Physicians and patients must unite to combat unfair business practices that increase costs, but not care

On Aug. 29, three prescription data-mining companies sued the state of Maine. These companies purchase the prescription writing histories of individual physicians from pharmacies and sell them to pharmaceutical companies.

Maine recently passed a law that allows physicians to decide whether they want their prescription practices collected and sold to pharmaceutical companies. When this statute goes into effect, Maine physicians will easily be able to “opt out” of the system. (There is a similar statute going into effect in Vermont that will require physicians to “opt in” to the system, should they so choose.)

Why have two states with small populations received such attention from large data-mining companies? They are afraid of a trend that will hurt their bottom line, and are willing to spend money to stop it. By fighting this action here, they can discourage similar legislation throughout the country.

The lawsuit alleges one of the companies’ major concerns is patient safety. The information they collect, however, lacks individual patient data and therefore cannot be used to protect specific patients; it is simply lists of prescriptions attached to the prescriber – not the patient.

Other means of contacting patients already exist, should there be a viable safety concern, such as pharmacy records (which are linked to patient names) and pharmacy benefit managers who, by law, must act on behalf of patients. For instance, this was how patients were contacted regarding concerns about Avandia, a controversial diabetes drug alleged to cause heart damage.

Why should the public care about this?

These data-mining companies sell this information to pharmaceutical companies so their sales representatives can tailor presentations for individual physicians. This has the effect of encouraging physicians to prescribe expensive newer medications that may, or may not, be more effective or safer for the patient.

Whether or not these products are better, the increased prescribing of new medicines certainly adds to the company profits and increases the cost for the system, and ultimately, increases the costs for the public.

John Abramson, a Massachusetts family physician, wrote a compelling book, “Overdosed America,” which explores and explains the pharmaceutical industry’s overwhelming influence on the practice of medicine. He writes, “[T]he upshot is that the drug companies know much more about doctors’ prescribing habits than doctors know themselves. They also understand that it doesn’t really matter that drug reps don’t know as much about medicine, or that their materials fail to present the whole truth. The only thing that matters is how to influence doctors.”

There is a lot of money at stake. The American Medical Association makes $40 million annually by selling detailed physician information on all physicians, whether they are members of the AMA or not, to pharmaceutical companies.

The drug companies then pair the information from the data-mining companies (which doctors prescribe which medications) with the AMA information (where the physician practices, their specialty, their year of graduation from medical school, etc.) and give synopses to representatives who will pitch the physicians in their offices.

Surprisingly, many, if not most, physicians are completely unaware of this practice. Pharmaceutical representatives use prescribing information and change their pitch to either show their product in a better light compared to a more prescribed competitor, or support the physician’s recent prescribing decisions.

Most physicians feel that they are immune to the sales pitches of pharmacy representatives in their offices, but data demonstrates that this practice works. It is an expensive approach for the pharmaceutical companies, so they are undoubtedly sure that it is effective.

So, now what?

A new physician group established in 2005, the National Physicians’ Alliance, is working to ensure equitable, affordable, high-quality health care for all people. The NPA believes it is time for physicians and patients to partner to fight industries striving to influence the care provided, the tests ordered and the medications prescribed.

Fighting this lawsuit is one critical step. Encouraging physicians to opt-out is another.

It’s time to return medicine to its core values of patient care: service, integrity and advocacy.

Dr. Bethany Picker is a family physician in Lewiston, and member of the National Physicians’ Alliance. Dr. Benjamin Schaefer is a cardiologist in Bangor, and member of the NPA’s board of directors.