Drug companies typically will often use any means possible to increase their profits. There is a line where good business practice crosses the line into violations of privacy and violations of the rights of doctors and patients. This is particularly a concern for us with psychiatric drugs, but there is a broader problem as well. As reported in The News Tribune from Washing State
Seattle pediatrician Rupin Thakkar’s first inkling that the pharmaceutical industry was peering over his shoulder onto 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.”
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 to better educate physicians about new drugs.
The issue is entering politics. 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.
The concerns are not merely about privacy. Proponents of legislation say using such detailed data for drug marketing serves mainly to influence doctors to prescribe more expensive medicines.
“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.) “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.
The AMA last year began allowing doctors to “opt out” and shield 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 Lazarus, a Denver psychiatrist and high-ranking AMA official.
The New Hampshire court 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.
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 magazine subscribers.
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 rep 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. “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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