Prescription mining strikes a nerve

Seattle pediatrician Rupin Thakkar’s first inkling that the pharmaceutical industry was peering over his shoulder and into his prescription pad came in a letter from a drug representative about the generic drops Thakkar prescribes to treat infectious pinkeye.

In the letter, the salesperson wrote that Thakkar was causing his patients to miss more days of school than they would if he put them on Vigamox, a more expensive brand-name medicine made by Alcon Laboratories.

“My initial thought was, ‘How does she know what I’m prescribing?’ ” Thakkar said. “It feels intrusive. … I just feel strongly that medical encounters need to be private.”

He is not alone. Many doctors object to drugmakers’ common practice of contracting with data-mining companies to track which medicines physicians prescribe and in what quantities – information marketers and salespeople use to fine-tune their efforts. The industry defends the practice as a way of better educating physicians about new drugs.

Now the issue is bubbling up in the political arena. Last year, New Hampshire became the first state to try to curtail the practice, but a federal district judge three weeks ago ruled the law unconstitutional.

This year, more than a dozen states have considered similar legislation, according to the National Conference of State Legislatures. They include Arizona, Illinois, Kansas, Maine, Massachusetts, New York, Nevada, Rhode Island, Texas, Vermont and Washington, although the results so far have been limited. In other states, bills are stalled or did not pass at the committee level.

The concerns are not merely about privacy. Proponents of the legislation say using such detailed data for drug marketing serves mainly to influence physicians to prescribe more expensive medicines, not necessarily to provide the best treatment.

“We don’t like the practice, and we want it to stop,” said Jean Silver-Isenstadt, executive director of the National Physicians Alliance, a two-year-old group with 10,000 members, most of them young doctors in training. (Thakkar is on the group’s board.) “We think it’s a contaminant to the doctor-patient relationship, and it’s driving up costs.”

The American Medical Association, a larger and far more established group, makes millions of dollars each year by helping data-mining companies link prescribing data to individual physicians. It does so by licensing access to the AMA Physician Masterfile, a database containing names, birth dates, educational background, specialties and addresses for more than 800,000 doctors.

After complaints from some members, the AMA last year began allowing doctors to “opt out” and shield their individual prescribing information from salespeople, although drug companies can still get it. So far, 7,476 doctors have opted out, AMA officials said.

“That gives the physician the choice,” said Jeremy Lazarus, a Denver psychiatrist and high-ranking AMA official.

Some critics contend the AMA’s opt-out option is not well-publicized or tough enough, noting that doctors must renew it every three years.

The New Hampshire court ruling has raised new doubts about how effective legislative efforts to curb the use of prescribing data will be, but the state attorney general has promised to appeal. And Democratic state Rep. Cindy Rosenwald, the law’s chief sponsor, vowed to not give up the fight.

“In this case commercial interests took precedence over the interests of the private citizens of New Hampshire,” Rosenwald said. “This is like letting a drug rep into an exam room and having them eavesdrop on a private conversation between a physician and a patient.”