Doctors Object to Gathering of Drug Data
By STEPHANIE SAUL
Published: 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 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 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 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 International and
a Dutch company, Wolters 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.
http://www.nytimes.com/2006/05/04/business/04prescribe.html?th&emc=th