Journal of Medicine -  Some of the nation's top medical schools cracked down on professors who give paid promotional talks for drug makers last year, and the firms themselves cut back on such spending in the wake of mounting scrutiny.

Last year began with the University of Colorado Denver and its affiliated teaching hospitals launching an overhaul of conflict-of-interest policies after the NPR website ProPublica found that more than a dozen of its faculty members had given paid promotional talks.

"We're going to just have to say we're not going to be involved with these speakers bureaus because they're primarily marketing," Dr. Richard Krugman, vice chancellor for health affairs, said in an interview in January 2011.

A few months later, Stanford University took disciplinary action against five faculty members identified by ProPublica for taking money to deliver drug company speeches, a violation of university policy.

And by last fall, there were indications that pharmaceutical companies were also reducing the money they spent on doctor speakers.

ProPublica first published its Dollars for Docs database in October 2010 listing payments to doctors from seven drug companies. When they updated it this September -- with data from five additional companies -- spending by some of the firms was down.

Cephalon, a relatively small Pennsylvania company that specializes in pain, cancer and central nervous system drugs, paid physicians nearly $9.3 million in 2009 for speaking and consulting. That figure dropped to $5 million in 2010.

AstraZeneca cut its spending on speakers from roughly $22.8 million in the first half of 2010 to about $9.2 million in the second half. Both companies cited business reasons for the decline.

Throughout 2011, ProPublica also examined the hefty financial support drug and medical-device makers give to medical societies and health advocacy groups and the impact it has on the groups' positions.

At the national conference of the Heart Rhythm Society in San Francisco, companies sponsored much of what doctors saw -- hotel key cards, bus banners, ads on staircases, even motorcyclists driving mini-billboards in a continuous loop around the Moscone convention center. Nearly 50 percent of the society's funding in 2010 came from the drug and medical device industry.

The society, which represents doctors who treat abnormal heart rhythms, said its funders don't influence its positions, but it unveiled a new policy requiring more detailed disclosure of board members' industry ties.

Then, last month, ProPublica reported about the extensive ties between makers of narcotic painkillers and the American Pain Foundation, which bills itself as the nation's largest organization representing patients afflicted by pain. The foundation received nearly 90 percent of its income in 2010 from drug and device makers and takes positions that closely align with the companies.

Despite a steep rise in overdose deaths tied to the drugs, the foundation has said the risk of addiction to the drugs has been overhyped and that, if anything, they are underused.

Like the heart society, the pain foundation said its funders have no influence on its positions.

ProPublica also investigated why physicians were not disciplined or prosecuted after they were accused in federal lawsuits of taking kickbacks from drug or device companies or pushing drugs for unapproved uses.

They reviewed lawsuits against 15 drug and device companies that were settled since 2006. None of the more than 75 doctors named as participants in alleged schemes were sanctioned by state medical boards or pursued by prosecutors, ProPublica found.

Last year, dozens of news outlets around the country used their data to localize stories about conflicts of interest in medicine -- bringing the discussion to communities large and small.



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