More Drug Marketing Tricks
..."We've shown that in our local community here, that physicians who see pharmaceutical drug reps more often, tend to prescribe, for example, antibiotics more frequently for common respiratory infections that don't really need an antibiotic...
...The drug companies spend a great deal on marketing and they don't do it without knowing why they're spending that money and they know exactly what they're doing. And they're very good at it....
....Why should patients care?
Patients, when they sit with the doctor, want their doctor to be unbiased, to be completely objective, to base their decision based on their knowledge and their skill and their understanding of the science of drugs and when all of that is influenced in the background by this pharmaceutical drug information that the pharmaceutical drug reps have, and that the doctors don't have, that's of great concern."...This most informative interview on the CBC Disclosure: Targeting Doctors program is yet again another behind the scenes pharma ploy to extract money from the medical system. Health concern of the their customer is surely not a concern but only a pretense to get our confidence in the system.
Next time you go to a pharmacy - demand that they not sell or hand out your prescription information to anyone.
Also if you are ever asked by your doctor to participate in trial, ask him what the drug company conducting the trial is paying him for you to participate in the trial. This conflict interest is often not disclosed to the trusting patients. Strangely, in these type of conflict of interest situations, one should have expected our regulators like, Health Canada, to be up and front batting for us - their constituents. But, hell no, they are too busy chasing innocuous health products that are in competition with their pharma friends toxic drugs....
Chris Gupta
Dr. Dick Zoutman is an infectious disease specialist at Kingston General Hospital. His biggest worry is the impact prescription profiles have on peoples' health. "Doctors don't realize that they're being influenced," he says. "We think we're immune. We think we're very powerful and we're immune but we're not."
Dr. Zoutman is about to publish his latest research. It shows how doctors influenced by drug reps are more likely to prescribe inappropriate drugs.
What was it that you saw that prompted you to look into this?
It was the fact that physicians' data was being compiled about individual practitioners in great detail that worried us.Why?
I have been in practice now for some fifteen years and I was not aware it was happening. So it surprised me and we started asking some questions of the various companies who are collecting this data. We found this is a common practice, it's widespread, it's multinational in countries around the world - and that was a surprise to me. Most of my colleagues were unaware that it was happening either.Then we did some research and realized that the Canadian Medical Association was aware of this practice and in 1997 issued a policy statement about the issue of physician profiling and data prescription mining.
How does it work? A doctor writes a prescription, the patient goes to the pharmacy. Then what happens?
There are several layers here. It appears that the information is entered into the computer by a pharmacist or a pharmacy technician. From there the information is removed and taken off either by another piece of software... It ends up in the hands of large data corporations who make it their job to profile the physicians by drug class and by geographical location, etc., to determine in great detail my prescribing behaviour around all aspects of every prescription that I write. This isn't happening in hospitals, it's in the community retail pharmacy area where we're seeing this.Who is the biggest seller of this information?
There are at least two companies that we know of. We believe the largest company in Canada is an organization called IMS Health. That they are one of the biggest players in this. But we also know there are others.What do they sell, IMS?
These companies are selling information about the physician's prescribing behaviour in great detail back to drug companies.Why do the drug companies want the information?
One particular use of the information that concerns us is that it's used to profile physician prescribing exactly. That information is provided to pharmaceutical drug representatives who visit doctors. That information allows the pharmaceutical drug representatives to have detailed information about the prescribing behaviour of the physician.Why do they want it?
They want it so that they can determine whether you are a high prescriber or a low prescriber for a particular targeted drug and then they ... talk to you about your prescribing habits, why you're using one drug versus another drug and so forth.The difficulty with this is that the vast majority of physicians don't know what's going on and are unaware that the pharmaceutical drug rep sitting in their office has a detailed profile. That information is hugely powerful to influence. If you're sitting there with the pharmaceutical drug rep in your office and you don't realize that they've got this information ... and not being able to see the information to critique it for its accuracy and its validity - you're at a severe disadvantage.
We know that this prescriber information is very powerful as a way to, in a form, coerce physicians in a passive kind of way into changing their prescribing behaviour. There's no doubt that physicians who are seeing pharmaceutical drug representatives are being influenced by what they're learning from the pharmaceutical drug representatives.
Why does it have an impact?
I'm not able to look at my own prescribing dispassionately and say: 'Well, maybe I'm prescribing too much of this and not enough of the other. Maybe I'm too old fashioned or I'm picking up the new drugs too soon.' Because of that, my not having that [information], but the pharmaceutical drug rep is having it, I'm at a severe disadvantage.Why?
Because I'm not able to be on the same footing. They're sitting in the room having a great deal of information about me that I don't have. And that's able to influence me. They're able to do a direct strike, a very targeted intervention to try and convince me to use one drug or the other, provide you with information about their drug. That may not be information about other drugs and about the whole therapeutic issue that's being addressed.We've shown that in our local community here, that physicians who see pharmaceutical drug reps more often, tend to prescribe, for example, antibiotics more frequently for common respiratory infections that don't really need an antibiotic.
And they also prescribe antibiotics that tend to be the newer more expensive varieties that we're all concerned about developing resistant bacteria too - we've shown locally here in Kingston area that that's an issue. And that's been shown over and over in other therapeutic areas. You know, cardiovascular drugs, cancer drugs; the impact of the pharmaceutical drug representatives is very powerful.
The drug companies spend a great deal on marketing and they don't do it without knowing why they're spending that money and they know exactly what they're doing. And they're very good at it.
The problem is, doctors don't realize that they're being influenced. We think we're immune. We think we're very powerful and we're immune but we're not. And that's something physicians have to realize, that we are influenced by it.
Why should patients care?
Patients, when they sit with the doctor, want their doctor to be unbiased, to be completely objective, to base their decision based on their knowledge and their skill and their understanding of the science of drugs and when all of that is influenced in the background by this pharmaceutical drug information that the pharmaceutical drug reps have, and that the doctors don't have, that's of great concern.Don't doctors like visits from drug reps?
Some do, some don't. I don't have much time in my schedule to meet with pharmaceutical drug reps. We have formal committees in the hospital. I can't speak for my colleagues who are in community practice however. But we do know that the average number of doctors, the average number of visits is four pharmaceutical drug rep visits per month in the office. That's about one a week, on average. Some more, some less.Overall, I do not believe that physicians are being informed adequately and sufficiently that this practice is going on, as I wrote in our article in the Canadian Medical Association Journal.
We think that's an important issue: that physicians really are not aware and physicians need to be made aware so that they can give informed consent. I believe physicians should consent to this data being profiled about their prescribing habits. I believe it's confidential information, and many other people believe it is as well.
A lot of doctors will say that they need the information that comes from the sales reps.
That's true. The sales reps can keep physicians up to date about new drugs, new drugs that are being released, new issues around adverse effects and proper use of drugs. Pharmaceutical drug representatives have a code of ethics and they are people who are trying to do a good job for their company to sell their drug.The concern that we have is the fact that physicians' data is being profiled without the physicians' consent up front - despite some mail outs that have gone on from several of these data collection companies, there's no opportunity for direct, positive informed consent. We believe that needs to be part of the process. Physicians need to be asked: Do you want to be profiled, yes or no? And if yes, fine. If not, then you have the option to have your name taken off the list.
Why do you think that doctors are so easily influenced this way?
I think all human beings are influenced. Why are there billboards along the highway? Why is television full of advertising? In many ways it pays the freight and we accept that in our society.There's something unique though about the physician-patient relationship, there's something sacred and special about the level of trust. It has to be at the highest possible level for patients to feel they can really trust what their physicians are doing, their physicians are uninfluenced and biased, and unbiased, in their decision-making.
I think this prescription data is very important and very valuable information. It is not only influential to physicians, but can be used to inform and educate physicians to optimize drug use. But in order for that to happen, the information has to be provided back to physicians on a regular basis in the form of a report.
What I'm suggesting is that if this data is available, it should probably be collected -- collected in a different way, by different people, I would think. I think it should be collected by the Canadian Medical Association or perhaps the Canadian Pharmaceutical Association ... I think if they were to collect the data together, they would be able to provide this information back to pharmacists and back to doctors so we could get reports back on a monthly or quarterly basis. That would be very helpful to me as a practitioner.
Has your research shown that it makes a difference in the way doctors prescribe - whether they've been visited or not?
We found that physicians who were visited by pharmaceutical drug reps were more likely to prescribe antibiotics for things where antibiotics weren't indicated and also to prescribe antibiotics that were more expensive and very broad spectrum.What would be the difference in prescribing practice according to whether you had a visit from a drug rep?
The drugs that are prescribed tend to be the more broad spectrum, newer antibiotics. We've also found that there's more likelihood, if you've been visited by pharmaceutical drug representatives, to be prescribing antibiotics when they're not even indicated - for things like coughs and colds and upper respiratory ailments that we see every winter.The link to a visit by a sales rep - why do you think that happens?
The visit from the sales rep presumably has an impact on the physician's thinking about the merits of a new drug that may have a broader spectrum, therefore kills more bacteria, might be more effective and the concern that the patients may find the drug more acceptable. The drug may also be able to be taken less frequently. Once a day, twice a day dosing is easier, there's no question.But those are all kinds of the issues and the physician is influenced because they've been told about the one drug - but not about all the others that are part of their choices. The marketing is aimed at the broader spectrum drugs.
Why?
Because that's where the money is.So the doctors that get all these visits aren't prescribing the cheaper, older drugs?
We want doctors to be prescribing the most appropriate drugs for the condition. We do know from the literature - not from our own research but from the literature - that physicians who have contact with pharmaceutical drug reps are more likely to be prescribing the newer drugs and ...Which are more expensive?
Which are invariably more expensive and that's been shown.When Dr. Schumacher complained to the Privacy Commissioner, the Commissioner said that ultimately there is no invasion of privacy. What did you think of that?
Well, I respected the review that the Privacy Commissioner did of the issue. I thought it was very thorough and had the same findings that we had. However, I don't agree with his conclusions. When the Privacy Commissioner described the value of a prescription to society, he described it as a product of our work. And therefore it's not confidential.He compared us, the medical profession, in his report, to chefs and to roofers and to mechanics. And all deference to the important value of chefs, roofers and mechanics and the important work they do in our society, it's a very different relationship between me and a chef when I'm in a restaurant. If the chef cooks a meal that I don't like, I may not come back or I may not leave a tip.
But the relationship between a physician and a patient is very different. I'm able, when I'm dealing in a restaurant or with a roofer or a mechanic, to say what I want to do. I'm in a situation of fairly equal power. The physician-patient relationship is very lopsided towards the physician who has a great deal of power over the patient and that has to be acknowledged.
I'm most concerned, not so much entirely about just the confidentiality, I'm most concerned about how the data is used to influence physicians to prescribe one way or the other. That to me, I think, is the big issue around this prescription data mining issue.
We've talked to IMS and they say that the information they sell to drug companies does not have individual doctors' names on it - that it's aggregate information.
That's right. The information is aggregated by the amounts of drugs that are being prescribed. So it's aggregated by the drug classes and by the amount of drug. But within that aggregated database are physician identifying numbers so that it's not very difficult then to link it back to another database which they have of all the physicians names, addresses and the identification numbers. You link up by the identification numbers and you've got the physician-identified database that allows you to profile physicians precisely.It starts off being aggregated by the amount of drug being prescribed. But if it can be de-aggregated directly to the physician, then the aggregation is more apparent than real.
How?
Because their data has a physician identifier number. You have a separate data set that has that identifying number linked directly to my name, for example.How many pharmacists are involved?
I believe it's a fairly widespread practice. I certainly know that it's international across many countriesÂ… The information we have is that approximately 4,000 pharmacies across the country, which will include some of the chains, are participating in this program to supply information to the data miner, the prescription data mining companies.Our research shows that the information is acquired at the pharmacy level. The Privacy Commission's report corroborates that information, that it is acquired at the pharmacy level. And from there it is used to produce reports.
IMS says they do this doctor profiling, but primarily the drug companies want this because it's a moral responsibility to know the prescribing trends of doctors. In other words, they're suggesting this is not about money; it's about health.
It's about money too. It's about influencing physicians. It's about affecting drug prescribing behavior. It's about using this information to subtly coerce physicians in an indirect kind of way by this information. It's been well studied that this information is very powerful information to convince physicians about prescribing one way or the other. So on that, I agree that the data is very powerful. But it's also about sales. It has to be.How valuable do you think it would be to drug companies?
I think this information is of immense value. It allows them to direct their marketing activities. It also would be of immense value to physicians to be able to look at their prescribing activities, to optimize them. It has great value. Of that there's no doubt.You're obviously concerned about this. But why aren't governments concerned about this?
I think the governments should be concerned. It's the health of patients is affected by the prescriptions that the doctors hand out. If the physicians are being influenced by this information unwittingly, then I think we should all be concerned.I would prefer to see the data collected by a third party agency that does not have a commercial vested interest in the use of this data. Now that could be the Canadian Pharmaceutical Association that represents the pharmacists and the Canadian Medical Association, for example, with some government funding. And that data could be run through the local medical schools for analysis and they give feedback from your colleague.
That would be very, very useful and powerful information to optimize prescribing. That's how I would view as an ideal situation. But that's not what's going on right now.
What about the Canadian Medical Association? Are there any rules that would prevent this or suggest it might be wrong?
The Canadian Medical Association became aware of this issue in about 1996 and in 1997 published guidelines on the issue of prescription data mining. Some of the key principles that the information should be collected with physician consent, that the data should be provided back to physicians in an educational manner so that physicians get profiles on a regular basis. Those are things that aren't happening right now.March 5th 2004 Disclusure Interview
posted by Chris Gupta on Monday March 8 2004
updated on Saturday September 24 2005URL of this article:
http://www.newmediaexplorer.org/chris/2004/03/08/more_drug_marketing_tricks.htm
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