Dr. Thomas Schwartz started moonlighting for drug companies about 10 years ago.



Schwartz, a psychiatrist at Upstate Medical University, supplemented his pay by giving pharmaceutical company-sponsored talks to other doctors about mental health conditions like depression and medications to treat them. He's traveled as far as California to speak at meetings, conferences and dinners.



Drug companies paid Schwartz nearly $43,000 in 2009 and 2010 for speaking.



"They will pay me well to go the hinterlands," Schwartz said. "They want me to market their product. If it's a product I believe in, a product that helps people, it's a win-win situation."



Schwartz recently stopped the promotional talks to comply with a new policy at Upstate that bans its doctors from giving them. But there are plenty of other area doctors on the pharmaceutical company-sponsored speaking circuit.



Drug companies paid more than $900,000 to 51 area doctors, nurses, pharmacists and other providers between January 2008 and June 2010 to give speeches to other medical professionals, according to a Post-Standard analysis of a database created by ProPublica, a nonprofit investigative journalism organization.



The money was for talks and in some cases meals and travel. The top earner locally was Dr. David Albala, chief of urology at Crouse Hospital and a prostate cancer expert, who was paid $180,200 by GlaxoSmithKline. The other local providers on the list made less than $100,000 — more than half of them got less than $10,000.



Drug companies paid U.S. doctors and other providers $258 million during the 18-month period, the database shows. New York state providers pocketed $23.6 million, second only to California, where providers got $26.4 million.



That money is just the tip of the iceberg. That's because the database represents payments made by just seven pharmaceutical companies, the only ones now disclosing the payments. The seven control 36 percent of the U.S. prescription market.



All U.S. pharmaceutical companies — 70 companies — have to publicly disclose these payments by 2013 to comply with the new federal health care reform law.



The payments are legal and taking them does not mean a health professional has done anything wrong. But the payments, long an industry secret, have raised ethical questions about whether the practice creates a potential conflict of interest for health providers.



Critics say the arrangement could influence doctors to prescribe more drugs made by the companies paying them. Supporters of the practice say the company-paid talks provide important education to health care providers who don't have time to read all the latest drug research.



Art Levin of the Center for Medical Consumers, a New York City-based nonprofit advocacy group, said drug companies would not be spending millions paying doctors to talk up their drugs if it did not sway doctors' prescribing decisions and boost sales.



"It has the potential of influencing physician decision-making," Levin said. "That's not good science, it's not good medicine and it's not good for patients. We should stop it."



Albala, the highest paid local physician-speaker, came to Crouse about six months ago from Duke University Medical Center in North Carolina. He's an expert in robotic prostate surgery and has written on that and many other topics. His articles have been published extensively in peer-reviewed medical journals.



He's paid by GlaxoSmithKline to speak about its drug Avodart, used to treat enlarged prostate. Albala said he believes Avodart is an effective drug, but it's not the only one he uses to treat patients.



"Morally my goal is to treat the patient with the best medications I know of," Albala said. "I find it hard to believe some people would write a (prescription for) a medication just because they are a speaker."



The talks let him share his expertise with urologists in small towns who would not have an opportunity otherwise to discuss their most challenging cases with an expert, he said.



"I would be happy to do these gratis," he said.



Dr. Anil K. Verma, a Syracuse psychiatrist paid $71,725 for giving talks for Eli Lilly, speaks mainly to primary care doctors and other providers in rural areas where there are no psychiatrists. He educates them about depression, bipolar disorder and other mental health problems. He said these health professionals are not trained to treat patients with mental health problems.



Verma believes some suicides in rural areas could be prevented if patients were getting the proper treatment.



Last week, for example, he drove to Edwards, a village of 465 people in St. Lawrence County, to talk to a nurse practitioner. He gives about one talk per week. Verma said he would make more money if he skipped the talks and devoted all his time to patient care. But he believes the talks are important, given the dearth of psychiatrists in the areas he visits.



"If I save one patient, I did my duty," he said.



Dr. Lou Bonavita, a partner in CNY Family Care of East Syracuse, made $81,355 for speaking about two osteoporosis drugs — Evista and Forteo — made by Eli Lilly. He gives about two talks a month.



The speaking makes him a better doctor, Bonavita said. "If I'm a smarter doctor, it benefits my patients because I have access to cutting-edge research that sometimes other doctors don't have," he said.



The payments do not influence his prescribing decisions, Bonavita said.



"I would never put a patient's health in jeopardy based on a compensation I received from a pharmaceutical company to talk about a disease or product," he said.



Dr. Greg Eastwood, a bioethics professor and conflict of interest officer at Upstate Medical University, said there's merit to both sides of the debate over drug company payments to doctors.



While most doctors say payments don't influence their prescribing patterns, there's plenty of evidence suggesting otherwise, according to Eastwood. He said studies have shown even small gifts like pens and notepads can affect prescribing habits.



Upstate banned faculty members from giving "canned" promotional drug talks developed by pharmaceutical companies when it revised its conflict of interest policy earlier this year, Eastwood said. These talks are carefully scripted by the drug companies and regulated by the U.S. Food and Drug Administration to prevent speakers from exaggerating a drug's benefits or making false claims.



Upstate permits faculty to give talks paid for by drug companies and other sponsors, as long as the sponsor does not dictate the content and the talk does not promote a specific product, he said.



Patients who spot their health care provider's name on the payment list should ask them about their relationships with drug companies and potential conflicts of interest, Eastwood said.



Levin of the Center for Medical Consumers agrees. Patients prescribed drugs by a doctor getting payments from the companies that make those drugs should ask the doctor if there is a generic drug available or other alternatives, he said.



"I wouldn't get on a moral high horse, but I'd ask, 'Why am I on this drug, doc?'" Levin said.



Schwartz, the Upstate psychiatrist, said when he was still on the speaking circuit he called some drug companies and asked to talk about specific drugs he had researched. Other companies approached him.



"There were plenty of companies that have asked me to speak and I say, 'No. I don't like your product,'" he said.



Doctors who give the talks must go to training sessions with officials of the drug companies and their attorneys, Schwartz said. At the sessions doctors are told what they must say about how a drug works and its side effects to make sure they comply with FDA rules, he said.



"There are some people who probably do this as a business," Schwartz said. "You could probably spend nearly 100 percent of your time speaking."



James T. Mulder can be reached at 470-2245 or jmulder@syracuse.com

List of Central New York doctors, others paid by drug makers to talk about their drugs