ST. LOUIS - Last year, pharmaceutical companies paid Dr. David Weinstein, an obstetrician and gynecologist with Consultants in Women's Healthcare in West County, Mo., $43,000 less than they did in 2009. His speaker fees dropped from $106,000 to $66,293.

Dr. Kathryn Diemer, assistant dean at Washington University School of Medicine, collected about $23,000 less from drug firms with her speaker fees falling from $78,000 in 2009 to $55,000.

And Eli Lilly paid Dr. Paul M. Packman, a psychiatrist in Clayton, $52,500 last year, $20,000 less than in 2009. So far this year they've paid him $4,000.

The cuts appear to be part of a nationwide trend, according to updated data compiled by Pro Publica, a nonprofit investigative journalism group in New York.

Pharmaceutical companies pay doctors to speak to their peers about their drugs and equipment. It's legal, but critics say such relationships can influence the way doctors prescribe medications and how they teach university students or their peers at company-sponsored events.

Packman believes the drug companies have grown leery of widespread scrutiny and being fined by the FDA, so they've cooled their relationships with doctors.

"The government has suggested that any teaching of our colleagues that is sponsored by anyone in the medical industry, such as pharmaceutical companies and equipment manufacturers, is suspect. It's considered almost a bribe, so the drug industry has cut back markedly on their teaching efforts," he said.

Pro Publica began compiling a "Dollars for Docs" database last year when seven drug companies posted names and compensation online as the result of legal settlements.

Recently the database was updated to include, for the first time, a full year of payments by eight pharmaceutical companies, allowing Pro Publica to compare the $220 million they spent in 2010 with money paid to doctors during 2009.

According to Pro Publica's analysis of the data, Cephalon paid doctors $5 million last year for speaking and consulting, down from $9.3 million in 2009. And AstraZeneca chopped its speakers' fees from about $22.8 million in the first half of 2010 to about $9.2 million in the second half.

Dr. James P. Crane, executive vice chancellor for clinical affairs and CEO of the faculty practice plan at Washington University in St. Louis, says the "amount of (drug company) activity is down" in general at the university.

He added the university revised its Policy and Con-sulting Agreements Guide-lines in January to require companies to write into their contracts that the speakers will have final editorial discretion over lecture content and materials.

"We are now requiring our physicians to provide copies of industry contracts to make sure the language is included," Crane said. "We also sent the policy to 100 pharmaceutical companies letting them know we were making the change and asking them to respect it."

Four of the companies, Pfizer, Bristol-Myers Squibb, AstraZeneca and Sanofi-aventis, Crane added, would not accept the policy change.

"We've advised our faculty to discontinue those relationships," he said.

Packman said he believes that experienced doctors who speak on behalf of drug firms impart a lot of information and experience to younger doctors and those who work in rural areas. Eliminating that interaction, he says, would not be a good thing.

Critics of the payments, however, say that the FDA-approved labeling and package inserts that come with pharmaceutical products should give doctors all of the information they need. They also point out that there are more than 2,000 accredited medical education providers who offer unbiased education.

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