Once again, psychiatrists top the updated Dollars for Docs list of large payments from pharmaceutical companies to individual US clinicians.

On March 12, the investigative journalism group ProPublica released the names of the 22 physicians who, since 2009, received more than $500,000 from these companies in speaking and consulting fees. Mirroring the organization's first report released in 2010, psychiatrists dominate the list.

This time, the top recipient was Jon Draud, MD, medical director of the psychiatric and addiction medicine program at Baptist Hospital in Nashville, Tennessee, and from the Middle Tennessee Medical Center in Murfreesboro.

According to the database, Dr. Draud has received a total of $1,009,213 from AstraZeneca, Cephalon, Eli Lilly, Forest, Merck, Novartis, and Pfizer — which is about $278,000 more than the amount received by the number 2 doctor. As noted by ProPublica, these figures do not include travel, meal, or research expenses.

The third and fourth spots are also psychiatrists, and in fact, 12 of the 22 are from this specialty.

APA Reaction

"My immediate, honest response was that this boggles the mind," James Scully, MD, CEO of the American Psychiatric Association (APA), told Medscape Medical News.

"It surprises me because we've made so many changes in what we've done here at the APA. Most of the leaders in the field and the leading researchers in the academic world have really looked at the role of pharmaceutical industries and the way they work with physicians. And they have struggled with how to do this the right way and maintain the public trust," added Dr. Scully.

Dr. James Scully

"Clearly, however, there are others out there who are still working closely with industry. That's perfectly legal. But it's important to have open communication. If people want to do marketing for drug companies, they need to be clear that that's what they're doing."

The other 10 spots on the list are held by 2 directors of pain management, a podiatrist, an allergist, a cardiologist, a pulmonologist, an associate professor of hematologic malignancies, a critical care surgeon, an endocrinologist, and a specialist in infectious diseases.

Of the 12 psychiatrists among ProPublica's top 22 pharma payment recipients, 3 are from New York, 2 from Tennessee, 2 from Texas, and 1 each from the states of New Hampshire, California, Ohio, Pennsylvania, and South Carolina.

The list's number 3 position is occupied by John J. Miller, MD, medical director of Brain Health in Exeter, New Hampshire, and a staff psychiatrist at Seacoast Mental Center. The report notes that he received $669,935 since 2009 from AstraZeneca, Forest, and Pfizer.

The number 4 position belongs to Gustavo Alva, MD, founder and medical director of ATP Clinical Research in Costa Mesa, California, and former associate professor of psychiatry at the University of California, Irvine. He received $663,751 from the same companies as Dr. Miller as well as from Johnson & Johnson, Eli Lilly, Merck, and Novartis.