Drug companies' secret reports outrage doctors

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> Drug companies' secret reports outrage doctors

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http://www.boston.com/dailyglobe2/145/metro/Drug_companies_secret_reports_outrag\

e_doctorsP.shtml

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> By Liz Kowalczyk, Globe Staff, 5/25/2003

>

> Several months ago, a pharmaceutical company salesman told Dr. Mario

> Motta something that surprised him. The salesman, who had scheduled a

> 15-minute appointment with Motta, said he knew that the doctor had

> been prescribing a competitor's cardiac drugs -- and he wanted Motta

> to switch.

>

> Motta had never discussed his personal prescribing habits with the

> salesman. ''I said `How would you know that?' '' Motta recalled. ''I

> couldn't get it out of him, so I told him to leave.''

>

> Drug makers, in a level of detail unknown to many physicians, are

> spending millions of dollars to develop secret reports about

> individual doctors and their patients, according to consultants to the

> drug companies.

>

> Most physicians know drug companies collect some information about

> which medications they prescribe. But they are often surprised by the

> depth of detail pharmaceutical makers now are buying about almost

> every US physician, mostly from large pharmacy chains. The details

> include whether doctors are switching specific patients from one drug

> to a competitor within days of it happening, and whether they treat

> many poor patients and may want free samples.

>

> With many doctors now holding sales representatives to strict time

> limits when they visit, these ''prescriber profiles'' allow reps to

> tailor their pitches to individual physicians. They are an

> increasingly important tool in drug company marketing to doctors,

> which accounts for the largest portion, $16 billion, of the $19

> billion that pharmaceutical companies spent on marketing in 2001,

> according to IMS Health, a Connecticut-based compmany that collects

> prescriber data.

>

> ''Average sales calls are shorter, and physicians are seeing fewer

> sales reps,'' said E.M. ''Mick'' Kolassa, a professor at the

> University of Mississippi and managing partner of Medical Marketing

> Economics, which provides consulting services to drug companies.

> ''Because of this, the sales call has become a more precious commodity

> and companies need to make sure they're putting their resources in the

> right place.''

>

> But even though patient names are removed from the data, some doctors

> believe these secret reports -- which they say sales reps almost never

> discuss openly with them -- are an unwelcome intrusion into the

> doctor-patient relationship. Doctors worry that the reports allow

> sales reps to push expensive drugs more effectively in a health care

> system that already is struggling with soaring costs.

>

> ''The amount of information they have about us and our prescribing is

> staggering,'' said Dr. Mark Rohrer, an internist and geriatrician at

> St. Elizabeth's Medical Center in Boston. ''The important thing is how

> it's used. If it's used by a rep to pressure me to provide a different

> drug than the one I'm prescribing, especially if there's a generic

> alternative, I don't think that's right.''

>

> Several drug makers, including Eli Lilly and Wyeth, and the

> Pharmaceutical Research and Manufacturers of America, the industry

> trade group, would not comment on prescriber profiling.

>

> Michael Barnes, vice president of business intelligence solutions at

> Dendrite International Inc., which provides prescription data to drug

> companies, said the data are used to promote safety.

>

> For instance, the Food and Drug Administration buys Dendrite's

> prescribing data, which allows the agency to monitor cases in which

> large groups of patients are taking drugs that could have dangerous

> interactions, he said. The agency can then direct the company to

> educate doctors about the potential harm.

>

> Prescriber profiles, albeit in a more rudimentary form, are a key

> element in the whistleblower lawsuit David Franklin filed against his

> former employer, Parke-Davis, now part of Pfizer, alleging illegal and

> off-label marketing of the company's top-selling epilepsy drug,

> Neurontin. Federal investigators are in settlement talks with Pfizer,

> which declines to discuss the case.

>

> Franklin, who worked as a medical liaison for Parke-Davis from April

> to July 1996, said his supervisors would provide him with a doctor's

> prescribing record for the previous month before he went on a sales

> call.

>

> A month later, they would send him the physician's new prescriptions,

> so he could see if the information he gave to the doctor led him to

> prescribe more Neurontin or other Parke-Davis drugs. Now sales reps

> can see within days if a doctor is responding to a pitch, he said.

>

> If a doctor was prescribing a competitor's product, Franklin knew that

> his presentation should focus on undermining that product, he said.

>

> Sales people also reviewed doctors' prescribing habits to determine

> who was loyal and should receive trips and gifts. The industry has

> since put in place voluntary guidelines discouraging lavish trips and

> gifts.

>

> ''The doctors it didn't work on didn't get the gifts anymore because

> it was throwing money away,'' he said. ''Your physician would be

> stunned to find out what pharmaceutical reps know about them before

> they walk into the office. We were trained in how to use this

> information without letting the doctor know we had it. It was

> absolutely imperative that you never referred to the report.''

>

> Documents recently unsealed in Franklin's lawsuit in US District Court

> in Boston also show Parke-Davis conducted prescriber profiling to

> determine whether dinner meetings, lectures, and teleconferences

> persuaded physicians who attended to prescribe more Parke-Davis drugs.

> Sometimes it worked, according to the company's analyses, and

> sometimes it didn't.

>

> Since the mid-1990s, drug companies have hired outside firms that

> purchase data on physicians from pharmacies and used the information

> in marketing. It's legal in the United States as long as patients are

> not identified. However, the Canadian province of British Columbia

> outlawed the practice in 1996. But in the last two years, the data

> have gotten more sophisticated. ''What's really changed in the last

> year or two is the speed at which they can get it,'' Kolassa said.

>

> Companies that buy data and sell it to drug makers are creating and

> advertising new products.

>

> Verispan, based in Pennsylvania, promises on its website that a new

> product called Market Mover will deliver changes in doctor prescribing

> behavior four days after the close of the week. It's ''the fastest

> available indicator of changes in individual prescribing behavior,''

> the company says. The company now sends these prescriber ''alerts''

> directly to the sales rep's laptop. Verispan executives would not

> discuss prescriber profiling.

>

> Companies such as IMS Health purchased computer records or tap

> directly into the pharmacy computer and extract information on the 3

> billion prescriptions US pharmacies fill annually, according to

> industry specialists. They combine this information with biographies

> on nearly 850,000 physicians compiled by the American Medical

> Association, which earns $30 million annually licensing detailed

> reports on physicians, including where they went to medical school,

> their fax numbers, and their specialties. About 20,000 doctors have

> opted to be removed from the list.

>

> AMA past president Dr. Richard Corlin said the list serves an

> important safety function: It allows drug companies to immediately

> alert doctors to a problem with a drug or change in how a medication

> should be used. But after some of its own members began criticizing

> the AMA for providing the list for marketing purposes, the

> organization a year ago adopted guidelines for drug companies that

> license the data, saying they should not use it to pressure doctors to

> change drugs.

>

> AMA officials said they would consider suspending a licensing

> agreement with any drug company that violated these guidelines, but

> that they haven't received any complaints from doctors to that effect.

>

> Verispan, IMS, and other companies also now buy data not just on

> individual doctors, but on individual patients and the medications

> they're taking. Executives at CVS and Walgreens, as well as Dendrite's

> Barnes, said pharmacies remove patient names and identifying details

> from the data and assign each person a non-traceable number. But the

> data include information such as a patient's insurance provider, all

> the drugs a patient takes, and their doses. Pharmacies would not say

> how much they charge for the data.

>

> Barnes said the patient data are crucial because they follow

> individual patients, so drug companies can see whether doctors are

> merely placing new patients on a competitor's drug or whether they're

> actually switching existing patients off of one drug and onto another

> -- a greater cause for alarm.

>

> If a drug company, for example, finds doctors are switching patients

> off of its cholesterol-lowering drug after they don't respond to a

> 40-milligram dose, the company can direct its sales force to focus on

> telling doctors to increase the dose.

>

> With doctor-specific data, drug companies could tell only if a doctor

> was writing more prescriptions for a particular medication, but

> nothing about who was getting the drugs. The patient-specific data

> allow drug companies to see changes in physician prescribing behavior

> eight months sooner, ''which could save tens of millions of dollars

> for the company,'' Barnes said. Barnes said the more advanced data

> also are used to promote safety. The FDA buys Dendrite's prescribing

> data, for example; this allows the agency to monitor cases in which

> large groups of patients are taking drugs that could have dangerous

> interactions. The agency can then direct the company to educate

> doctors about the potential harm.

>

> But even when it comes to pure marketing, Kolassa said he doesn't

> believe prescriber profiling is unethical. ''It's done throughout

> business. Frito-Lay knows a lot more about you than Merck knows about

> individual physicians. They know whether you bought beer or Diet Coke

> with your corn chips. Besides, physicians can always tell sales reps

> to take a hike.''

>

> Liz Kowalczyk can be reached at kowalczyk.

>

> This story ran on page A1 of the Boston Globe on 5/25/2003.

> © Copyright 2003 Globe Newspaper Company.