A nationwide database reveals the amount of money some pharmaceutical companies gave to physicians from 2009 to 2012, but local doctors say the numbers can be misleading.
ProPublica's Dollars for Docs database shows more than $2 billion in payments, disclosed by drug companies and made to doctors, other medical providers and health care institutions.
Several dozen other drug companies have not reported payments, according to the nonprofit news source.
Charles Ornstein, a senior reporter with ProPublica who writes about Dollars for Docs, said the database is aimed at sparking discourse between doctors and patients.
"The public shouldn't be alarmed, but be aware," he said.
He said patients should feel comfortable asking their doctors questions about what they did for the money and their relationship with the company.
He said the organization began compiling the information in 2010 because companies were disclosing payments in obscure places patients couldn't easily find.
In York County: The list includes more than 160 instances in which York-area physicians or medical facilities received payments from pharmaceutical companies. Of those, 50 of the payments were for more than $1,000.
Dr. Wanda Filer, a family medicine physician at Family First Health, is one of the top York earners on the database, with three payments for speaking from 2009 to 2012. They range from about $12,000 to almost $30,000.
Merck, a large pharmaceutical drug company, paid Filer -- a provider with WellSpan Medical Group at the time -- for traveling across the United States giving educational vaccine lectures to medical staff, she said.
"It wasn't for prescribing anything," she said. "It was for travel costs."
Filer's lectures were mostly about Gardisil, an HPV vaccine. The Merck product was the most protective vaccine at the time, she said.
As a result of the lectures, she said, she helped incorporate new public health guidelines in practices nationwide, as "a lot of people were not up-to-date on their guidelines."
Filer stopped giving the talks in 2011, she said, because she was elected to the board of directors of the American Academy of Family Physicians and didn't want a conflict of interest. As part of the board's agreements, members must "avoid conflicts of interest between (their) own personal agendas and the good of the organization."
According to ProPublica, conflict-of-interest policies like this have become "increasingly important," because these lectures could affect the credibility of both the physician and the institution he represents.
For research: Dr. Kevin McCullum, a cardiologist at Cardiac Diagnostic Associates, is listed at the top of the database for York doctors with an $84,615 payment from Merck for research.
But he said the money actually went to York Hospital, not his bank account.
He said the U.S. government funds almost no research, so his clinical research on preventive drugs is paid by pharmaceutical companies because his team looks almost exclusively at new drugs.
"It really doesn't (affect what I prescribe)," he said, noting the results of current research are still unknown. He said the clinical trials he's involved with now will not have results for more than five years.
McCullum said he keeps the patient's needs and the cost of medicine in mind when prescribing to patients.
"It's no secret that health care costs are going through the roof," he said.
He said he prescribes drugs that correlate to the individual's clinical condition, recommends cost-effective medicine when he can and takes the results of his research into account.
McCullum said he is doubtful about the possibility of these payments being used for unethical purposes -- like doctors partnering with a drug company and getting paid to promote its product.
"First and foremost, I don't think it happens," he said. "And I can assure you that here in the WellSpan Health system, that doesn't go on."
He said there are layers and layers of safeguards in place when it comes to clinical research, such as performing double-blind trials, where both patient and researcher are unaware if drugs or placebos are being administered.
An institutional review board, which is made up of physicians, nurses and laypeople who are unaffiliated with the trial in question, must also approve it before the research begins.
"All (the safeguards in place) are acting as advocates to the patient," he said. "The cost is so high because there is so much work involved."
He said he thinks the possibility of unethical practices between doctors and drug companies is contemptible -- and tdisclosure is a good thing.
"I think it's good for things to be transparent," he said, adding he doesn't know why only his name comes up on the database because other physicians were also involved in the research.
Deadline: The Affordable Care Act requires that all pharmaceutical and medical device companies publicly report this data beginning in 2014. It will be posted on a government website.
"For a long time, this information has been kept secret," Ornstein said. "And that era is ending."
Readers can access the database at http://projects.propublica.org/docdollars/. Its search feature allows the user to browse by city, state, institution and provider.-- Reach Mollie Durkin at firstname.lastname@example.org.