[privacy] Doctors Object to Gathering of Drug Data

["Richard M. Smith" <rms () bsf-llc com>]

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May 4, 2006

Doctors Object to Gathering of Drug Data 

By STEPHANIE
<http://topics.nytimes.com/top/reference/timestopics/people/s/stephanie_saul
/index.html?inline=nyt-per> SAUL

Although virtually unknown to consumers, the information has long been
considered the most potent weapon in pharmaceutical sales — computerized
dossiers showing which physicians are prescribing what drugs. Armed with
such data, a drug sales representative can pressure a doctor to write more
prescriptions for a name-brand medicine or fewer orders for a competitor's
drug. 

But now a rebellion is under way by some doctors, who consider the
data-gathering an intrusion that feeds overzealous sales practices among the
nation's estimated 90,000 drug company representatives. Public officials are
also weighing in. A vote on a state bill to clamp down on the practice is
scheduled for today in New Hampshire, and similar bills have been introduced
in other states, including Arizona and West Virginia. 

To appease the doctors and try to stave off the 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 A.M.A., which has lucrative contracts with data-mining
companies, hope will keep states from banning sales of prescription data
altogether. 

If the A.M.A 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 A.M.A. 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 C. 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 A.M.A. system will get comparisons of their
prescribing patterns in 17 classes of drugs from the data companies, said
Dr. 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, Calif., who said he was
surprised four years ago when pharmaceutical representatives began thanking
him for writing prescriptions — the first time he realized that the drug
representatives had information he assumed was private. 

"I think it adds to the potential that physicians could be targeted one way
or another for perks," said Dr. Drexler, alluding to the practice by drug
companies of deciding which doctors to reward with the gifts, meals and
other perks that sales representatives have dangled over the years, or to
gauge which physicians might be worthy of signing 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
<http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.m
arketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=LLY> Lilly &
Company after writing "Hard Sell," a humorous exposé of the pharmaceutical
industry. Mr. Reidy said the pharmaceutical representatives received updated
prescription data every two weeks. The information also sometimes
characterizes each physician's prescribing patterns, Mr. Reidy said. 

For example, "early prescribers" — also known among drug representatives as
"cowboys," according to Mr. Reidy — are those doctors who start prescribing
a drug as soon as it comes to market. If you are a drug sales
representative, "you go to see that doctor in the first week," Mr. 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. 

"It just creates a weird atmosphere," Mr. Reidy said. 

State Representative Cindy Rosenwald of New Hampshire, lead sponsor of her
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," Ms. 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." 

Ms. Rosenwald's legislation has been adopted by the New Hampshire House and
is tentatively set for a Senate vote this afternoon. 

She said she did not believe the A.M.A.'s self-policing measure would
provide enough protection, partly because even if doctors specify that their
prescription records not be available to drug sales representatives, the
information would still be sold to drug companies for other marketing and
research purposes. The drug companies, she said, would be on their honor not
to share the data with their sales staffs. A Gallup Poll commissioned by the
A.M.A. in 2004 found that two-thirds of doctors surveyed were opposed to the
release of such data to pharmaceutical representatives, and 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 A.M.A.
prohibit the release or sale of doctors' prescribing information. The
college represents internists and related medical subspecialties, while the
A.M.A. is a broader trade group whose members include all doctors, including
surgeons.

Dr. Dean Abramson, an Iowa physician, is among the doctors who plan to opt
out under the new A.M.A. process, which will involve a sign-up registry that
goes into use on July 1. His opposition began nearly a decade ago, he
recalled, when a representative from TAP Pharmaceutical Products let slip
during a sales call that Dr. Abramson wrote more prescriptions for Prevacid,
a treatment for acid reflux, than any other doctor in the state. 

"I was pretty surprised that they kept that data, and I was not happy at
all," Dr. Abramson said. "I said, 'Why is that data even kept?' She didn't
really give me an answer." 

Since then, Dr. Abramson has become something of an activist against the
lunches and gifts that the pharmaceutical industry dispenses to doctors. His
gastroenterology group in Cedar Rapids, Iowa, accepts neither, he said. 

The leading compiler and vendor of prescription data is IMS
<http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.m
arketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=RX> Health, a
publicly traded company based in Fairfield, Conn., that had revenue last
year of $1.75 billion. IMS and its competitors gather the data through
contracts with retail pharmacy chains and companies that manage drug plans
for insurers, then sell it to pharmaceutical companies. 

IMS and its competitors — the main ones are Verispan, Dendrite
<http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.m
arketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=DRTE>
International and a Dutch company, Wolters
<http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.m
arketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=WTKWY> Kluwer —
also pay the A.M.A. for access to its repository of information on
approximately one million doctors who are graduates of American medical
schools, as well as foreign medical school graduates licensed in the United
States. 

The A.M.A., which calls this repository Masterfile, begins collecting the
information when a doctor enters medical school. Over doctors' careers,
additional material includes information on their board certifications,
types of practice and disciplinary records. The Masterfile information is
among data that companies like IMS use in developing physician profiles.

In an interview, IMS officials said they believed that state efforts to
curtail their activities were misguided. "Limiting the access to our data
will not stop pharmaceutical marketing," said Robert J. Hunkler, whose job
with the company includes serving as a liaison with the medical profession.
Mr. Hunkler also says that the data his company collects is valuable for
medical research and is sometimes shared free with researchers. 

Mr. Hunkler was a co-author of the Pharmaceutical Executive article
describing the new A.M.A. program. The other writer was Robert A. Musacchio,
the A.M.A.'s senior vice president for publishing and business services.
While Mr. Musacchio declined to disclose the exact value of its Masterfile
contracts with the four main data companies, he said that the organization
made $40 million a year selling information, which also includes mailing
lists and a service through which hospitals can check the credentials of
doctors. Mr. Musacchio said that doctors had always been able to put a "no
contact" status on their Masterfile record, meaning their name would not be
licensed for marketing by mail, telephone or fax. 

The A.M.A.'s new registry, administered partly through a Web site, will
enable doctors listed in its Masterfile to indicate that they do not want
their prescribing data shared with pharmaceutical sales representatives. The
decision will remain in force for three years. 

And yet, even those doctors' prescription information will still be
collected and transmitted to drug companies, whose other uses of the data
include tallying bonuses paid to pharmaceutical representatives, which are
based on sales. "What we've always stressed is that physicians have rights
and they can always tell pharmaceutical representatives that they don't want
to be called upon," said Mr. Musacchio. But he said the organization had
always made clear to the pharmaceutical industry that its representatives
should never "badger or embarrass or harass" physicians.

"They sometimes try to get their point across a little too strongly," he
said. 


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