‘Prescriber Profiles’ Target Doctors
While pharmaceutical companies have long targeted doctors to promote new medications, recently drug marketers have begun compiling "prescriber profiles," or doctors' "prescribing patterns," often without the doctors' knowledge, the New York Times reports. The profiles are the "centerpiece of an increasingly vigorous ... effort by drug makers to sway doctors' prescribing habits," the Times reports. The profiles also have only recently become available, as computer technology has been more widely used to track physician and prescription information. To compile the profiles, drug makers buy information from pharmacies, the federal government and the American Medical Association.
Although the records pharmacies sell to drug makers do not include patient or prescribing doctor names, they "typically" do include identification numbers issued to doctors by the Drug Enforcement Administration "for the purpose of tracking controlled substances." The government sells a list of the numbers with corresponding doctor names, for as much as $10,200 per month, depending on how widely the list will be distributed. In addition, the AMA sells a "physicians' master file," which includes "detailed personal and professional information," as well as the D.E.A. number of member physicians. Pharmaceutical companies consider this list the "gold standard," the Times reports. Once the profile is assembled, pharmaceutical manufacturers can identify who prescribes the most or least of a particular drug within a single ZIP code, county, state or entire country.
The profiles "play a significant role" in how drug companies court doctors, helping determine which doctors should be offered "certain perks" to entice them into prescribing a specific medication, the Times reports. West Palm Beach, Fla., internist Dr. Bruce Moskowitz said, "Drug companies ask me, 'How can we change your prescribing, what would it take, do you want to serve as a consultant?' The schemes get more and more desperate." For example, in 1997, market research firm Boron, LePore & Associates hosted 10,400 "peer-to-peer meetings," in which "medical experts" presented information on medications to a select group of doctors, who often received a free meal and a stipend for attending.
Overall spending on promoting pharmaceuticals rose from $12.4 billion in 1998 to $13.9 billion last year, an increase of 10%. The spending and the dinners "are creating unease" for officials serving on the AMA's Council of Ethical and Judicial Affairs, which has published guidelines limiting what gifts doctors can accept. The council's chair, Dr. Herbert Rakatansky, said that compliance is voluntary, but "doctors routinely ignore the rules," which "are murky." Pharmaceutical companies and marketers maintain that the dinners are ways to educate doctors about new medications. But Rakatansky said that "99% of [the dinners] are shams," adding, "They are marketing devices and not true requests for information."
To address the council's concerns about doctors' acceptance of gifts, the AMA is "beginning an educational campaign" and dedicated "the bulk of its Nov. 1" journal issue to conflicts of interest in medicine. But some "prominent doctors" turn the blame back to the AMA, pointing out that the association "needs to address its own role, as a seller of information that helps drug marketers select which doctors to target," the Times reports. Sales of the AMA master file bring in about $20 million per year for the association. AMA officials would not say what they charge individual companies for the file, the Times reports. Dr. David Blumenthal, a Harvard Medical School professor of health policy, said of the practice, "It potentiates this gift giving, and implicitly endorses it." But former AMA President Dr. Thomas Reardon pointed out that even if the AMA did not sell its list, drug companies could obtain information about doctors from other sources.
Lawrence Gostin, a health privacy "expert" at Georgetown University Law Center, maintains that the prescribing profiles are a "fundamental violation" of patient-doctor privacy. He said, "We live in a society where, if you comb long enough and hard enough with sophisticated enough search tools, you can find just about everything. That doesn't mean it's all right for people to assemble it, make it easy and sell it" (Stolberg/Gerth, New York Times, 11/16).