Here’s how it works: A company purchases prescription information from pharmacies and matches that together with physician identities (usually obtained from the American Medical Association, which makes a lot money from selling that information) to create prescriber profiles, a rundown of who’s prescribing what, where. Drug companies purchase those profiles in order to better shape their marketing tactics. What doctors are already prescribing the drug in question? What doctors are prescribing the cheaper, generic version when they could be prescribing the company’s brand-name product? What doctors are using a different class of drugs and could possibly be persuaded to try another approach to treating a given disease?
Yes, this happens. Now, brace yourself for the numbers:
In 2005, the pharmaceutical industry spent $7.2 billion on marketing directly to physicians. (Just a fraction of the $29 billion spent overall on promoting and marketing prescription drugs that year.) More than 90,000 sales representatives spend about $8,800 per doctor, per year, to promote the prescription of one drug or another. (PDF) Now, let your stomach settle and read on.
Many states have banned the practice, and several others have legislation in the works to do so. The Supreme Court recently heard arguments from the state of Vermont about why its ban—challenged by data mining companies—should be upheld. Based on that hearing this past April, it seems unlikely that Vermont’s law will be upheld. The Court’s decision is expected by the end of June.
But the legal arguments made against data mining practices are not the genuine reasons for why people don’t like it. The case seems mainly to be about private versus commercial information. Vermont says that industry access to prescription data violates physician-patient confidentiality. The industry has argued that free speech protects its right to the information. (Legal representation for Vermont also argue that the practice of data mining drives up healthcare costs by marketing expensive drugs to doctors who could prescribe the cheaper version without compromising patients’ health.)
Does data mining benefit anyone besides drug companies? Those who do the mining would argue yes, for several reasons. One of the major hot-button issues in medicine right now is variability in patient care. Doctors in one practice are treating patients with X disease in a completely different way than doctors in another practice, either across the street or across the country. Data mining could help streamline treatment approaches, eliminating that variability, which does contribute to high healthcare costs. In addition, doctors are increasingly beholden to follow medical society- or insurer-issued “critical pathways,” which are, essentially, guidelines for how to treat a given disease. Data mining could help ensure adherence to those pathways, which are currently on the rise (doctors who resist could suffer financial consequences). Data mining could even play a role in negotiating drug prices and reimbursement rates. All of this could be true. And, data mining companies that deal with physician prescriptions, such as IMS Health and Walter Kleuwers Health, now have mechanisms in place to allow physicians to opt-out, so that prescriptions they write will not be included in information provided to drug companies.
The Vermont case addresses only one segment of data mining practices. First, there are many other sources from which to obtain data that reveal prescribing patterns than corner pharmacies. Specialty pharmacy providers (companies that manage hard-to-handle medications) have a wealth of data. Claims-processing companies and pharmacy benefit managers also have a great deal of data ripe for the mining.
Second, information gleaned about patient care can be used in all sorts of ways. For example, prescribing and outcomes data enable drug companies to identify areas where new therapeutics are needed, to determine whether the significant investment needed to develop a new drug and gain FDA approval will be worthwhile. It could be said that data mining helps rein in marketing expenses, because knowing how to tailor those efforts eliminates wasted visits, etc.
As Marc Duey, president of ProMetrics, explains, the information enables companies to see the daily consumption of a particular medication, how many patients are switching over to a new drug once it becomes available, what percentage of a drug’s usage is for any particular disease (say, renal cell carcinoma versus colorectal cancer). “Data mining permits fine tuning, clear decision-making, prioritization of resources, and makes the whole process of marketing much more efficient, saving money and delivering healthcare in a cheaper, more efficacious fashion than would otherwise be,” says Duey.
At the heart of much of the knee-jerk reactions against data mining is the belief that we are in the grip of a pharmaceutical industry that is out of control, with excessively soaring profits and an approach to controlling prescription drug use that borders on sinister (or, some might say, that is already way past sinister).
But the problem is this: pharmaceuticals are a for-profit industry. Data mining of prescriptions is essentially no different than the advertisement that pops up on your Facebook page as soon as you put “Went to the Gap!” as your status update. People will argue that healthcare is different from shopping for a new pair of jeans, that the former should be kept confidential because it involves private information about the state of one’s health. But it’s impossible to draw that line clearly. Drug companies are in it for the money. That’s what they do: they are businesses that make money by making and selling medicine. The public at large seems to want access to every possible bit of medical care around, but without being held accountable for the fact that we are healthcare consumers, just the same as we are clothing consumers.
That being said, there’s no denying either the unsettling amount of money at play or the sense that the pharmaceutical industry holds way too many cards when it comes to dealing with medical care. It just seems (to me!) that stopping data mining one state at a time isn’t going to alter the heart of what these states really have a problem with, which is the unfortunate repercussions of market-driven healthcare. In fact, if you drive even further into the core, the problem could be said to stem from our focus on treatment rather than prevention, on what makes people sick in the first place, on what makes a society so focused on consuming things as a way to make ourselves well, and on how healthcare came to be a for-profit business in the first place. To that same end, when data mining companies say that all they, or drug companies, want is to get this “life-saving information” out to doctors in order to help patients, it’s increasingly hard to believe.
Finally—although I’m sure there is some law or legal loophole that would prevent this—why can’t patients be the ones to decide what happens to their prescriptions? Simply, a checkbox could be added onto the prescription pad that lets patients opt-out of having that information sold or provided in any way to a third-party company. After all, the prescription belongs to the patient … doesn’t it? I know, I know: be careful, my naivete is showing.
“Lots of Drugs”
This post was edited for clarity on June 18.