How do Big Pharma know which doctors prescribe the latest and most expensive brand name drugs?
They have inside information on the prescribing habits of virtually every doctor in the United States. Pharmaceutical and device manufacturers buy this information from the American Medical Association and from companies that match the AMA's data with pharmacy records.
While such practices have gone on for years, the issue is expected to be a hot topic at this week's annual meeting of the AMA in Chicago, with some groups planning to protest during the gathering at the Hilton Chicago.
"Doctors are not aware that companies are out there that know every prescription a doctor prescribes," said Dr. John Santa, an internist at the Portland Veterans Affairs Medical Center and consultant to the Prescription Project, which is part of a coalition trying to curb drug companies' access to doctor prescribing information.
"Consumers should care because here's this very effective information and data system that is not being used to improve quality or safety of their care but to increase the sales of specific drugs, many of which are no more effective than much-cheaper alternatives," Santa said. "If these data-mining companies use this information in a systematic way to improve safety or quality, that would be different. But they don't. They use it for sales, and most doctors don't even know it's there."
The controversy also has triggered bills in more than a dozen state legislatures, including Illinois, as lawmakers see a worrisome connection between the release of such data to the drug and device manufacturers and consumers' rising health-care costs.
In its defense, the AMA says such information has been available for years and has helped get public health and education to the right doctors when new products or devices have come on the market.
The AMA also says its contracts with data-mining companies allow doctors who do not want certain information shared to "opt out" of what is sold to commercial interests.
Patient information is not included in the AMA records, but its Masterfile includes profiles of more than 900,000 physicians, two-thirds of whom are not members of the AMA.
Revenue generated from the Masterfile is an undisclosed part of the more than $44 million the association reaped in 2005 from sales of data licensing and credentialing services.
More current information is not yet available.
Opposition to the data sales comes from a coalition of doctor groups, including the Prescription Project, the American Medical Student Association and the National Physicians Alliance. The group plans to stage protests as well as handing out fliers advocating an end to the AMA's practices.
"The average doctor has no idea that this is going on," said Dr. Michael Mendoza, clinical assistant professor in the department of family medicine at the University of Chicago's Pritzker School of Medicine who is involved in the Prescription Project.
"If doctors are unaware it happens, they aren't in a position to choose," Mendoza said. "It's a practice that flies under the radar of most docs. At least two-thirds of doctors do not know that this goes on because they are not members of the AMA."Under pressure from member doctors about its role in selling its database to companies that do business with the drug industry, the AMA last year began allowing doctors to opt out of having their information sold, through the creation of a "physician data restriction program."
More than 8,000 doctors have opted out, and the AMA said it has launched a campaign to let physicians know they can hide their prescribing information from pharmaceutical sales reps. The physician data restriction program is prominently displayed at the AMA's Web site.
The AMA said it is also stepping up a campaign, using ads in specialty medical journals, to let doctors outside of its membership know they can opt out.The AMA considers its data to be licensed rather than sold. So it says it can pull the plug on any licensing if it feels the information is used inappropriately.
"I think the pharmaceutical industry is on notice about physicians' concerns about this," said Dr. Jeremy Lazarus, a Denver psychiatrist and member of the AMA board.
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