Billions of dollars every year flow from drug company coffers into the pockets of doctors nationwide. NPR and the investigative nonprofit ProPublica have created a database of those payments showing more than a thousand North and South Carolina doctors receiving money from drug companies. You already know that big pharmaceutical companies like Eli Lilly spend billions pushing their drugs in ubiquitous TV commercials. But did you know drug companies also write checks directly to doctors? For example, Eli Lilly paid Greensboro family physician Sloan Manning nearly $98,000 over the last 18 months to review marketing materials about depression medication Cymbalta and make speeches about the drug to other doctors. Manning is one of 16 North Carolina doctors who received more than $100,000 from drug companies in the last year and a half. He also says he frequently prescribes Cymbalta to his patients. Doesn't that create an ethical conflict? "None at all," says Dr. Manning. "My primary focus is my patients' well-being and my prescription habits are focused in and around that. If the medicines I helped promote were not indicated for, or helpful for, my patients, I wouldn't prescribe them at all." But medical ethicist Rosemarie Tong at UNC Charlotte says the line is not always so clear. "Part of the deal in many instances (is) once they buy the company line so to speak, then they promote the product in their practice," says Tong. "They're not being paid to prescribe the drugs, but it's sort of an out-flowing of having had good relations with that particular pharmaceutical company." Numerous studies over the years have shown payment from pharmaceutical companies does make a doctor more likely to prescribe a drug. But Dr. Manning says his patients benefit from his drug company work because of the expertise he has developed. He also says he's open about his drug company work when his patients ask. "I don't think it matters to my patients whether I consult with these companies because it's very clear to my patients I am absolutely for them and they are first and foremost in my mind and priorities," says Manning. The North Carolina physician who received the most money from drug companies in the last 18 months is David Rizzieri - an oncologist at the Duke Medical Center in Durham who received $240,150. The highest in the Charlotte area was family doctor Richard Rachima with pharmaceutical payments of $147,337. More than a thousand other doctors in the Carolinas received smaller payments ranging from a few hundred to several thousand dollars. Their names are now available in a new online search tool here. Health reform advocate Adam Linker of the North Carolina Justice Center says information in the new database should prompt patients to ask questions of their doctors. "You know, what exactly did you do for this drug company?" says Linker. "And also if there's something suspicious there - you're being prescribed a lot of drugs from a particular company and you're doctor's being paid by that company, not only do you want to talk to your doctor about it, you might also want to seek a second opinion." There's currently no legal limit to what pharmaceutical companies can pay doctors for consulting and speaking services. The American Medical Association guideline states only that the payment must be reasonable for the service rendered. The North Carolina Medical Board has not created any more specific rule governing the issue, mainly because it hasn't come up. "Since we haven't had complaints on this topic, the board hasn't had occasion to act," says NC Medical Board legal director Thom Mansfield. "Now that doesn't mean it's not a problem. It just means it hasn't been brought to the attention of the board." One possible reason there haven't been any complaints about the flow of money from pharmaceutical companies to North Carolina doctors is those companies only began releasing that information in the last two years. ProPublica has now compiled those payments into a single database so patients can easily learn how much their doctors are being paid by the companies whose names are in their medicine cabinet.