1. Investigating sponsored doctors
with spreadsheets
#Dataharvest
Brussels 6 May 2012
@anpe / anderspeders@gmail.com

2. @anpe
• Data journalism for DK media / analytics for
Dutch NGOs
• Political scientist by training
• Trying to do more EU journalism

3. 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?

4. 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

5. Inspiration – Dollars for Doctors

6. Inspiration: Dollar for Docs
• Documenting relations between doctors and
pharmaceutical companies in the US
• Created a database based on web-scraped
information

7. 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.

8. The data – ready for download

9. Content of data – columns available
Name of doctor
Specialty (orthopeadic, psychiatrist, etc.)
Pharmaceutical sponsor
Data of expiration of sponsorship
•But not available:
Work place address
Company registration or ID
Amount paid by pharmaceutical company

10. Finding the missing information?
• Public register registered general practitioners
with information on doctors, address and
specialty
• Data not accessible as download – copied off
website.

11. How to track a doctor in DK?
• Authorization registry: ca. 270,000
Solely 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.

12. Copying data the old fashioned way

13. 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?

14. Matching names in Google Refine

15. How does cluster work

16. Follow-up checks
• Use “control” columns identified in both data
sets
• Check with original raw data

17. Getting the data online with Fusion
Tables

18. 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

19. Countrywide: 235 sponsored clinics

20. Identifying the extreme cases

21. The big picture: Big pharma sponsors
lots of doctors
450
400
350
300
250
200
150
Sponsor agreement
100
Employed in DK
50
0

22. 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.”

23. 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

24. A few case countries on
transparency

25. 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…”

26. 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.”

27. 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.”

28. 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.”

29. 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

30. US: Health Care reform to push
transparency
• Physician Payments Sunshine provisions in
Health Care Reform Act (2010) implemented
in 2013

31. 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

32. Where to go from here?
• A European doctor transparency register?
• Cross border investigations on multinational
pharmaceuticals?