Dozens of Colorado doctors have continued to accept hundreds of thousands of dollars from drug companies since a national database first spotlighted the payments, but an ethics crackdown by two major academic institutions is slowing the controversial practice.

An ethics board at the University of Colorado School of Medicine has rejected more than one-third of proposed contracts between doctors and drug companies since it took authority to approve the deals on June 1, school officials said.

National Jewish Health now reviews all contracts with drug companies and audits physicians’ prescribing patterns to ensure they are not unduly emphasizing drugs from manufacturers who pay them.

The latest database from the investigative nonprofit ProPublica captures payments from about 40 percent of the drug industry, a much broader view of drug company payments than one released last year. The companies disclosing so far have spent nearly $13.4 million in Colorado since 2009.

The new database shows some company payments dropping, in part from tougher ethics policies at medical schools and other institutions.

AstraZeneca spent $9.2 million on speakers in the second half of 2010 after paying about $22.8 million in the first half, ProPublica said. The company said some of the drop was due to conference scheduling, but also said it had changed practices.

Medical ethics experts and consumer watchdogs say the speaking fees blur marketing boundaries, as doctors appear to shill for manufacturers. The fees also create conflicts when paid doctors make prescription choices.

National Jewish officials said they are working to put disclosures of all relationships with doctors on the hospital’s website. The hospital has also banned all gifts to staff, whether in the form of meals, pens or other trinkets.

Some National Jewish doctors will give up speaking by their own choice under the new scrutiny, hospital chief operating officer Ron Berge said. For others, he added, “I expect to see significant diminution” of payments in future reports.

For now, though, National Jewish doctors have some of the highest earnings in speaking and consulting fees since 2009.

Dr. Ronald Balkissoon, a pulmonologist, earned more than $300,000. The total includes $64,750 in speaking fees from GlaxoSmithKline in the first quarter of 2011, according to the database.

The ProPublica data shows Dr. Joseph Spahn, with more than $200,000; Dr. Barry Make, at more than $148,000; and Dr. Rohit Katial, at more than $100,000.

The doctors declined to address the fees themselves, instead referring questions to National Jewish.

National Jewish said the paid relationships with Balkissoon, Spahn and others met guidelines that define legitimate research and education, as opposed to mere marketing.

Katial’s total, for example, includes $18,260 that went straight to National Jewish for a comparative drug study, officials said.

Make’s talks are roundtable question-and-answer sessions on disease research, without promoting any one drug, Berge said.

After expressing surprise at CU-affiliated doctors who figured highly in the 2010 version of the database, CU officials vowed to review their oversight.

“The work that was being done giving talks as part of marketing for pharmaceutical companies was not appropriate,” said CU medical school dean Dr. Richard Krugman.

The latest release of payment figures showed the faculty that previously made the most from the drug companies registering no payments in the latest quarters.

Some doctors have decided on their own to stop taking money, Krugman said, including Dr. Michael McDermott, who is listed as making more than $130,000 in 2009 and 2010.

McDermott declined to comment.

For doctors who want to continue taking payments, speeches that could be construed as marketing are out, Krugman said. Other consulting or educational arrangements must be submitted to an oversight committee, which so far has reviewed 22 such proposals and rejected eight, Krugman said.

Some of the approved arrangements with CU doctors include ongoing consulting on drug development and specific biologic properties of proposed treatments, Krugman said.

Many doctors are embarrassed to talk about the fees they earn from drug companies because they know it’s not just an appearance of conflict, it’s an actual conflict of interest, said retired orthopedic surgeon Art Strasburger, who teaches medical ethics courses at UC Denver and the University of Denver.

“There’s no doubt all the gifts and trips and honoraria they dole out to physicians are very specifically designed to get their business,” Strasburger said. “Doctors are influenced, even by the name on the free pen. Drug companies know this; otherwise they wouldn’t be spending all this big money.”

Still, Strasburger said, he understands the need for drug companies to disseminate information and the doctors to hear it.

Drug companies — all of which must report payments to medical workers by 2013 — say they also have reworked their policies to reflect the ethical concerns, but will continue to hire speakers and make other payments.

“We believe health care professionals benefit from peer- to-peer discussions of disease states and treatment options,” said Mary Anne Rhyne, director of U.S. media relations for London-based GlaxoSmithKline.

The company has now clearly defined paid relationships with doctors and others, Rhyne said. The guidelines govern what information is presented, where the meetings take place and fair compensation.

Berge said National Jewish has met with two of the larger drug companies it deals with frequently, and “they’ve clearly gotten the message” of public concern.

Some private hospitals said they also have worked to make their ethics policies more clear to the public.

Porter Adventist physicians seeking to add drugs to hospital formularies “are asked to provide conflict-of-interest statements to determine if pharmaceutical companies could be influencing their requests,” said chief medical officer Dr. Dianne McCallister.

At the same time, McCallister said, doctors “deserve to be paid for their efforts” when they do legitimate research and education. The transparency effort “is a positive move” to maintain trust, she said.

Michael Booth: 303-954-1686 or mbooth@denverpost.com