[e-drug] Big Pharma's "Right" to Doctors' prescribing information

[e-drug@healthnet.org]

E-DRUG: Big Pharma's "Right" to Doctors' prescribing information
------------------------------------------------------

crossposted with thanks from
http://www.multinationalmonitor.org/editorsblog

The First Amendment Gone Wild: Big Pharma's "Right" to Find Out What Doctors Are Prescribing. 

By Robert Weissman (excerpts). 

Two crucial developments in U.S. constitutional jurisprudence ? the grant of Bill of Rights protections to corporations, and the extension of First Amendment protections to commercial speech -- have enabled corporations to invoke the First Amendment to defend their right to hawk goods, so long as they are legal, by almost any means short of outright lying or clear deception. 

Now corporations are suggesting the First Amendment should effectively immunize them from government-imposed rules related to the simple commercial exchange of information. This new expansion of the First Amendment to block broad public regulatory powers emerges from efforts in New England to control one of the most insidious pharmaceutical marketing practices. Drug companies devote much money, and time, to influencing those with the power to prescribe medicines -- as much as $34 billion in the United States, more than eight times what is spent on direct-to-consumer marketing.

The most important element of the marketing onslaught directed at doctors is "detailing" -- the activities of the sales representatives who visit doctors constantly, and provide free lunches, free pens, free charts and other free goodies (including, very importantly, free samples). The average primary care physician sees drug detailers more than five times a day.

When a sales rep walks into a doctors office, he or she knows a lot about that doctor -- including exactly what medicines the doctor prescribes, and in what quantities. How can this be? Pharmaceutical companies purchase the information from data-mining companies, the largest of which is IMS Health. Pharmacies track what drug is sold to each customer. IMS buys the data from the pharmacies, deletes all patient names, combines it with data that enables the identification of prescribers for each prescription, and aggregates the information.

Then, when the drug company representatives cheerfully bound in to a doctor's office, they know exactly what the doctor is prescribing. They know if the doctor prescribes a lot of medicine or a little (drug company reps rate the doctors on a scale of 1-10, or A-F), and whether they go for the rep's company's product or a competitor's or a generic. They know where to focus their efforts, and how to frame their sales pitches. And, as the New York Times explained, quoting an e-mail message from a pharmaceutical executive to company salespeople, they use the data to "hold [doctors] accountable for all the time, samples, lunches, dinners, programs and past preceptorships that you have paid for and get the business!" 

The sales reps obviously do not have punitive power over the doctors, but they use the prescribing information to exploit and manipulate the social ties built on the giving relationship. Neither doctors nor patients consent to this use of prescribing data, and only a tiny few even know about it. This is about industry surveillance of the doctor-patient relationship. Pharmaceutical detailing results in more brand-name and fewer generic drugs being prescribed, at greater expense, but there is no evidence that prescriber data "is being used to propagate false or misleading marketing messages."

Robert Weissman is editor of the Washington, D.C.-based Multinational Monitor, http://www.multinationalmonitor.org and director of Essential Action http://www.essentialaction.org.