One of Nissen's colleagues at the clinic, endocrinologist Adi Mehta, earned at least $202,600 from three companies. Mehta said in a statement that he feels "passionately" that such speaking educates his peers, the same rationale drug companies use to defend their reliance on practitioners. The prestigious clinic does not prohibit participation in pharma speakers' bureaus.
ProPublica sought out many of the best-compensated speakers to learn more about their backgrounds, motivations and opinions on the influence of the money on their practices.
Ten physicians gave lengthy interviews or responded to written questions. Fourteen declined to comment or did not respond to calls and e-mails. Three others agreed to talk but were unable to schedule interviews.
The top speaker, Las Vegas endocrinologist Firhaad Ismail, did not respond to repeated calls. He earned more than $303,500 from three companies since 2009.
The second-highest paid, Dr. Stephen Landy, directs a Memphis headache clinic. Much of his research is performed with employees of Glaxo, his biggest funder, but Landy also invented a headband to treat migraines using heat and cold. The band, on sale for $29.99, is "ideal for people who wish to avoid medication[s] and their possible side effects," according to asseenontvguys.com.
Landy, who earned at least $302,100 since 2009, lectures about migraine remedies and muscle relaxants for three companies. The talks are not simply promotional, he said, but "scientifically beneficial" for everyone involved.
"At the end of the day, I'm not there to sell their drug," Landy said. "I'm there to educate health care providers about their drug."
Landy conceded that pharma-physician relationships have become somewhat tainted in the public's eyes, but he said they should not automatically be viewed as negative.
"I think most physicians, whether they accept money or not, will do exactly what's best for the patients," he said.
Landy, like many of his peers in the top group, considers himself to be an excellent communicator, chosen as much for his speaking ability as his knowledge.
Psychiatrist Jon W. Draud, also from Tennessee, declared in aconference bio this year that he has "delivered over 3,500 professional lectures to medical personnel."
Draud earned at least $200,000 since 2009 from AstraZeneca, Cephalon, Lilly and Pfizer. At a 2009 conference, he disclosed that he speaks or consults not only for those companies, but also for Forest Laboratories, Sanofi-Aventis, Takeda Pharmaceuticals and Wyeth Pharmaceuticals (Pfizer acquired Wyeth in October 2009).
Draud requested questions by e-mail, but he did not respond to them.
St. Louis pain doctor Anthony Guarino includes an endorsement from a Cephalon drug sales representative in an online brochure advertising his services: "I would definitely recommend him as a medical speaker!"