U.S. doctors object to data-mining
By Stephanie Saul The New York Times
THURSDAY, MAY 4, 2006
Although virtually unknown to consumers, the information has long been considered the most potent weapon in pharmaceutical sales: computerized dossiers showing which physicians were prescribing what drugs.
Armed with such data, a drug sales representative can put pressure on a doctor to write more prescriptions for a name-brand medicine, or fewer orders for a competitor’s drug.
But a rebellion is under way among some doctors, who consider the data-gathering an intrusion that feeds overzealous marketing among the estimated 90,000 drug company representatives in the United States.
Public officials are also weighing in. A vote on a state bill to clamp down on the practice was scheduled for Thursday in New Hampshire, and similar bills have been introduced in other states, including Arizona and West Virginia.
To appease the doctors and attempt to stave off state restrictions, the American Medical Association will soon give individual physicians the choice of declaring their prescription records off limits to drug sales representatives. The new measure is viewed as a self- policing move that the drug industry and the association, which has lucrative contracts with data-mining companies, hope will keep states from banning sales of prescription data altogether.
If the AMA’s effort succeeds, “legislators will turn their attention elsewhere, and the industry can hang on to one of its most valuable data sources,” according to an article this week in the industry trade magazine Pharmaceutical Executive, which was co-written by an AMA official and an executive with the leading vendor of prescription data.
Even many critics concede that patients’ privacy is apparently not an issue, because the tracking systems identify only the prescribing doctors, not patients. But many doctors find the use of the data by sales representatives an intrusion into the way they practice medicine.
“These doctors were outraged that people came into their office and talked to them about how many times they prescribed a particular drug,” said Dr. John Lewin, the chief executive of the state medical association in California, one of the states where complaints about the current system arose.
The California group is beginning its own program under which doctors who do not “opt out” under the AMA system will get comparisons of their prescribing patterns in 17 classes of drugs from the data companies, said Lewin, who added that the program was being started as a pilot effort that he hoped would be extended statewide.
Among the doctors who raised an early complaint about the system was Dr. Brad Drexler, an obstetrician in Healdsburg, California, who said he was surprised four years ago when pharmaceutical representatives began thanking him for writing prescriptions - the first time he realized the drug representatives had information that he assumed was private.
“I think it adds to the potential that physicians could be targeted one way or another for perks,” Drexler said, alluding to the practice by drug companies of deciding which doctors to reward with the gifts, meals and other perquisites that sales representatives have dangled over the years, or to gauge which physicians might be worthy of being signed up as paid speakers or consultants.
“It’s the most powerful tool a drug rep has, for sure,” said Jamie Reidy, a former drug salesman who was fired last year by Eli Lilly after writing “Hard Sell,” a humorous expose of the pharmaceutical industry. Reidy said the prescription data received by pharmaceutical representatives were updated every two weeks. The information also sometimes characterizes each physician’s prescribing patterns, Reidy said.
For example, “early prescribers” - also known among drug representatives as “cowboys,” according to Reidy - are doctors who start prescribing a drug as soon as it comes on the market. If you are a drug sales representative, “you go to see that doctor in the first week,” Reidy said.
Although the drug representatives are told not to share the prescribing details with doctors, some nonetheless have confronted doctors with the data. A representative might become frustrated, for example, if after providing numerous lunches to a doctor’s staff, the data show that the doctor is not writing prescriptions for the company’s drug.
State Representative Cindy Rosenwald, a New Hampshire Democrat who is the lead sponsor of that state’s bill, said she was motivated partly by high Medicaid drug costs, which she said she believed had been driven up by the pharmaceutical industry’s success in coaxing doctors to prescribe expensive brand-name drugs.
“To me this is a money issue,” Rosenwald said. “When I look at our state’s budget, the fastest-growing part of the Medicaid program here in New Hampshire is for prescription drugs. It’s an enormous cost for a small state like New Hampshire.”
A Gallup Poll commissioned by the American Medical Association in 2004 found that two-thirds of doctors surveyed opposed the release of such data to pharmaceutical representatives but that 77 percent felt that an opt-out program would alleviate concerns about the release of data.
Nearly a quarter of the doctors were not even aware that the pharmaceutical industry had access to such information.
That same year, the American College of Physicians requested that the AMA prohibit the release or sale of doctors’ prescribing
And legislative efforts in California to stop the use of prescribing data that were ultimately stymied…
Doctors take on drug makers
Physicians oppose the tracking of their prescriptions for marketing purposes.
The Sacramento Bee
March 10, 2004
Author: Lisa Rapaport
Bee Staff Writer
Estimated printed pages: 3
California doctors want state lawmakers to give physicians the ability to stop drug companies from using information about their prescription habits in marketing campaigns.
During a state Senate committee hearing Tuesday, physicians urged legislators to pass a bill sponsored by the California Medical Association that would restrict a common industry practice known as “detailing,” or sales efforts targeted at individual doctors to influence which drugs they prescribe to patients.
Steve Thompson, lobbyist for the Medical Association, said the estimated $1.5 billion drug makers spend on physician detailing and marketing each year in California harms patients because it encourages doctors to use expensive brand name drugs even when cheaper generic equivalents exist.
“This is about physicians’ right to privacy, but this is also about stopping a practice that is disadvantageous to patients,” Thompson said.
The bill, AB 262 by Assemblywoman Wilma Chan, D-Ala-meda, would create a “do not sell list” modeled on “do not call lists” for telemarketers. It would stop pharmacies from selling prescription data of doctors who ask that their information not be used for marketing. The bill would not block disclosure of physicians’ prescription data for public health research.
Under current law, doctors, unlike patients, have no specific right to privacy. Federal law prohibits the sale of prescription data that includes patients’ names.
Drug makers, however, do not need the consent of patients or doctors to buy physicians’ prescription data. The data is collected by drugstores that fill an estimated 260 million prescriptions in the state each year. Drug makers that purchase the information can identify individual doctors and determine the specific drugs they most commonly prescribe.
Pharmaceutical companies use the data to tailor marketing messages to individual physicians, a practice drug makers say benefits doctors and patients alike.
“Manufacturers use the data to target specific physicians with drug safety information, notify doctors about recalled drugs, and identify certain physicians for participation in clinical trials,” said Kassy Perry, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, a drug industry trade group.
Detailing is so prevalent in the industry that medical students often get training on how to handle sales pitches as part of their formal education.
Consumer and patient advocates have loudly condemned the practice as a major cause of skyrocketing prescription costs. The nation’s biggest drug makers spend more than $2 on advertising and marketing for every $1 devoted to developing new medicine, according to the advocacy group, Families USA.
In response to consumer and physician backlash against drug makers’ lavish marketing practices, most major physician groups and hospital chains have detailing policies that strictly limit the perks doctors can accept from sales representatives.
Free samples of drugs are typically allowed because doctors often give these to uninsured patients. But free steak dinners or fancy trips to tropical locales for industry-sponsored education are frowned upon, or banned outright, by most health systems.
Still, detail representatives are a regular fixture in area physician offices.
Joanne Berkowitz, an urgent-care physician at The Doctors Center in Fair Oaks, said drug sales representatives drop by her office all the time, offering, in addition to needed sample pills, all manner of pens, notepads, magnets and other gadgets emblazoned with the brand name of a drug they want to promote.
“I take only the free samples I know my uninsured patients will use,” Berkowitz said. “Almost all the stuff with their names on it, I throw out or give to my staff to use at home. I don’t want that name around the office influencing what people do.”
Some doctors concede the marketing probably works despite their best efforts to disregard its message.
“We all like to think we’re not influenced, but I’m sure the drug companies wouldn’t spend all this money on marketing if they didn’t have proof to the contrary,” said Richard Pan, a pediatrician at the University of California, Davis, Medical Center in Sacramento.
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The Bee’s Lisa Rapaport can be reached at (916) 321-1005 or lrapaport@sacbee.com.
Caption:
Wilma Chan
The legislation by the Alameda assemblywoman would create a “do-not-sell” list for doctors.
Edition: METRO FINAL
Section: BUSINESS
Page: D1
Copyright 2004 The Sacramento Bee
Record Number: SAC_0404897769
(not the entire text but some of the relevant language)
328:1 New Sections; Pharmacists and Pharmacies; Prescription Information to be Kept Confidential. Amend RSA 318 by inserting after section 47-e the following new sections:
318:47-f Prescription Information to be Kept Confidential. Records relative to prescription information containing patient-identifiable and prescriber-identifiable data shall not be licensed, transferred, used, or sold by any pharmacy benefits manager, insurance company, electronic transmission intermediary, retail, mail order, or Internet pharmacy or other similar entity, for any commercial purpose, except for the limited purposes of pharmacy reimbursement; formulary compliance; care management; utilization review by a health care provider, the patient’s insurance provider or the agent of either; health care research; or as otherwise provided by law. Commercial purpose includes, but is not limited to, advertising, marketing, promotion, or any activity that could be used to influence sales or market share of a pharmaceutical product, influence or evaluate the prescribing behavior of an individual health care professional, or evaluate the effectiveness of a professional pharmaceutical detailing sales force. Nothing in this section shall prohibit the dispensing of prescription medications to a patient or to the patient’s authorized representative; the transmission of prescription information between an authorized prescriber and a licensed pharmacy; the transfer of prescription information between licensed pharmacies; the transfer of prescription records that may occur in the event a pharmacy ownership is changed or transferred; care management educational communications provided to a patient about the patient’s health condition, adherence to a prescribed course of therapy or other information about the drug being dispensed, treatment options, or clinical trials. Nothing in this section shall prohibit the collection, use, transfer, or sale of patient and prescriber de-identified data by zip code, geographic region, or medical specialty for commercial purposes. In addition to other appropriate remedies under this chapter, a violation of this section is an unfair or deceptive act or practice within the meaning of RSA 358-A:2. Any right or remedy set forth in RSA 358-A may be used to enforce the provisions of this section.
