Drug company payments to county doctors Nature of payment Count Amount Non-consultant compensation 3,113 $62,689,366 Consulting fee 2,360 $8,281,332 Royalty or license 185 $4,911,903 Travel and lodging 8,187 $2,951,160 Food and beverage 89,084 $2,673,995 Honoraria 498 $976,264 Education 3,983 $578,287 Grant 39 $300,510 Speaker or faculty fees 159 $280,671 Ownership or investment payments 9 $246,697 Other 264 $79,446 Total 107,881 $83,969,630

Doctors in San Diego County received $84 million in payouts from drug and medical device companies last year, according to federal data.

Health professionals received payments for services such as consulting, promotional speaking and research, as well as gifts in the form of meals and entertainment, according to a review of federal data by The San Diego Union-Tribune. More than 107,000 transactions were documented.

The information is being gathered and disclosed as part of a federal effort to bring more transparency to relationships that could lead to conflicts of interest, if doctors take money or gifts and then prescribe certain drugs.

The San Diego data was dominated by some larger transactions, such as a doctor collecting royalties on an invention, or a La Jolla couple who recently sold their medical device maker to one of the large drug companies.

The data also contains many examples of the kinds of transactions intended for scrutiny under new disclosure requirements, such as $8.2 million in consulting fees, $2.9 million in travel and lodging and $2.7 million in food and beverages.

That last item amounted to more than 89,000 meal and drink tabs.

“Sometimes [patients] don’t get all the choices because their doctor went to a couple of lunches, had some wine, and got convinced that choice A is better than choice B,” said Arthur Caplan, director of New York University’s Division of Medical Ethics. “There’s less of that, but it hasn’t disappeared.”

How often physicians receive payments is cause for concern, Caplan said, since sustained payments or gifts are more likely to influence behavior. Compensation details show that about 200 physicians in the San Diego area received more than 100 gifts or payments last year.

“It’s basic psychology that that is going to create a need to please the gift giver,” Caplan said.

Eugene Rhee, chief of urology at Kaiser Permanente San Diego Medical Center, received free food and drinks on 107 occasions, including a $262 dinner in October and another in April for $139. Coloplast, a Danish medical device maker, paid the bills.

Rhee was on vacation when the Union-Tribune reached out for comment, according to Rodger Dougherty, director of public of affairs for Kaiser Permanente. Dougherty declined to comment himself.

Details of other drug company giving included a $53 baby gift, tickets to see a medical documentary, and one doctor who received $36,000 of unspecified products. Doctors accepted travel and lodging payments involving 370 transactions in Las Vegas, 163 in Hawaii and 28 in Paris, among scores of destinations worldwide.

According to the American Medical Academy code of ethics, physicians should decline all gifts made in cash, or where there is an expectation to reciprocate. A gift should only be accepted when it will directly benefit patient care and has minimal worth. Meals should only be accepted within reason, it says.

The Union-Tribune contacted dozens of doctors about payments they received, and most of them did not respond.

Calls seeking comment to Stephen Stahl, a Carlsbad psychiatrist, and Alexander Salloum, a vascular surgeon in San Diego, went unanswered.

Stahl received 55 different payments totaling more than $1.5 million. Salloum had more than $4,000 worth of free meals and drinks, in addition to nearly $230 in unspecified “entertainment.”

Carolyn Mulroney, an associate clinical professor at the University of California San Diego, did come to the phone to discuss 22 payments she received, categorized as food and beverage or travel and lodging.

The majority of payments came from Amgen Inc., a biopharmaceutical company headquartered in Thousand Oaks, and totaled about $4,900. Mulroney said she was a principal investigator for a clinical trial funded by Amgen. The company paid for all investigators to attend meetings to review research methods, data and statistics of the trial.

She said the payments did not influence her opinion of the drug being researched.

Benjamin Frishberg, director of clinical research at the Neurology Center of Southern California in Encinitas, received 622 payments last year, more than any other physician.

He said it’s common for pharmaceutical companies to make payments to a director or principal investigator rather than a facility, and the majority of his payments funded research at the center, not his own bank account.

“It’s easy to take that data and come to some false conclusions,” he said.

Frishberg also received payments for promotional speaking about a variety of multiple sclerosis treatments. He said speaking for at least six different companies that back different treatments helps keep him objective.

Caplan said problems arise when doctors become more of a marketer than an educator. A study published by the Journal of the American Medical Association in 2006 found that general practitioners involved in industry-sponsored studies increased their use of the trial sponsor’s drugs.

Mary Devereaux, a bioethicist and assistant director of the University of California-San Diego research ethics program said compensation, no matter how minimal, can become a conflict of interest.

“It’s pretty clear that the gifts influence behavior,” Devereaux said. “No one would do it if it didn’t work.”

She cautioned that the recently posted federal data lacks important context.

“We want to be careful when we start evaluating people from a legal or ethical point of view when you don’t have the full picture,” Devereaux said.

For example, two San Diego doctors top the list of recipients of drug money for the nation. Dr. Sanjiv Narayan and his wife, Dr. Sujata Narayan, co-founded a private, venture-backed medical device company and received $54.8 million when it was bought out by Abbott Laboratories in December 2014.

Dr. Peter Newton looks over digital x-rays on a large screen of his patient at Rady Children's Hospital. — Nelvin C. Cepeda / San Diego Union-Triubune / Twitter @NelCepeda

Dr. Peter Newton, chief of orthopedics and scoliosis at Rady Children’s Hospital-San Diego, received 102 payments totaling nearly $1.4 million, according to the data.

Newton said he does not receive gifts, and the payments are royalties for a spinal implant device he developed.

Industry funding plays a critical role in medical research and innovation, especially on the device side, Newton said. With limited government funding, physicians often need financial help to prove devices are effective and bring them to the market.

The Centers for Medicare and Medicaid Services, a federal agency, released the 2014 payment data earlier this month. It covers $6.49 billion in payments nationwide.

The database is required under a provision in the 2010 Affordable Care Act, to help address ethical issues behind industry-to-doctor payments. The law requires all pharmaceutical and medical device manufacturing companies to disclose payments made to doctors, dentists, podiatrists, chiropractors and optometrists.