An unprecedented disclosure of payments from drug companies shows that $3.07 million for consulting was paid in 2,388 payments to Rochester-based Mayo Clinic researchers, doctors and hospitals during five months last year.

However, Mayo Clinic officials point out that they have a strict policy about such payments, which all must be approved by its Conflict of Interest Committee. Such policies, which many medical centers have, are a way of preventing medical professionals from being unduly influenced by money from drug companies in their decisions, such as what drugs they prescribe.

For the same period, Cleveland Clinic staff collected $4.3 million in private money for consulting, while Johns Hopkins Hospital employees took in a mere $4,627.

Dr. Richard Ehman, vice-chair of the Conflict of Interest Committee, said that Mayo Clinic's restrictive policies are unusual within the medical industry.

"We know all of the financial relationships of our staff. That's unheard of," said Ehman.

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Cleveland Clinic and Johns Hopkins urge their employees to disclose their private contracts, though they stop short of requiring it in every case, according to their policies posted on their websites. Mayo, Cleveland and Johns Hopkins all agree that a physician or scientist serving as primary leader of a research project are banned from having private contracts with the companies involved.

Hundreds of Mayo Clinic doctors are receiving millions from drug companies and medical device makers for private consulting every year, while many others are paid one-third of the royalties generated by their work.

Disclosing all of the financial contracts between private companies and doctors is the goal of the Open Payments website run by Centers for Medicare and Medicaid Services. It features a database of doctors and the money they receive from outside sources. It's now required by the Physician Payment Sunshine Act, which was part of the Affordable Care Act health reform.

In late September, data from August to December 2013 was released on the site. This batch of records includes about 4.4 million payments made to about 550,000 doctors and 1,360 teaching hospitals. However, some of the information reported by private companies is incomplete, confusing and, in some cases, incorrect.

For Mayo Clinic doctors, 100 percent of the payments for private consulting go directly to them. Mayo began allowing such consulting contracts in 1999, when it changed the rule that required all consulting payments to go to the clinic.

The payments for those five months show all different types, including royalties, research money and royalties.

In addition to the consulting payments during those five months, a total of 68 payments totaling $3.01 million were made to Mayo Clinic for research, according to the database.

All research money, like grants, goes directly to Mayo Clinic.

However, physicians or researchers receive one-third of the amount of royalty payments received by the clinic from drug companies, according to clinic policy. During the five months of reports, Mayo Clinic received a total of $1.9 million in royalties.

Just one company -- DePuy Synthes Sales Inc., a subsidiary of heath care giant Johnson & Johnson, reported paying a total of more than $1.15 million to Mayo Clinic or its doctors in 278 payments from August to December.

In the wake of the recent federally-mandated deluge of information about the financial ties between doctors and private drug/medical device companies, Ehman explained that Mayo Clinic does allow its employees to personally profit from such agreements. However, every financial relationship must be approved by the Conflict of Interest Committee.

Mayo Clinic approved 1,003 consulting contracts for 308 doctors and researchers in 2013 to personally work with private companies on their own time. The Mayo Clinic committee, which meets every other week, approved 953 such agreements with 301 individuals in 2012 and 1,071 for 292 employees in 2011.

The largest contract approved from 2010 to 2013 was for $60,000 and the lowest was for $45. The median contract cost for the four-year period is $4,000.

Less than 5 percent of contracts submitted to the committee are rejected. Mayo officials say that's primarily because its staff are very clear on the rules and work hard to make sure any potential contract follows the clinic's regulation.

"Within health care, it is almost impossible not have a conflict of interest," said Ehman, who is also the chair of Mayo Clinic's Medical-Industry Relations Committee. "However, if there is a conflict, we manage it."

He added that Mayo Clinic's restrictive policies are unusual within the medical industry.

"We know all of the financial relationships of our staff. That's unheard of," said Ehman.

Since 2009, it has also taken the step of including a contact number - 284-0075 - for the Office of Conflict of Interest Review in patient materials for anyone with questions about their doctor's ties with private companies.

"Few very patients have used it," said Ehman.

Mayo Clinic does not allow its employees to personally accept gifts, though the Open Payments database does report some Mayo doctors as receiving "gifts." It's unclear how the reporting companies are using the term. If a doctor is working on research for a company, they are not allowed to also consult for the company.

Ehman also pointed out that Mayo Clinic does not allow employees to promote a product or service.

"Mayo is a very trusted name in health care and there would be many companies that would want in one way of another to exploit that confidence people have in Mayo Clinic," he said. "We've opened up an exception to that in the last few years… when it (product or service) was developed at Mayo Clinic. We believe best people to speak on it are the people who developed it."

However, if an employee speaks in favor of a Mayo-developed product, they cannot accept payment for that speaking engagement.


Open Payments highlights

• $3,077,765 - Total amount reported paid to Rochester-based researchers/doctors/health care staff/hospitals from August to December 2013.

• 2,388 - Total payments reported as made to researchers/doctors/health care staff/hospitals who work/reside in Rochester from August to December 2013.

• $1,154,853 - Total reported as paid by DePuy Synthes Sales Inc., an orthopedic subsidiary of Johnson & Johnson, to Rochester physicians or hospitals in 278 payments from August to December 2013.

• $586,080 - Largest "Royalty or Licensing" payment reported as being made to a Rochester physician. It was paid by Acumed LLC, an orthopedic device company in Hillsboro, Oregon. Recipient listed as Dr. Shawn W. O'Driscoll, orthopedic surgeon. Mayo Clinic owns all licensing, but it does give doctors one-third of royalty payments, or $195,000 in this case.

• $27,906 - Largest "Consulting" fee payment reported as being made to a Rochester physician. Since Mayo Clinic approved the relationship, the doctor received 100 percent of the payment made by DePuy Synthes Sales Inc., an orthopedic subsidiary of Johnson & Johnson. The recipient was listed as Dr. Daniel John Berry, the chair of Mayo Clinic's Orthopedic Surgery Department. Berry was named in DePuy payments totaling $910,695, though many were royalties or other types of payments that went at least partially to Mayo Clinic.

• $18,728 - Largest "Compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program" payment made by Allergan Inc., a pharmaceutical company based in Irvine, Calif. Recipient was listed as Dr. Valerie Lemaine, assistant professor of plastic surgery.

• $18,605 - Largest payment under the description of "Gift." It was made by Intuitive Surgical, Inc., the maker of the da Vinci robotic surgical system, directly to Mayo Clinic. Mayo Clinic does not allow individual staff members to accept gifts.

• $14,436 - Largest payment under the description of "Travel and lodging." Payment reported by Novo Nordisk AS, a pharmaceutical company based in Denmark, for a trip to Barcelona, Spain. Recipient listed as Dr. Robert Rizza, the executive dean for research at Mayo Clinic and professor of medicine.

• $10,000 - Largest payment under description of "Education" for an educational grant provided to Stanford University School of Medicine. Payment reported by Smith & Nephew, Inc. Recipient listed as Dr. Micheal Kalisvaart, an orthopedic surgeon who was a resident at Mayo Clinic. He now practices at the Reno Orthopedic Clinic in Reno, Nevada.

• 1,210 - Largest payment under description of "Food and Beverage." It was made by Novartis Pharmaceuticals Corp., a U.S. affiliate of Basel, Switzerland-based Novartis AG. The recipient is listed as Dr. Brian G. Weinshenker, Mayo Clinic Professor of Neurology.

Doctors: Drug company money can corrupt, cause loss of public trust