Investigating sponsored doctors with spreadsheets

#DataharvestBrussels 6 May 2012

@anpe / anderspeders@gmail.com

@anpe

• Data journalism for DK media / analytics for Dutch NGOs

• Political scientist by training

• Trying to do more EU journalism

Two different approaches for investigating?

• What issue do we want to investigate?Letting the issue drive your investigation methodology. If no data available – find them.

• What data can we explore?A reverse approach: We have a data set – what story can we get from it?

Why investigate doctor-pharma relations?

• +700 mio. dollars from only 12 companies over multi year period in the US

• +200 mio. dollars from the big 3 in 2011 in the US (Source: Pro Publica)

• Why: The doctor is a gate keeper

• The relations are relevant to investigate at several levels: • 1) Contributor to research• 2) Voice in debates on public health• 3) Recommendations made at government levels• 4) Prescriptions in daily treatment of patients

Inspiration – Dollars for Doctors

Inspiration: Dollar for Docs

• Documenting relations between doctors and pharmaceutical companies in the US

• Created a database based on web-scraped information

Taking it to DK: What kind of data is available?

• A spreadsheet of 5000 sponsorship relations between doctors and pharmaceutical companies issued by Danish Medical Authority.

• The list has been available since 2010, according to requirements in Danish legislation.

The data – ready for download

Content of data – columns available

Name of doctorSpecialty (orthopeadic, psychiatrist, etc.)Pharmaceutical sponsorData of expiration of sponsorship

•But not available: Work place addressCompany registration or IDAmount paid by pharmaceutical company

Finding the missing information?

• Public register registered general practitioners with information on doctors, address and specialty

• Data not accessible as download – copied off website.

How to track a doctor in DK?

• Authorization registry: ca. 270,000Solely a number and thus not useful.

• Public register of 3,000 GP and specialist clinics

Limited information about the individual clinic.Different issuing authority.Different columns and data architecture.

Copying data the old fashioned way

How to match names from different databases?

• Example:

• Birgitte E. Jensen is sponsored by Lundbeck

• Gitte Esther Jensen is a GP in Copenhagen

• What to do?

Matching names in Google Refine

How does cluster work

Follow-up checks

• Use “control” columns identified in both data sets

• Check with original raw data

Getting the data online with Fusion Tables

A few tips for Fusion Tables

• Use the fusion table format for addresses address, zip, country (some addresses will still be unavailable)

• Prepare the data as much as possible prior to upload in Excel

• Use clear identifiable column headers• Have others test the usability or functionality

of your visualization

Countrywide: 235 sponsored clinics

Identifying the extreme cases

The big picture: Big pharma sponsors lots of doctors

Pfizer

AstraZeneca

Boehringer In

gelheim

Novartis

Merck Sharp

& Dohme

GlaxoSmith

Kline

Bristol-M

yers Squibb

Grünenthal

Sanofi-Aventis

0

50

100

150

200

250

300

350

400

450

Sponsor agreement Employed in DK

How stories can help build coalitions for better access to data

• March 2012: Danish Regions declines to hand out transparency data for registered doctors: “We do not process individual requests.”

• April: Story published Academics show interest in data.

GP association “We favor transparency, but would have preferred that the data had been compiled by the authorities.”

Challenges for replicating across Europe:

• Lack of reporting requirements on medical transparency

• Lack of access to lists of registered doctors• Issues are often solved internally between the

industry and doctor associations rather than in public

A few case countries on transparency

Norway: Ethical standard, but no transparency

• Response from Norwegian Doctors Association (Legeforeningen): • “Neither the authorities nor the Norwegian Doctors Association

develop lists of doctors with relations to the pharmaceutical industry.”

• “Doctors must adhere to ethical standards…”

Germany: Studies, but no transparency

• German doctors association (Deutschen Ärzteschaft):

“There isn’t any institution in Germany that functions as a central contact point and covers the collaboration between doctors and pharmaceutical industry in a systematic way. At this time, all existing overviews only describe the types of collaboration, a disclosure about the amount of financial benefit is not designated.”

Sweden: Doctors and industry settle disputes internally – no transparency

• The Swedish doctors association (Sveriges Läkarförbund):

“Av överenskommelsen framgår att den ska gemensamt utvärderas genom SKL:s och LIF:s samrådsgrupp. Läkemedelsföretagens ev. överträdelser granskas av Informationsgranskningsmannen (IGM) och Nämnden för bedömning av Läkemedelsinformation (NBL).”

”Vi är överens om att sponsring ska präglas av öppenhet.”

The Netherlands: Transparency from 2013

• The NL doctors association KNMG is assisting implementing this:

• “If the amount of one of more relationships is beyond € 500,- per calendar year, the parties shall disclose within 3 months following the calendar year. The first financial relationships will be published in 2013.”

• The registration will include:• “The nature of agreement;- The name of

pharmaceutical company ;- The name of the medical professional or partnerships of healthcare professionals.”

DK: Transparency (sort of) in place since ca. 2010

What is disclosed: - Payments, but not in kind transfers (ie. travels)

Who is included?- Authorized doctors and dentists

How specific are the disclosures?- Reporting companies are required to report the receiving physician’s name and role.- The name of product need not to be reported. - Amount is not reported

US: Health Care reform to push transparency

• Physician Payments Sunshine provisions in Health Care Reform Act (2010) implemented in 2013

US: The specifics

What will be disclosed: - Payments or in kind transfers (ie. Travels)

Who is included?- Covered recipients include physicians and teaching hospitals.

How specific are the disclosures?- Reporting companies are required to report the receiving physician’s name, address, and national provider identifier.- The name of product promoted must be reported. - Everything above $100 should be reported

Where to go from here?

• A European doctor transparency register?

• Cross border investigations on multinational pharmaceuticals?