Psychiatrist Dr. Jason Kellogg is proud that drug makers ask him to make presentations to his peers about their products.
"There’s not many ways a standard physician can find out about these innovative products," says Kellogg. Journal articles and the internet "are excellent ways of learning," he says, but "it's not a verbal dialogue."
According to data from the Centers for Medicare and Medicaid Services, drug makers paid Kellogg $355,000 in 2014.
He is part of an elite club of providers - less than 1 percent of those at California hospitals with 50 or more doctors - who earn six figures or more from drug and/or device companies for speaking and consulting. Some make handsome sums in royalties.
This week ProPublica released national data showing how many doctors at large hospitals receive money from drug and device makers. The database includes more than 45,000 doctors affiliated with large California hospitals. Most providers received no money or less than $500 in payments for meals and consulting. Some received grants.
Kellogg was paid mainly for giving talks related to two drugs. He says he’s performing an important service when drug makers set up his speaking engagements and provide the information for the talks.
"We take that information via the pharmaceutical companies out to lunches, dinners, in services and they get groups of physicians, nurses, psychologists, what have you, together and we discuss the new indication and the new treatment," he says.
Critics say doctors like Kellogg are perpetuating a tainted system that boosts drug and device company profits.
Kellogg says that’s a distortion of what’s going on. He says the education he provides is important and that three-fourths of the money he's paid goes toward helping keep his four clinics open. His practice, Progeny Psychiatric Group, operates in Orange County and Long Beach.
"Here in this clinic we take all comers, we take patients of all insurances here," he says. "In order to make this thing work I need to hustle, I need to do what it takes."
His love for science and research make the talks all the more interesting, says Kellogg. Other doctors, he points out, do different things to bring in additional cash.
"I could work ER shift after ER shift and work 70 hours like some of them do," he says. And he says he does work long weeks, except his overtime is spent traveling and speaking.
It isn't just about the money, says Kellogg.
Kellogg says he only gives talks about drugs he knows well. As an example he points to the two he talks about the most – the mood stabilizer Nuedexta and the anti-psychotic Latuda. He says he ran the clinical trials that helped get both drugs approved by the U.S. Food and Drug Administration.
"When they do get FDA approved it’s very common for the companies to call me and say, ‘Hey, you are one of 10 people who have experience with it can you please get out there and educate,'" he says.
Presentations range from lectures in ballrooms with hundreds of attendees to intimate dinners with a handful of providers.
Critics say the system is flawed because it’s paid for by drug makers with a financial stake in the outcome.
Presentations sponsored by pharmaceutical companies only focus on one drug and do not include all the options available, including generics, says R. Adams Dudley, Director of the Center for Healthcare Value at the University of California San Francisco.
"They’re going to emphasize the education aspect of it but they wouldn’t pay for it if it did not lead to sales," he says.
Dudley recently conducted a study that shows an association between doctors receiving a free meal and increased prescribing of drugs.
"I’m not sure which contributes more to the extra spending, whether it’s the doctors who get the big paychecks to do the talks or whether it’s just the run-of-the-mill doctors who change their prescriptions just a little bit because someone brings in donuts," he says.
Kellogg says he doesn’t believe donuts or dinner will influence a doctor’s judgement about his patients well-being.
And he says the talks themselves are strictly regulated. The FDA has to approve the power point presentations and he’s required to talk about all aspects of a drug, adhering to what is called a "fair and balanced" approach.
"We can’t just talk about efficacy, we have to talk about, ‘Okay, it’s an effective medication but some people have issues with adverse effects,’" says Kellogg. "We have to include important safety information."
Dudley argues there’s no way to guarantee that’s happening.
"How you interpret [the information about the drug], what you say it means to people, that is not something the FDA has the resources to monitor," he says.
Dudley believes in educating doctors about new treatments but he doesn’t think it should involve drug companies at all, whether they’re providing free meals or paying doctors hundreds of thousands of dollars to give talks.
Instead, he says, the government and professional societies should be in charge of education, possibly through webinars or recorded lectures.
But Kellogg believes the current system works and he emphasizes the face-time doctors get with one another during the presentations. He says it keeps providers like him up-to-date on the latest treatments and standards of care. And that, he says, is good for patients as well.
"My patients trust me when they sit out there in the waiting room and they’ve driven to see me," he says. "They expect me to be ethical as well as well educated."