/other pertaining to drugs.
6. Dr. William J. Nicholson, York, interventional cardiologist, $545,000, mostly for consulting and promotional speaking/other for medical devices.
5. Dr. Rajesh M. Dave, Camp Hill, interventional cardiologist, $608,000, mostly for consulting or promotional speaking/other pertaining to medical devices.
4. Dr. Gerald V. Naccarelli, Hershey, cardiovascular disease, $719,000, mostly from promotional speaking/other, related to drugs.
3. Dr. William J. Beutler, Harrisburg, neurosurgeon and orthopedic spine surgeon, $730,000, mostly from royalty or licensing.
2. Dr. Walter C. Peppelman, Harrisburg, orthopedic surgery of the spine, $740,000, mostly from royalty or licensing.
1. Dr. Seth J. Worley, Lancaster, cardiovascular disease, $795,000, from from royalty or licensing.
Here is a link to the government website that allows to search for any doctor.
Here is a link to the searchable ProPublica database.
Ad Choices