Doctors, Legislators Resist Drugmakers' Prying Eyes

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Doctors, = Legislators=20 Resist Drugmakers' Prying Eyes

By Christopher Lee
Washington Post Staff = Writer
Tuesday,=20 May 22, 2007; A01

Seattle pediatrician Rupin Thakkar's first inkling that the = pharmaceutical=20 industry was peering over his shoulder and into his prescription pad = came in a=20 letter from a drug representative about the generic drops Thakkar = prescribes to=20 treat infectious pinkeye.

In the letter, the salesperson wrote that Thakkar was causing his = patients to=20 miss more days of school than they would if he put them on Vigamox, a = more=20 expensive brand-name medicine made by Alcon Laboratories.

"My initial thought was 'How does she know what I'm prescribing?' " = Thakkar=20 said. "It feels intrusive. . . . I just feel strongly that medical = encounters=20 need to be private."

He is not alone. Many doctors object to drugmakers' common practice = of=20 contracting with data-mining companies to track exactly which medicines=20 physicians prescribe and in what quantities -- information marketers and = salespeople use to fine-tune their efforts. The industry defends the = practice as=20 a way of better educating physicians about new drugs.

Now the issue is bubbling up in the political arena. Last year, New = Hampshire=20 became the first state to try to curtail the practice, but a federal = district=20 judge three weeks ago ruled the law unconstitutional.

This year, more than a dozen states have considered similar = legislation,=20 according to the National Conference of State Legislatures. They include = Arizona, Illinois, Kansas, Maine, Massachusetts, New York, Nevada, Rhode = Island,=20 Texas, Vermont and Washington, although the results so far have been = limited.=20 Bills are stalled in some states, and in others, such as Maryland and = West=20 Virginia, they did not pass at the committee level.

The concerns are not merely about privacy. Proponents say using such = detailed=20 data for drug marketing serves mainly to influence physicians to = prescribe more=20 expensive medicines, not necessarily to provide the best treatment.

"We don't like the practice, and we want it to stop," said Jean=20 Silver-Isenstadt, executive director of the National Physicians = Alliance, a=20 two-year-old group with 10,000 members, most of them young doctors in = training.=20 (Thakkar is on the group's board of directors.) "We think it's a = contaminant to=20 the doctor-patient relationship, and it's driving up costs."

The American Medical Association, a larger and far more established = group,=20 makes millions of dollars each year by helping data-mining companies = link=20 prescribing data to individual physicians. It does so by licensing = access to the=20 AMA Physician Masterfile, a database containing names, birth dates, = educational=20 background, specialties and addresses for more than 800,000 doctors.

After complaints from some members, the AMA last year began allowing = doctors=20 to "opt out" and shield their individual prescribing information from=20 salespeople, although drug companies can still get it. So far, 7,476 = doctors=20 have opted out, AMA officials said.

"That gives the physician the choice," said Jeremy A. Lazarus, a = Denver=20 psychiatrist and high-ranking AMA official.

Some critics, however, contend that the AMA's opt-out is not well = publicized=20 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=20 legislative efforts to curb the use of prescribing data will be, but the = state=20 attorney general has promised to appeal. And state Rep. Cindy Rosenwald = (D), the=20 law's chief sponsor, vowed not to give up the fight.

"In this case, commercial interests took precedence over the = interests of the=20 private citizens of New Hampshire," Rosenwald said. "This is like = letting a drug=20 rep into an exam room and having them eavesdrop on a private = conversation=20 between a physician and a patient."

The April 30 ruling by U.S. District Judge Paul Barbadoro, nominated = to the=20 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=20 doctors who write the most prescriptions and go after them the way = publishers=20 court people who subscribe to lots of magazines. They zero in on = physicians who=20 prescribe a competitors' drug and target them with campaigns touting = their own=20 products. Salespeople chart the changes in a doctor's prescribing = patterns to=20 see whether their visits and offers of free meals and gifts are having = the=20 desired effect.

"It's a key weapon in determining how we want to tailor our sales = pitch,"=20 said Shahram Ahari, a former drug detailer for Eli Lilly who is now a = researcher=20 at the University of California at San Francisco's School of Pharmacy. = "The=20 programs give them [doctors] a score of 1 to 10 based on how much they = write.=20 Once we have that, we know who our primary targets are. We focus our = time on the=20 big [prescription] writers -- the 10s, the 9s, and then less so on the = 8s and=20 7s. . . . We're dealing with individual physicians who might give us the = biggest=20 dividend for our investment."

Ahari said he used the data to tout the virtues of Eli Lilly's = antidepressant=20 Prozac to doctors who favored the rival drug Effexor -- noting, for = example,=20 that its longer half-life meant that if patients missed a dose over a = weekend,=20 they would experience less severe agitation and other withdrawal = symptoms that=20 might prompt them to call their doctor. He did not mention the rival = drug by=20 name or disclose that he knew the physician's prescribing habits, he = said.

Data-mining companies and the pharmaceutical industry argue that the = practice=20 has value far beyond the corporate bottom line. The information helps = companies,=20 federal health agencies and others educate physicians about drugs, track = whether=20 prescribing habits change in response to continuing medical education = programs,=20 and promote higher-quality care, they say. They stress that patient = names are=20 encrypted early in the process and cannot be accessed, even by the = data-mining=20 companies.

A drug company might use the database to help determine whether = physicians=20 prescribing a particular high-risk drug have undergone required training = about=20 the medicine, said Marjorie E. Powell, senior assistant general counsel = for the=20 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=20 plan that the FDA [Food and Drug Administration] is requiring you to = implement=20 in order to allow the drug to be on the market."

The prescribing data also let "the company do more targeted = marketing, which=20 lowers the total costs of its marketing," she said.

Randolph Frankel, a vice president at IMS Health Inc., the = Connecticut-based=20 health-data-mining company that challenged the New Hampshire law, said = the more=20 a drug representative knows about a physician, the easier it is to = provide=20 information that meets the needs of the doctor's practice.

"We are about more information and more education, and not less," = said=20 Frankel, whose company had operating revenue of $1.75 billion in 2005, = not all=20 of it from sales to drugmakers. "The vast majority of physicians welcome = these=20 people as part of the overall educational process about drugs and their = use. And=20 any doctor in the country can close the door to these sales reps. It = doesn't=20 require legislation to do that."