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Before a drug rep approaches an individual physician with a sales pitch, it’s likely that he or she is already fully aware which antihypertensive medications a physician prefers for diabetics, or which antidepressants the physician typically prescribes to elders.
This is because prescribing data is routinely purchased from most pharmacies in the United States, with physicians identified through information purchased from the American Medical Association.1
"This information is combined with patient medical history information purchased from insurance companies," says Adriane Fugh-Berman, MD, an associate professor in the Department of Pharmacology and Physiology at Georgetown University Medical Center in Washington, DC. The two sources of information are used to tailor drug marketing to physicians.
"In other words, prescription tracking is used to manipulate physicians’ choices of therapies," says Fugh-Berman, director of PharmedOut, a project that promotes rational prescribing. "Obviously, this has major implications for the health of patients."
Use of data on physicians’ prescribing by pharmaceutical companies is a serious ethical problem, according to David Orentlicher, MD, JD, co-director of the William S. and Christine S. Hall Center for Law and Health at Indiana University in Indianapolis.
"That is why Vermont, New Hampshire, and Maine passed statutes to restrict it," Orentlicher says. "Unfortunately, the Supreme Court rejected the statutes on First Amendment grounds."
One possibility is for Congress to amend the Health Insurance Portability and Accountability Act to change the definition of confidential information to include prescription data.
"The problem is that we know that drug company promotions increase the likelihood that patients will get prescribed a drug they don’t need, a more expensive drug, a less effective drug, or one with more side effects," Orentlicher says.
Drug companies promote drugs that still have patent protection, decreasing the likelihood that a patient will be prescribed a generic drug. "Prescription data mining allows drug companies to make their promotions more efficient," says Orentlicher. "They can target doctors better because they see what their preferences are."
A related ethical concern is that the companies are doing so with information that is part of the physician-patient and pharmacy-patient relationship.
"Patients need assurance that relationships with providers are not only confidential, but also that private information will be used only for the patient’s own benefit, not the benefit of others," explains Orentlicher.
As drug companies using this information can undermine patient interests, says Orentlicher, "it really is a misuse of this information."