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Dr. Eric Lindstrom, president of the Mississippi State Medical Association.

It's a new world. Gone are the glory days when that white coat signified the doctor knew best about how to treat his patients — and his business.

Because of outside corporate and government interferences, the profession has undergone dramatic changes. Physicians are now caught in the cross hairs between managed care, insurance companies, pharmacy benefit mangers and pharmaceutical reps trying to tell them how to run their business, how many prescriptions to write, and how to treat patients.

Even patients are getting more demanding.

Heated debates are ongoing between the American Medical Association (AMA), who attempts to protect and empower its own, and pharmaceutical companies. The ever-growing misuse of prescribing data for marketing purposes has led the AMA to develop the Physician Data Restriction Program, which gives doctors an opportunity to opt-out of releasing prescribing practices to pharmaceutical reps and a way to complain against them for violations. The AMA is also rapping at the door of companies to get them to stop marketing "ask your doctor" on drug ads.

Dr. Eric Lindstrom, president of the Mississippi State Medical Association, said although he is aware of the problems regarding misuse of prescribing data, to his knowledge there have been no complaints brought before the Mississippi board. There is a great concern, however, regarding drug company TV and magazine ads.

"You've got these TV spots and articles saying 'go ask your doctor.' Patients come in all the time and ask for a certain drug, convinced that's what they need," Lindstrom explained. "A lot of times, we haven't had a chance to research it on our own yet so we can't prescribe it. Sometimes, you'll lose them and they'll go somewhere else to get it. I understand the pharmaceutical companies spending millions of dollars to develop and study these drugs to get FDA approval and they have to make their money back. But doctors really do get caught in the middle between the pharmaceutical reps and patients seeing these ads."

Some physicians believe the use of prescribing data for marketing purposes is an invasion of physician privacy. Reps will tell them their "scripts," or number of prescriptions, for certain drugs are down and push them to prescribe more. Although reps deny it, mailers are sometimes received by patients with ads for a medicine they've taken or renewal notices. This practice skirts the fringes of HIPAA violations, which prohibit the release, selling or disclosing of patient information without patient consent. Privacy is no longer an issue if the information is gathered from prescribing data. Pharmaceutical researchers say they need the data to provide services to physicians.

"I have a DEA number that is my personal, private identification, not like the social security numbers that are out there everywhere," Lindstrom said. "But, somehow they're getting the information. For example, I prescribe a glaucoma medication. These reps can tell me how many prescriptions I've written for it and, I imagine, pinpoint the date it was written. There is pressure from pharmaceutical reps pushing their drugs."

Members of Pharmaceutical Research and Manufacturers of America (PhRMA) invested an estimated $39.4 billion in 2005 in discovering and developing new medicines. Industry-wide research and investment reached a record $51.3 billion in 2005.

PhRMA senior vice president Ken Johnson issued this statement: "Banning access to prescriber data could result in significant unintended consequences that may have an adverse impact on activities aimed at enhancing patient care and the appropriate use of medicines. Foreclosing all access to prescribing data could also hamper manufacturers' ability to alert physicians of important new information about medicines in a timely fashion."

According to Johnson, numerous healthcare entities would be negatively affected with a ban on prescribing data. For example, the FDA depends on pharmaceutical companies to relay critical drug information to physicians in case of recall, shortage or drug counterfeiting or tampering.

But Lindstrom said that doctors usually aren't the first to find out if there's a problem. In fact, they usually don't know until they've read it for themselves in something like USA Today.

There are also other issues at stake. The AMA licenses certain health information offices. Restricting the use of prescribing data would impact the business interest. Health insurance organizations (HIOs) would have to gather data from other organizations, which would lead to termination of their agreements with the AMA.

Rather than risk losing control of the data, the AMA is encouraging pharmaceutical companies to exercise responsible use of physician prescribing data through the use of its 2001 "Best Practice Guidelines for Use of Prescribing Data."

But the news is not all negative. Verisipan CEO Wayne P. Yetter said the new AMA restrictive policy could actually "open up additional opportunities for Verispan and clients."

Pharmaceutical companies will not be able to show their sales representatives specific prescribing information for physicians who opt-out. However, they will still be able to use the granular information in the corporate office, Yetter said. "Further, pharmaceutical companies will still be able to send specific messaging to representatives for opt-out physicians," he added.

To opt-out of sharing your prescribing information, visit www.ama-assn.org and log in with username and password to the Prescribing Data Information Center.


January 2007

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