[Congressional Record Volume 154, Number 91 (Wednesday, June 4, 2008)]
[Senate]
[Pages S5029-S5033]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         PAYMENTS TO PHYSICIANS

  Mr. GRASSLEY. Mr. President, starting last year, I started looking at 
the financial relationships between physicians and drug companies. I 
first began this inquiry by examining payments from Astra Zeneca to Dr. 
Melissa DelBello, a professor of psychiatry at the University of 
Cincinnati.
  In 2002, Dr. DelBello published a study that found that Seroquel 
worked for kids with bipolar disorder. The study was paid for by Astra 
Zeneca, and the following year that company paid Dr. DelBello around 
$100,000 for speaking fees and honoraria. In 2004, Astra Zeneca paid 
Dr. DelBello over $80,000.
  Today, I would like to talk about three physicians at Harvard Medical 
School--Drs. Joseph Biederman, Thomas Spencer, and Timothy Wilens. They 
are some of the top psychiatrists in the country, and their research is 
some of the most important in the field. They have also taken millions 
of dollars from the drug companies.
  Out of concern about the relationship between this money and their 
research, I asked Harvard and Mass General Hospital last October to 
send me the conflict of interest forms that these doctors had submitted 
to their institutions. Universities often require faculty to fill these 
forms out so that we can know if the doctors have a conflict of 
interest.
  The forms I received were from the year 2000 to the present. 
Basically, these forms were a mess. My staff had a hard time figuring 
out which companies the doctors were consulting for and how much money 
they were making. But by looking at them, anyone would be led to 
believe that these doctors were not taking much money. Over the last 7 
years, it looked like they had taken a couple hundred thousand dollars.
  But last March, Harvard and Mass General asked these doctors to take 
a second look at the money they had received from the drug companies. 
And this is when things got interesting. Dr. Biederman suddenly 
admitted to over $1.6 million dollars from the drug companies. And Dr. 
Spencer also admitted to over $1 million. Meanwhile, Dr. Wilens also 
reported over $1.6 million in payments from the drug companies.
  The question you might ask is: Why weren't Harvard and Mass General 
watching over these doctors? The answer is simple: They trusted these 
physicians to honestly report this money.
  Based on reports from just a handful of drug companies, we know that 
even these millions do not account for all of the money. In a few 
cases, the doctors disclosed more money than the drug companies 
reported. But in most cases, the doctors reported less money.
  For instance, Eli Lilly has reported to me that they paid tens of 
thousands of dollars to Dr. Biederman that he still has not accounted 
for. And the same goes for Drs. Spencer and Wilens.
  What makes all of this even more interesting is that Drs. Biederman 
and Wilens were awarded grants from the National Institutes of Health 
to study the drug Strattera.
  Obviously, if a researcher is taking money from a drug company while 
also receiving Federal dollars to research that company's product, then 
there is a conflict of interest. That is why I am asking the National 
Institutes of Health to take a closer look at the grants they give to 
researchers. Every year, the NIH hands out almost $24 billion in 
grants. But nobody is watching

[[Page S5030]]

to ensure that the conflicts of interest are being monitored.
  That is why Senator Kohl and I introduced the Physician Payments 
Sunshine Act. This bill will require companies to report payments that 
they make to doctors. As it stands right now, universities have to 
trust their faculty to report this money. And we can see that this 
trust is causing the universities to run afoul of NIH regulations. This 
is one reason why industry groups such as PhRMA and Advamed, as well as 
the American Association of Medical Colleges, have all endorsed my 
bill. Creating one national reporting system, rather than relying on a 
hodge-podge of state systems and some voluntary reporting systems, is 
the right thing to do.
  Before closing, I would like to say that Harvard and Mass General 
have been extremely cooperative in this investigation, as have Eli 
Lilly, Astra Zeneca and other companies. I ask unanimous consent that 
my letters to Harvard, Mass General, and the NIH be printed the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                      U.S. Senate,


                                         Committee on Finance,

                                     Washington, DC, June 4, 2008.
     Elias A. Zerhouni, M.D.
     Director, National Institutes of Health,
     Bethesda, Maryland.
       Dear Director Zerhouni: As a senior member of the United 
     States Senate and the Ranking Member of the Committee on 
     Finance (Committee), I have a duty under the Constitution to 
     conduct oversight into the actions of executive branch 
     agencies, including the activities of the National Institutes 
     of Health (NIH/Agency). In this capacity, I must ensure that 
     NIH properly fulfills its mission to advance the public's 
     welfare and makes responsible use of the public funding 
     provided for medical studies. This research often forms the 
     basis for action taken by the Medicare and Medicaid programs.
       Over the past number of years, I have become increasingly 
     concerned about the lack of oversight regarding conflicts of 
     interest relating to the almost $24 billion in annual 
     extramural funds that are distributed by the NIH. In that 
     regard, I would like to take this opportunity to notify you 
     about five problems that have come to my attention on this 
     matter.
       First, it appears that three researchers failed to report 
     in a timely, complete and accurate manner their outside 
     income to Harvard University (Harvard) and Massachusetts 
     General Hospital (MGH). By not reporting this income, it 
     seems that they are placing Harvard and MGH in jeopardy of 
     violating NIH regulations on conflicts of interest. I am 
     attaching that letter for your review and consideration.
       Second, I am requesting an update about a letter I sent you 
     last October on problems with conflicts of interest and NIH 
     extramural funding regarding Dr. Melissa DelBello at the 
     University of Cincinnati (University). In that letter, I 
     notified you that Dr. DelBello receives grants from the NIH, 
     however, she was failing to report her outside income to her 
     University.
       Third, the Inspector General for the Department of Health 
     and Human Services Office (HHS OIG) released a disturbing 
     report last January which found that NIH provided almost no 
     oversight of its extramural funds. But your staff seemed to 
     show little interest in this report. In fact, Norka Ruiz 
     Bravo, the NIH deputy director of extramural programs was 
     quoted in The New York Times saying, ``For us to try to 
     manage directly the conflict-of-interest of an NIH 
     investigator would be not only inappropriate but pretty much 
     impossible.''
       Fourth, I am dismayed to have read of funding provided to 
     several researchers from the Foundation for Lung Cancer: 
     Early Detection, Prevention & Treatment (Foundation). Dr. 
     Claudia Henschke and Dr. David Yankelevitz are two of the 
     Foundation's board members. As reported by The New York 
     Times, the Foundation was funded almost entirely with monies 
     from tobacco companies, and this funding was never fully 
     disclosed. Monies from the Foundation were then used to 
     support a study that appeared in The New England Journal of 
     Medicine (NEJM) back in 2006 regarding the use of computer 
     tomography screening to detect lung cancer. The NEJM 
     disclosure states that the study was supported also by NIH 
     grants held by Drs. Henschke and Yankelevitz.
       Regarding the lack of transparency by Dr. Henschke and Dr. 
     Yankelevitz, National Cancer Institute Director John 
     Niederhuber told the Cancer Letter, ``[W]e must always be 
     transparent regarding any and all matters, real or perceived, 
     which might call our scientific work into question.''
       The NEJM later published a clarification regarding its 
     earlier article and a correction revealing that Dr. Henschke 
     also received royalties for methods to assess tumors with 
     imaging technology. There is no evidence that the 
     Foundation's tobacco money or Dr. Henschke's royalties 
     influenced her research. But I am concerned that the funding 
     source and royalties may have not been disclosed when the NIH 
     decided to fund Dr. Henschke.
       Fifth, I sent you a letter on April 15, outlining my 
     concerns about a report on the National Institute of 
     Environmental Health Sciences (NIEHS). That report found 45 
     cases at the NIEHS where extramural grants had not receiving 
     sufficient peer review scores but were still funded. This 
     finding is yet another example that the NIH provides little 
     oversight for its extramural program.
       Dr. Zerhouni, you faced similar scandals back in 2003 when 
     it came to light that many NIH intramural researchers enjoyed 
     lucrative arrangements with pharmaceutical companies. It took 
     you some time, but you eventually brought some transparency, 
     reform and integrity back to NIH. As you told Congress during 
     one hearing, ``I have reached the conclusion that drastic 
     changes are needed as a result of an intensive review by NIH 
     of our ethics program, which included internal fact-finding 
     as well as an external review by the Blue Ribbon Panel.''
       NIH oversight of the extramural program is lax and leaves 
     people with nothing more than questions--$24 billion worth of 
     questions, to be exact. I am interested in understanding how 
     you will address this issue. American taxpayers deserve 
     nothing less.
       In the interim, I ask you to respond to the following 
     requests for information and documents. In responding to each 
     request, first repeat the enumerated question followed by the 
     appropriate response. Your responses should encompass the 
     period of January 1, 2000 to April 1, 2008. I would 
     appreciate receiving responses to the following questions by 
     no later than June 18, 2008:
       1. Please explain what actions the NIH has or will initiate 
     to provide better oversight and transparency for its 
     extramural funding program.
       2. Please explain how often the NIH has investigated and/or 
     taken action regarding a physician's failure to report a 
     ``significant financial interest,'' as defined by NIH 
     regulation. For each investigation, please provide the 
     following information:
       a. Name of the Doctor(s) involved;
       b. Date investigation began and the date ended;
       c. Specific allegations which triggered investigation;
       d. Findings of the investigation; and
       e. Actions taken by the NIH, if any.
       3. Since receiving notice that the University of Cincinnati 
     was provided incomplete information from Dr. DelBello 
     regarding her outside income, what steps has/will NIH take to 
     address this issue? Please be specific.
       4. Please provide a list of all NIH grants received by Dr. 
     DelBello. For each grant, please provide the following:
       a. Name of grant;
       b. Topic of grant; and
       c. Amount of funding for grant.
       5. Please provide a list of any other interactions that Dr. 
     DelBello has had with the NIH to include membership on 
     advisory boards, peer review on grants, or the like.
       6. Since reports appeared in the press regarding the 
     undisclosed funding of the Foundation for Lung Cancer: Early 
     Detection, Prevention & Treatment, what steps has/will NIH 
     take to address this issue? Please provide all external and 
     internal communications regarding this issue.
       7. Please provide a list off all NIH grants received by Dr. 
     Claudia Henschke. For each grant, please provide the 
     following:
       a. Name of grant;
       b. Topic of grant; and
       c. Amount of funding for grant.
       8. Please provide a list of any other interactions that Dr. 
     Henschke has had with the NIH to include membership on 
     advisory boards, peer review on grants, or the like.
       9. Please provide a list off all NIH grants received by Dr. 
     David Yankelevitz. For each grant, please provide the 
     following:
       a. Name of grant;
       b. Topic of grant; and
       c. Amount of funding for grant.
       10. Please provide a list of any other interactions that 
     Dr. Yankelevitz has had with the NIH to include membership on 
     advisory boards, peer review on grants, or the like.
       11. Please provide a list off all NIH grants received by 
     Dr. Joseph Biederman. For each grant, please provide the 
     following:
       a. Name of grant;
       b. Topic of grant; and
       c. Amount of funding for grant.
       12. Please provide a list of any other interactions that 
     Dr. Biederman has had with the NIH to include membership on 
     advisory boards, peer review on grants, or the like.
       13. Please provide a list off all NIH grants received by 
     Dr. Timothy Wilens. For each grant, please provide the 
     following:
       a. Name of grant;
       b. Topic of grant; and
       c. Amount of funding for grant.
       14. Please provide a list of any other interactions that 
     Dr. Wilens has had with the NIH to include membership on 
     advisory boards, peer review on grants, or the like.
       I request your prompt attention to this matter and your 
     continued cooperation. I also request that the response to 
     this letter contain your personal signature. If you have any 
     questions please contact my Committee staff, Paul Thacker at 
     (202) 224-4515. Any formal correspondence should be sent 
     electronically in PDF searchable format to brian_
[email protected].
           Sincerely,
                                              Charles E. Grassley,
                                                   Ranking Member.

[[Page S5031]]

     
                                  ____
                                                      U.S. Senate,


                                         Committee on Finance,

                                     Washington, DC, June 4, 2008.
     Dr. Drew Gilpin Faust,
     President, Harvard University,
     Massachusetts Hall, Cambridge, MA.
     Dr. Peter L. Slavin,
     President, Massachusetts General Hospital (Partners 
         Healthcare), Boston, MA.
       Dear Drs. Faust and Slavin: The United States Senate 
     Committee on Finance (Committee) has jurisdiction over the 
     Medicare and Medicaid programs and, accordingly, a 
     responsibility to the more than 80 million Americans who 
     receive health care coverage under these programs. As Ranking 
     Member of the Committee, I have a duty to protect the health 
     of Medicare and Medicaid beneficiaries and safeguard taxpayer 
     dollars appropriated for these programs. The actions taken by 
     thought leaders, like those at Harvard Medical School who are 
     discussed throughout this letter, often have a profound 
     impact upon the decisions made by taxpayer funded programs 
     like Medicare and Medicaid and the way that patients are 
     treated and funds expended.
       Moreover, and as has been detailed in several studies and 
     news reports, funding by pharmaceutical companies can 
     influence scientific studies, continuing medical education, 
     and the prescribing patterns of doctors. Because I am 
     concerned that there has been little transparency on this 
     matter, I have sent letters to almost two dozen research 
     universities across the United States. In these letters, I 
     asked questions about the conflict of interest disclosure 
     forms signed by some of their faculty. Universities require 
     doctors to report their related outside income, but I am 
     concerned that these requirements are disregarded sometimes.
       I have also been taking a keen interest in the almost $24 
     billion annually appropriated to the National Institutes of 
     Health to fund grants at various institutions such as yours. 
     As you know, institutions are required to manage a grantee's 
     conflicts of interest. But I am learning that this task is 
     made difficult because physicians do not consistently report 
     all the payments received from drug companies.
       To bring some greater transparency to this issue, Senator 
     Kohl and I introduced the Physician Payments Sunshine Act 
     (Act). This Act will require drug companies to report 
     publicly any payments that they make to doctors, within 
     certain parameters.
       I am writing to try and assess the implementation of 
     financial disclosure policies of Harvard University (Harvard) 
     and Massachusetts General Hospital (MGH/Partners), (the 
     Institutions). In response to my letters of June 29, October 
     25, and October 26, 2007, your Institutions provided me with 
     the financial disclosure reports that Drs. Joseph Biederman, 
     Thomas Spencer, and Timothy Wilens (Physicians) filed during 
     the period of January 2000 through June 2007.
       My staff investigators carefully reviewed each of the 
     Physicians' disclosure forms and detailed the payments 
     disclosed. I then asked that your Institutions confirm the 
     accuracy of the information. In March 2008, your Institutions 
     then requested additional information from the Physicians 
     pursuant to my inquiry. That information was subsequently 
     provided to me.
       In their second disclosures to your Institutions, the 
     Physicians revealed different information than they had 
     disclosed initially to your respective Institutions. On April 
     29, 2008, I received notification from Harvard Medical 
     School's Dean for Faculty and Research Integrity that he has 
     referred the cases of these Physicians to the Standing 
     Committee on Conflicts of Interest and Commitment (``Standing 
     Committee''). The Chief Academic Officer (CAO), Partners 
     HealthCare System, also wrote me that Partners will look to 
     the Standing Committee to conduct the initial factual review 
     of potential non-compliance that are contained in both the 
     Harvard Medical School Policy and the Partners Policy. In 
     addition, the CAO stated that, in addition to the Standing 
     Committee's review process, Partners will conduct its own 
     independent review of conflicts of interest disclosures these 
     Physicians submitted separately to Partners in connection 
     with publicly funded research and other aspects of Partners 
     Policy. I look forward to being updated on these reviews in 
     the near future.
       In addition, I contacted executives at several major 
     pharmaceutical companies and asked them to list the payments 
     that they made to Drs. Biederman, Spencer, and Wilens during 
     the years 2000 through 2007. These companies voluntarily and 
     cooperatively reported additional payments that the 
     Physicians do not appear to have disclosed to your 
     Institutions.
       Because these disclosures do not match, I am attaching a 
     chart intended to provide a few examples of the data that 
     have been reported me. This chart contains three columns: 
     payments disclosed in the forms the physicians filed at your 
     Institutions, payments revealed in March 2008, and amounts 
     reported by some drug companies.
       I would appreciate further information to see if the 
     problems I have found with these three Physicians are 
     systemic within your Institutions.


                     INSTITUTIONAL AND NIH POLICIES

       Both Harvard and MGH/Partners have established an income de 
     minimus limit. This policy forbids researchers working at 
     your Institutions from conducting clinical trials with a drug 
     or technology if they receive payments over $20,000 from the 
     company that manufactures that drug or technology. Prior to 
     2004, the income de minimus limit established by your 
     institutions was $10,000.
       Further, federal regulations place several requirements on 
     a university/hospital when its researchers apply for NIH 
     grants. These regulations are intended to ensure a level of 
     objectivity in publicly funded research, and state in 
     pertinent part that NIH investigators must disclose to their 
     institution any ``significant financial interest'' that may 
     appear to affect the results of a study. NIH interprets 
     ``significant financial interest'' to mean at least $10,000 
     in value or 5 percent ownership in a single entity.
       Based upon information available to me, it appears that 
     each of the Physicians identified above received grants to 
     conduct studies involving atomoxetine, a drug that sells 
     under the brand name Strattera. For example:
       In 2000, the NIH awarded Dr. Biederman a grant to study 
     atomoxetine in children. At that time, Dr. Biederman 
     disclosed that he received less than $10,000 in payments from 
     Eli Lilly & Company (Eli Lilly). But Eli Lilly reported that 
     it paid Dr. Biederman more than $14,000 for advisory services 
     that year--a difference of at least $4,000.
       In 2004, the NIH awarded Dr. Wilens a 5-year grant to study 
     atomoxetine. In his second disclosure to your Institutions, 
     Dr. Wilens revealed that he received $7,500 from Eli Lilly in 
     2004. But Eli Lilly reported to me that it paid Dr. Wilens 
     $27,500 for advisory services and speaking fees in 2004--a 
     difference of about $20,000.
       It is my understanding that Dr. Wilens' NIH-funded study of 
     atomoxetine is still ongoing. According to Eli Lilly, it paid 
     Dr. Wilens almost $65,000 during the period January 2004 
     through June 2007. However, as of March 2008, and based upon 
     the documents provided to us to date, Dr. Wilens disclosed 
     payments of about half of the amount reported by Eli Lilly 
     for this period. Dr. Wilens also did three other studies of 
     atomoxetine in 2006 and 2007.
       I have also found several instances where these Physicians 
     apparently received income above your institutions' income de 
     minimus limit. For instance, in 2003, Dr. Spencer conducted a 
     study of atomoxetine in adolescents. At the time, he 
     disclosed no significant financial interests related to this 
     study. But Eli Lilly reported paying Dr. Spencer over $25,000 
     that year.
       In 2001, Dr. Biederman disclosed plans to begin a study 
     sponsored by Cephalon, Inc. At the time; Dr. Biederman 
     disclosed that he had no financial relationship with the 
     sponsor of this study. Yet, on his conflict of interest 
     disclosure, he acknowledged receiving research support and 
     speaking fees from Cephalon, Inc., but did not provide any 
     information on the amounts paid. In March 2008, Dr. Biederman 
     revealed that Cephalon, Inc. paid him $13,000 in 2001.
       In 2005, Dr. Biederman began another clinical trial 
     sponsored by Cephalon, Inc., which was scheduled to start in 
     September 2005 and end in September 2006. Initially, Dr. 
     Biederman disclosed that he had no financial relationship 
     with the sponsor of this study. But in March 2008, Dr. 
     Biederman revealed that Cephalon, Inc. paid him $11,000 for 
     honoraria in 2005 and an additional $24,750 in 2006.
       In light of the information set forth above, I ask your 
     continued cooperation in examining conflicts of interest. In 
     my opinion, institutions across the United States must be 
     able to rely on the representations of its faculty to ensure 
     the integrity of medicine, academia, and the grant-making 
     process. At the same time, should the Physician Payments 
     Sunshine Act become law, institutions like yours will be able 
     to access a database that will set forth the payments made to 
     all doctors, including your faculty members. Indeed at this 
     time there are several pharmaceutical and device companies 
     that are looking favorably upon the Physician Payments 
     Sunshine Bill and for that I am gratified.
       Accordingly, I request that your respective institutions 
     respond to the following questions and requests for 
     information. For each response, please repeat the enumerated 
     request and follow with the appropriate answer.
       1. For each of the NIH grants received by the Physicians, 
     please confirm that the Physicians reported to Harvard and 
     MGH/Partners' designated official ``the existence of [his] 
     conflicting interest.'' Please provide separate responses for 
     each grant received for the period from January 1, 2000 to 
     the present, and provide any supporting documentation for 
     each grant identified.
       2. For each grant identified above, please explain how 
     Harvard and MGH/Partners ensured ``that the interest has been 
     managed, reduced, or eliminated?'' Please provide an 
     individual response for each grant that each doctor received 
     from January 2000 to the present, and provide any 
     documentation to support each claim.
       3. Please report on the status of the Harvard Standing 
     Committee and additional Partners reviews of the 
     discrepancies in disclosures by Drs. Biederman, Spencer and 
     Wilens, including what action, if any, will be considered.
       4. For Drs. Biederman, Spencer, and Wilens, please report 
     whether a determination can be made as to whether or not any 
     doctor violated guidelines governing clinical trials and the 
     need to report conflicts of interest to an institutional 
     review board (IRB). Please respond by naming each clinical 
     trial for which the doctor was the principal investigator, 
     along with confirmation that conflicts of interest were 
     reported, if possible.

[[Page S5032]]

       5. Please provide a total dollar figure for all NIH monies 
     annually received by Harvard and MGH/Partners, respectively. 
     This request covers the period of 2000 through 2007.
       6. Please provide a list of all NIH grants received by 
     Harvard and MGH/Partners. This request covers the period of 
     2000 through 2007. For each grant please provide the 
     following:
       a. Primary Investigator;
       b. Grant Title;
       c. Grant number;
       d. Brief description; and
       e. Amount of Award.
       Thank you again for your continued cooperation and 
     assistance in this matter. As you know, in cooperating with 
     the Committee's review, no documents, records, data or 
     information related to these matters shall be destroyed, 
     modified, removed or otherwise made inaccessible to the 
     Committee.
       I look forward to hearing from you by no later than June 
     18, 2008. All documents responsive to this request should be 
     sent electronically in PDF format to Brian_Downey@finance-
rep.senate.gov. If you have any questions, please do not 
     hesitate to contact Paul Thacker at (202) 224-4515.
           Sincerely,
                                              Charles E. Grassley,
                                                   Ranking Member.

       SELECTED DISCLOSURES BY DR. BIEDERMAN AND RELATED INFORMATION REPORTED BY PHARMACEUTICAL COMPANIES
----------------------------------------------------------------------------------------------------------------
                                                                                          Payments      Amount
                Year                          Company           Disclosure filed with   revealed in    company
                                                                     institution         March 2008    Reported
----------------------------------------------------------------------------------------------------------------
2000................................  GlaxoSmithKline........  Not reported...........       $2,000       $3,328
                                      Eli Lilly & Company....  <$10,000...............        3,500       14,105
                                      Pfizer Inc.............  Not reported...........        7,000        7,000
2001................................  Cephalon...............  No amount provided.....       13,000          n/a
                                      GlaxoSmithKline........  No amount provided.....        5,500        4,428
                                      Eli Lilly & Company....  No amount provided.....        6,000       14,339
                                      Johnson & Johnson......  Not reported...........        3,500       58,169
                                      Medical Education        Not reported...........       21,000          n/a
                                       Systems.
                                      Pfizer Inc.............  No amount provided.....        5,625        5,625
2002................................  Bristol-Myers Squibb...  No amount provided.....        2,000        2,000
                                      Cephalon...............  No amount provided.....        3,000          n/a
                                      Colwood................  Not reported...........       14,000          n/a
                                      Eli Lilly & Company....  No amount provided.....       11,000        2,289
                                      Johnson & Johnson......  Not reported...........          Not          706
                                                                                           reported
                                      Pfizer Inc.............  No amount provided.....        4,000        2,000
2003................................  Bristol-Myers Squibb...  No amount provided.....          500          250
                                      Cephalon...............  <10,000................        4,000          n/a
                                      Eli Lilly & Company....  <10,000................        8,250       18,347
                                      Johnson & Johnson......  <10,000................        2,000        2,889
                                      Medlearning............  Not reported...........       26,500          n/a
                                      Pfizer Inc.............  <10,000................        1,000        1,000
2004................................  Bristol-Myers Squibb...  No amount provided.....       6, 266        6,266
                                      Cephalon...............  Not reported...........        4,000          n/a
                                      Eli Lilly & Company....  No amount provided.....        8,000       15,686
                                      Johnson & Johnson......  Not reported...........          Not          902
                                                                                           reported
                                      Medlearning............  Not reported...........       26,000          n/a
                                      Pfizer Inc.............  Not reported...........        3,000        4,000
2005................................  Cephalon...............  Not reported...........       11,000          n/a
                                      Eli Lilly & Company....  <20,000................       12,500        7,500
                                      Johnson & Johnson......  Not reported...........          Not          962
                                                                                           reported
                                      Pfizer Inc.............  Not reported...........        3,000        3,000
                                      Medlearning............  Not reported...........       34,000          n/a
2006................................  Cephalon...............  Not reported...........       24,750          n/a
                                      Johnson & Johnson......  Not reported...........          Not          750
                                                                                           reported
                                      Primedia...............  Not reported...........       56,000          n/a
2007................................  Primedia...............  Not reported...........       30,000         n/a
----------------------------------------------------------------------------------------------------------------
Note 1: Dr. Biederman revealed in March 2008 that his outside income totaled about $1.6 million during the
  period January 2000 through June 2007. Information reported by the pharmaceutical companies indicate that they
  made additional payments that are not reflected in Dr. Biederman's disclosures.
Note 2: When a Physician named a company in a disclosure but did not provide an amount, the text reads ``no
  amount reported.'' When a Physician did not list the company in the disclosure, the column reads ``not
  reported.'' The Committee contacted several companies for payment information and the notation n/a (not
  available) reflects that a company was not contacted.


        SELECTED DISCLOSURES BY DR. SPENCER AND RELATED INFORMATION REPORTED BY PHARMACEUTICAL COMPANIES
----------------------------------------------------------------------------------------------------------------
                                                                                          Payments      Amount
                Year                          Company           Disclosure filed with   revealed in    company
                                                                     institution         March 2008    reported
----------------------------------------------------------------------------------------------------------------
2000................................  GlaxoSmithKline........  Not reported...........       $3,000       $1,500
                                      Eli Lilly & Company....  Not reported...........       12,345       11,463
2001................................  GlaxoSmithKline........  Not reported...........        4,000        1,000
                                      Eli Lilly & Company....  Not reported...........        8,500       10,859
                                      Strategic Implications.  Not reported...........       16,800          n/a
2002................................  GlaxoSmithKline........  Not reported...........        3,000        3,369
                                      Eli Lilly & Company....  Not reported...........       14,000       14,016
                                      Strategic Implications.  Not reported...........       29,000          n/a
2003................................  Eli Lilly & Company....  Not reported...........        6.000       25,500
                                      Johnson & Johnson......  Not reported...........        1,250            0
                                      Thomson Physicians       Not reported...........       46,500          n/a
                                       World.
2004................................  Eli Lilly & Company....  Not reported...........          Not       23,000
                                                                                           reported
                                      Pfizer Inc.............  Not reported...........        3,500        3,500
2005................................  Eli Lilly & Company....  <$20,000...............        6,000        7,500
                                      Johnson & Johnson......  Not reported...........        1,500          227
                                      Medlearning............  Not reported...........       28,250          n/a
2006................................  Eli Lilly & Company....  No amount provided.....       15,688        8,188
                                      Johnson & Johnson......  Not reported...........        5,500            0
                                      Primedia...............  Not reported...........       44,000          n/a
2007................................  Eli Lilly & Company....  No amount provided.....        6,000       16,188
----------------------------------------------------------------------------------------------------------------
Note 1: Dr. Spencer revealed in March 2008 that his outside income totaled about $1 million during the period
  January 2000 through June 2007. Information reported by the pharmaceutical companies indicate that they made
  additional payments that are not reflected in Dr. Spencer's disclosures.
Note 2: When a Physician named a company in a disclosure but did not provide an amount, the text reads ``no
  amount reported.'' When a Physician did not list the company in the disclosure, the column reads ``not
  reported.'' The Committee contacted several companies for payment information and the notation n/a (not
  available) reflects that a company was not contacted.


         SELECTED DISCLOSURES BY DR. WILENS AND RELATED INFORMATION REPORTED BY PHARMACEUTICAL COMPANIES
----------------------------------------------------------------------------------------------------------------
                                                                                          Payments      Amount
                Year                          Company           Disclosure filed with   revealed in    company
                                                                     institution         March 2008    reported
----------------------------------------------------------------------------------------------------------------
2000................................  GlaxoSmithKline........  Not reported...........       $5,250      $12,009
                                      Eli Lilly & Company....  Not reported...........        2,000        2,057
                                      Pfizer Inc.............  Not reported...........        1,250        2,250
                                      TVG....................  Not reported...........       11,000          n/a
2001................................  GlaxoSmithKline........  <$10,000...............          n/a        2,269
                                      Eli Lilly & Company....  No amount provided.....        3,952          952
                                      J.B. Ashtin............  Not reported...........       14,500          n/a
2002................................  GlaxoSmithKline........  Not reported...........        7,500       10,764
                                      Eli Lilly & Company....  Not reported...........        4,500        3,000
                                      Pfizer Inc.............  Not reported...........        1,500        1,500
                                      Phase 5................  Not reported...........       20,000          n/a

[[Page S5033]]

 
2003................................  Eli Lilly & Company....  Not reported...........       12,000            0
                                      Phase 5................  Not reported...........       90,500          n/a
                                      TVG....................  Not reported...........       31,000          n/a
                                      Medlearning............  Not reported...........       24,000          n/a
2004................................  Eli Lilly & Company....  Not reported...........        7,500       27,500
                                      Phase 5................  Not reported...........       84,250          n/a
                                      Medlearning............  Not reported...........       46,000          n/a
2005................................  Eli Lilly & Company....  <20,000................        9,500        9,500
                                      Promedix...............  Not reported...........       70,000          n/a
                                      Advanced Health Media..  Not reported...........       37,750          n/a
2006................................  Eli Lilly and Physician  No amount provided.....        5,963       12,798
                                       World (Lilly).
                                      Advanced Health Media..  Not reported...........       56,000          n/a
                                      Primedia...............  Not reported...........       32,000          n/a
2007................................  Eli Lilly & Company....  Not reported...........        9,000       14,969
                                      Veritas................  Not reported...........       25,388         n/a
----------------------------------------------------------------------------------------------------------------
Note 1: Dr. Wilens revealed in March 2008 that his outside income totaled about $1.6 million during the period
  January 2000 through June 2007. Information reported by the pharmaceutical companies indicate that they made
  additional payments that are not reflected in Dr. Spencer's disclosures.
Note 2: When a Physician named a company in a disclosure but did not provide an amount, the text reads ``no
  amount reported.'' When a Physician did not list the company in the disclosure, the column reads ``not
  reported.'' The Committee contacted several companies for payment information and the notation n/a (not
  available) reflects that a company was not contacted.

  

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