AMA Data Mining Plan Is A Dud… Adriane Explains
15 CommentsBy Ed Silverman // May 28th, 2008 // 11:45 am
To appease legislators and some doctors who objected to data mining, which is the practice of gathering and selling prescription data, the American Medical Association created the Prescription Data Restriction Plan. But the program remains contentious, according to Adriane Fugh-Berman an associated professor in the physiology and biophysics department at Georgetown University Medical Center, who also heads out PharmedOut, an independent, publicly funded project that examines pharmaceutical promotion practices.
As she noted in a recent paper, docs must opt-out, not sign up. So far, though, less than 2 percent of all US docs have registered - and she notes that those who have opted out aren’t the ones targeted for marketing. Moreover, only sales reps and their immediate superviors are prevented from accessing the most detailed reports. In other words, lots of people can peek and use the data for various purposes. We spoke with her about her concerns…
Pharmalot: Why are some doctors offended by tracking?
Fugh-Berman: Doctors are offended because they feel its an invasion of privacy. They’re concerned that drug reps know what they’re prescribing, and they don’t think industry should have access to that.
Pharmalot: But what’s wrong with the AMA plan?
Fugh-Berman: It was created with industry to undermine state legislation that was, itself, created to eliminate the sale of prescription data. If a legislator wants to prevent the sale of prescription data, they may be mollified when they learn the AMA has an opt-out plan. But it’s not accomplishing anything. It only appears to address physician concerns with prescription tracking while, in reality, offering no hindrance to industry access to the data.
Pharmalot: How so?
Fugh-Berman: By signing up with the AMA plan, they think companies can’t access prescription data anymore. But that’s not true. Only sales reps and their immediate supervisors don’t have access to specific drugs, but the company has access to prescribing info. And the rep may still know if a doctor is in the top 10 percent for prescribing SSRI’s (antidepressants), just not whether the doctor prescribes more Prozac or Zoloft. But the company still has full access to the data…The program is, essentially, a sham.
Pharmalot: Why do you think more doctors aren’t opting out?
Fugh-Berman: They don’t know about it. Some physicians have heard of prescription tracking, but very few have heard of the (AMA) program. It seems to be a local phenomenon. In some audiences where I’ve spoken, they’re aware of the program, but in others, nobody is aware. As of January 2008, about 12,000 out of 785,000 practicing physicians had opted out. That’s less than 2 percent. And those who did are the lower prescribing doctors - they’re among the 72 percent who are not high prescribers to begin with. The high prescribers aren’t targeted anyway. So industry breathes a sigh of relief.
Pharmalot: Why should this matter?
Fugh-Berman: Prescription tracking is bad for public health on a lot of levels, but particularly because it’s used to influence physicians to prescribe the most expensive and most widely promoted drugs, which some patients may not need. And the information gathered by the data-mining companies (such as IMS Health and Verispan) is used in market research to determine when and how a drug is being used, or it can uncover adverse events, all of which can also influence public health, but the information is only shared with industry.
Pharmalot: So what’s the remedy?
Fugh-Berman: Well, state legislators have to realize the plan is a sham, and then maybe there’s be more movement on creating effective state legislation. At the very least, the companies should be required to report to the federal government when they uncover adverse events generated by a drug. But I believe prescription tracking should be banned altogether.
Bruce Grant
What’s interesting is that ultimately Dr. Fugh-Berman’s objection to data mining is that it is “…used to influence physicians to prescribe the most expensive and most widely promoted drugs…” i.e., it is used to enable marketing.
The essence of her argument is not merely that physicians’ privacy rights are somehow infringed but that the information enables pharmaceutical companies to target messaging to them with somewhat more precision (or at least to concentrate their sales force on their best customers).
There are, of course, legitimate arguments for and against all of the world’s actual and theoretical economic systems, but to say that marketers in a market economy engage in marketing is neither a shocking revelation nor a withering condemnation. It’s merely how that particular economic system works.
Like marketers in many other categories (automotive, financial services, etc.) pharmaceutical marketers operate, not in a completely laissez faire market but in a regulated one, which puts a limit on potentially abusive or market-distorting practices.
Limiting the conditions under which marketers can obtain personally identifiable information about their customers is a legitimate enough object of regulation, a patchwork of fifty different sets of regulations covering the same set of practices is, as you might imagine, not something that any industry could be expected to welcome warmly.
In this context, offering up a national “self-regulatory” mechanism is at the very least a likewise reasonable counter-offer, not a sinister plot to subvert democracy at the state level.
I do find the picture that industry critics paint of physicians as gullible pawns, easily manipulable by crafty marketers, an interesting view of some of our society’s most highly educated professionals.
I wonder, too, why physician-critics of the pharmaceutical industry, such as Dr. Fugh-Berman, do not more publicly agitate within their own professional society, the AMA, to modify its policies on the sale of physician data.
It is the AMA’s “masterfile” data, after all, which enables pharma marketers to connect the de-identified pharmacy data collected by IMS and Verispan to be traced back to individually identifiable physicians.
Surely those who wish to see the AMA’s policy changed — from opt-out to opt-in, for example — could easily bring such a proposal to the AMA House of Delegates. Doing so would certainly clarify just how much their fellow physicians were or were not concerned about this issue.
Atlex
I agree with Bruce and would ike to add that if doctors were so offended with the tracking, why have only 2% signed up? I think academics like Fugh-Berman should stick with what they know best–academics. For Dr. Fugh-Berman that seems to be the study of the medicinal value of dandelions (I’m not making this up. It is highlighted in her bio.)
Sisyphus
If physician do not care…let them opt in. Let’s see if more than 2% decide to opt in. Makes more sense for prescribers to give their permission to have their prescribing practices monitored by industry.
Doc
I disagree with Bruce’s comments in general. It is the very mindset by MDs and others that “those pens,pads, etc do not influence my prescribing” that indeed sets them up to be influenced. Its not about $ value per say, its about human relationships and trust between reps and their customers. To think that pharma spends billions of dollars on marketing without having done their ROI calculations, is just like saying MDs are too smart to be influenced.
Pharma Researcher V
What people don’t want to face is that the AMA — an organization that is supposed to represent the interests of the medical community — receives the vast majority of its funding from PhRMA under the data licensing agreements. Without that money, the AMA cannot function. Of course, neither the AMA nor PhRMA want to talk about that. What happened here is that the AMA cut a deal that made it look like they were taking a big step forward but it was in essence a sham. The AMA acted to preserve its funding. The ultimate arrangement was so watered down it’s a joke. Even if physicians act to opt-out, PhRMA companies don’t lose that much data. Moreover, the AMA has done very little to advertise the idea. In my opinion, the AMA needs to re-group and get back to its roots. Unfortunately, like a few too many of its constituents, the AMA is addicted to big phrma money.
Bruce Grant
Doc,
Let me repeat, I’m not arguing that physicians are too smart to be influenced by marketing…just that in a market economy marketing is what marketers do, subject to regulation. And that, whether or not an opt-in system is preferable, physicians *are* smart enough to opt out.
Assuming that we’re not going to change our economic system, those who have problems with marketing prescription drugs have every right to advocate specific regulatory measures to correct abuses or market distortions.
Remember, taking physician prescribing data out of the equation will do nothing in and of itself to stop the pharmaceutical industry from marketing to physicians…it will just make that marketing less precise.
Doc
Bruce,
From many years on the marketing/sales side, it think taking the rx data out of pharma’s hands is a good thing. After all, isnt the stated mission of virtually every company patient well being. By using rx volume for targeting efforts, many lower to mid volume prescribers are ignored. Are their patients not ‘worth’ the investment?
anonymous
Doc,
I have to agree with Bruce. In a free-market (with some regulations) economy, companies must market. And the more precise the data, the better the marketing. I suspect the vast majority of physicians would rather have targeted marketing–then they only see reps that have something of interest to them. Most of the physicians I see know we have data; it only bothers those who seem to think that medicine is some sort of sacred subset of the economy that should be treated as somehow off-limits to the exigencies of the market economy.
Most of the physicians like that suffer from one terrible deficit in their education: they don’t understand the free market, capitalism and economics. The equation is simple, as Bruce pointed out: marketing drives sales, sales provide profits which in turn allow further risk-taking and development of potentially (POTENTIALLY) profitable products. Nathan has pointed out elsewhere that antibiotic research is in the toilet because it is no longer profitable.
If the objection is that because physicians like their reps they will prescribe more expensive drugs (and don’t we wish it were that easy), then let’s look at the core assumption driving this lament: medical care should be paid for by someone other than the patient. If you don’t concede that medical care is a “right” granted by the constitution and something that should be paid for all by the few, then you come down to patients being responsible for their own care–and perhaps then making cost-based decisions.
Granted that some sort of pooling of risk and consequent subsidization of care for some is necessary, that doesn’t mean that care should be “free” and therefore not scrutinized by the consumer. I think the vast majority of the populace should pay for most of their care–especially maintenance and preventive care. Let the subsidization process kick in with major expenses. Let patients choose among plans that offer more or fewer benefits such as branded drugs, IVF, sex-change operations, mental health benefits, etc.
And let’s not lose sight of the fact that drug costs are only about 12% of total medical costs in this country. You could ban drugs entirely and not make much of a dent in the medical economy of this country. And that’s assuming that the 12% that is spent on drugs does nothing to lower other costs, which is an erroneous assumption.
Justice in Michigan
Couple of points -
Irony is that much regulatory effort has gone into _defending_ free market. Kefauver hearings were originally about price-fixing and industry’s attempt to end competition. Antibiotics were central in all this, and thus is was the industry itself that was ready to flush away innovation encouraged by market.
Re: drug costs, latest estimates are closer to 19% of total medical costs. PhRMA has been using the lower number for a long time, but it doesn’t stand up to scrutiny.
norman kelley
I find it interesting that Dr. Fugh-Berman was addressed as
“AMA Data Mining Plan Is A Dud… Adriane Explains.”
After all, the woman is a medical doctor and not merely an academic. I doubt that if she had been a male,she would have been addressed as such. By doing this, her views can be addressed out of hand because a) she’s a woman; b) she’s an academic. However, she is a medical doctor who knows what she’s talking about.
The AMA isn’t fully up to the task of regulating itself, because, despite free-market rhetoric, its job is to look after the health interest of the public. Oh, but that kind of contradictions its trade association mission, which is to look after its proprietary interests, right?
No one is begrudging MDs making a living, but there seems to be a conflict of interest in the AMA selling its members Rx information and giving Rx firms the inside track to it, and then developing a “plan” to merely mollify reasonable legislative oversight.
Ed Silverman
Hi Norman,
I’m not sure if you’re complaining about the headline, but I didn’t intend to be dismissive or insulting. I couldn’t fit Fugh-Berman in the headline. But I still wanted to personalize this somehow because it’s Q&A. Hope this helps.
Regards
ed
Doc
Anon,
Good points, except remember that the Fed Govt (us) pays for about 40% of all meds. Also the ultimate consumer does not make the choice, and the majority of ultimate consumers of drugs are the elderly, many easily confused unfortunately. My only reserve is the misleading promotion that has been and will continue to be pushed at MDs. Branded rxs are sig more costly than generics and many great drugs are now generic - statins, ACEIs, Ca blockers, b-blockers etc - So I would rahter pharma not have this data - based on their own uncontrollable quest for profits at any cost.
Rich V
Norman,
The AMA doesn’t sell prescribing data. They don’t have access to this data. prescribing data is sold by pharmacies, and others who have access to it, to healthcare information companies. They compile all the data and license it back to pharmaceutical companies.
Jane
Rich V,
According to http://carlatpsychiatry.blogspot.com/2007/09/prescription-data-mining-transparent-ly.html The AMA makes over $40 million a year by leasing out its physician Masterfile.
atlex
Jane, the physician master file doesn’t contain prescribing data. Rich is exactly right. It allows the data companies to link prescribing data to physicians.
JiM, please cite a reference for your 19% number. If you like, I can cite the federal government is a reference that <12% of health care spending is on prescription drugs.