Doctors,
Legislators Resist Drugmakers' Prying Eyes
Christopher
Lee
Washington Post, May 22 2007
Seattle
pediatrician Rupin Thakkar's first inkling that the pharmaceutical
industry was peering over his shoulder and into his prescription pad came
in a letter from a drug representative about the generic drops Thakkar
prescribes to treat infectious pinkeye.
In the letter, the salesperson wrote that Thakkar was causing his
patients to miss more days of school than they would if he put them on
Vigamox, a more expensive brand-name medicine made by Alcon Laboratories.
"My initial thought was 'How does she know what I'm prescribing?'
" Thakkar said. "It feels intrusive. . . . I just feel strongly
that medical encounters need to be private."
He is not alone. Many doctors object to drugmakers' common practice of
contracting with data-mining companies to track exactly which medicines
physicians prescribe and in what quantities -- information marketers and
salespeople use to fine-tune their efforts. The industry defends the
practice as a way of better educating physicians about new drugs.
Now the issue is bubbling up in the political arena. Last year,
New Hampshire
became the first state to try to curtail the practice, but a federal
district judge three weeks ago ruled the law unconstitutional.
This year, more than a dozen states have considered similar
legislation, according to the National Conference of State Legislatures.
They include
Arizona
,
Illinois
,
Kansas
,
Maine
,
Massachusetts
,
New York
,
Nevada
,
Rhode Island
,
Texas
,
Vermont
and
Washington
, although the results so far have been limited. Bills are stalled in some
states, and in others, such as
Maryland
and
West Virginia
, they did not pass at the committee level.
The concerns are not merely about privacy. Proponents say using such
detailed data for drug marketing serves mainly to influence physicians to
prescribe more expensive medicines, not necessarily to provide the best
treatment.
"We don't like the practice, and we want it to stop," said
Jean Silver-Isenstadt, executive director of the National Physicians
Alliance, a two-year-old group with 10,000 members, most of them young
doctors in training. (Thakkar is on the group's board of directors.)
"We think it's a contaminant to the doctor-patient relationship, and
it's driving up costs."
The American Medical Association, a larger and far more established
group, makes millions of dollars each year by helping data-mining
companies link prescribing data to individual physicians. It does so by
licensing access to the AMA Physician Masterfile, a database containing
names, birth dates, educational background, specialties and addresses for
more than 800,000 doctors.
After complaints from some members, the AMA last year began allowing
doctors to "opt out" and shield their individual prescribing
information from salespeople, although drug companies can still get it. So
far, 7,476 doctors have opted out, AMA officials said.
"That gives the physician the choice," said Jeremy A.
Lazarus, a
Denver
psychiatrist and high-ranking AMA official.
Some critics, however, contend that the AMA's opt-out is not well
publicized or tough enough, noting that doctors must renew it every three
years.
The
New Hampshire
court's ruling has raised new doubts about how effective legislative
efforts to curb the use of prescribing data will be, but the state
attorney general has promised to appeal. And state Rep. Cindy Rosenwald
(D), the law's chief sponsor, vowed not to give up the fight.
"In this case, commercial interests took precedence over the
interests of the private citizens of
New Hampshire
," Rosenwald said. "This is like letting a drug rep into an exam
room and having them eavesdrop on a private conversation between a
physician and a patient."
The April 30 ruling by U.S. District Judge Paul Barbadoro, nominated to
the federal bench in 1992 by President George H. W. Bush, called the
state's pioneering law an unconstitutional restriction on commercial
speech.
Since at least the early 1990s, drug companies have used the data to
identify doctors who write the most prescriptions and go after them the
way publishers court people who subscribe to lots of magazines. They zero
in on physicians who prescribe a competitors' drug and target them with
campaigns touting their own products. Salespeople chart the changes in a
doctor's prescribing patterns to see whether their visits and offers of
free meals and gifts are having the desired effect.
"It's a key weapon in determining how we want to tailor our sales
pitch," said Shahram Ahari, a former drug detailer for Eli Lilly who
is now a researcher at the University of California at San Francisco's
School of Pharmacy. "The programs give them [doctors] a score of 1 to
10 based on how much they write. Once we have that, we know who our
primary targets are. We focus our time on the big [prescription] writers
-- the 10s, the 9s, and then less so on the 8s and 7s. . . . We're dealing
with individual physicians who might give us the biggest dividend for our
investment."
Ahari said he used the data to tout the virtues of Eli Lilly's
antidepressant Prozac to doctors who favored the rival drug Effexor --
noting, for example, that its longer half-life meant that if patients
missed a dose over a weekend, they would experience less severe agitation
and other withdrawal symptoms that might prompt them to call their doctor.
He did not mention the rival drug by name or disclose that he knew the
physician's prescribing habits, he said.
Data-mining companies and the pharmaceutical industry argue that the
practice has value far beyond the corporate bottom line. The information
helps companies, federal health agencies and others educate physicians
about drugs, track whether prescribing habits change in response to
continuing medical education programs, and promote higher-quality care,
they say. They stress that patient names are encrypted early in the
process and cannot be accessed, even by the data-mining companies.
A drug company might use the database to help determine whether
physicians prescribing a particular high-risk drug have undergone required
training about the medicine, said Marjorie E. Powell, senior assistant
general counsel for the Pharmaceutical Research and Manufacturers of
America, a trade association.
"If you don't have that information, then you are in a very
difficult situation," Powell said. "There is no way you can
implement the risk-management plan that the FDA [Food and Drug
Administration] is requiring you to implement in order to allow the drug
to be on the market."
The prescribing data also let "the company do more targeted
marketing, which lowers the total costs of its marketing," she said.
Randolph Frankel, a vice president at IMS Health Inc., the
Connecticut-based health-data-mining company that challenged the
New Hampshire
law, said the more a drug representative knows about a physician, the
easier it is to provide information that meets the needs of the doctor's
practice.
"We are about more information and more education, and not
less," said Frankel, whose company had operating revenue of $1.75
billion in 2005, not all of it from sales to drugmakers. "The vast
majority of physicians welcome these people as part of the overall
educational process about drugs and their use. And any doctor in the
country can close the door to these sales reps. It doesn't require
legislation to do that."
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