Along with his thriving Redwood City pain management and rehabilitation practice, Dr. Moshe Lewis is one of hundreds of California doctors who banks on another lucrative client: pharmaceutical companies.
Since 2009, the Bay Area physician has received more than $224,000 from five drugmakers for speaking, consulting, travel and meals.
And he's in good company in the Golden State: Big Pharma paid doctors, researchers and institutions here more than $241 million from 2009 to 2012.
Critics say the payments raise conflict of interest questions: Are doctors giving you a drug because you need it, or because they're getting paid?
And does the money affect research results?
Doctors and researchers stoutly deny that the money influences them.
"Pharmaceutical companies used to take doctors to dinner, but that was banned years ago," said Dr. Arthur Chanzel Jeng, an infection control specialist at UCLA-Olive View Medical Center in Sylmar.
"Now they must provide some educational content."
The payments are revealed in a new database compiled by ProPublica, an independent nonprofit that focuses on investigative journalism.
California received more drug company money than any state, exceeding 10 percent of the $2 billion paid out nationally, the database reveals. And that is only a partial accounting covering payments from 15 companies -- such as Merck, Johnson and Johnson, GlaxoSmithKline and Astra Zeneca --
Some of the biggest Bay Area research institutions, who tout their own disclosure rules, showed hundreds of thousands of dollars in research grants.
Consumers who visit the ProPublica website at www.propublica.org can type in their doctor's name and find out if he or she received money. Next year, every drug and medical device maker that pays physicians will have to report such spending to a federal database as part of the Affordable Care Act health reform law.
Lewis, the Redwood City doctor, said he supports the transparency and insists the money does not influence him.
He said he lectures to doctors about new medications on the horizon. "I don't over-endorse one product over another. I try to align myself with companies that I find to be ethical, that have not had multiple products pulled from the market."
His 2011 payments included $76,450 in speaking fees and $27,283 for travel from AstraZeneca, $20,700 for speaking and $3,159 for travel from Eli Lilly, and $7,250 for speaking and $961 for travel from Johnson & Johnson. He also received several thousand dollars for meals.
"I receive nothing -- let me be very clear on that," said Singh, who is an adjunct clinical professor at Stanford University."There's absolutely issues of conflict that you have to be careful about," he said. "That's why our contracts are written in such a way that we have 100 percent control over what we do."
Several years ago, Singh pointed out potential risks for patients of an anti-arthritis drug known as Vioxx while he was a paid consultant to Merck, its manufacturer. Merck ultimately withdrew the drug from the market.
Concerns over influence have prompted institutions such as Stanford University to guard against conflicts.
In 2006, Stanford's medical school banned its physicians from accepting gifts from companies, including free meals and drug samples. It also limited industry marketing at the medical center. And in 2009, Stanford required its medical school faculty to publicly disclose on their website profiles if they received $5,000 or more for consulting activities from outside firms.
"Stanford has been concerned that the integrity of research and patient care" not be influenced by private financial interests, said Kathryn Gillam, who since January has directed Stanford's conflict of interest program.
UC San Francisco requires its faculty to report funds from outside of the university and limits such payments to $20,000 per year, or less in some departments. Faculty members cannot spend more than 21 days per year on outside industry activities.
Direct payments to doctors raise the most questions, but critics also worry about bias when drug companies pay for research, which Stanford and UCSF accept.
Lisa Bero, a professor of clinical pharmacy and health policy at UCSF who studies bias and conflict of interest, and others recently published a study that found an association between industry funding of research and a favorable outcome for the company's product.
"There are many, many ways to influence the outcome of drug studies," she said. "We need studies that aren't done by the people who profit from the outcome."
The Los Angeles Daily News reporter Susan Abram and ProPublica contributed to this report. Sandy Kleffman covers health. Contact her at 510-293-2478. Follow her at Twitter.com/skleffman.