out of the office reply

i'll be over here for the next month: whougandabelieve.blogspot.com

Data Mining's Decline

The Supreme Court decided not to hear the appeal of the New Hampshire data-mining law.

This should be a kick in the pants for legislators in states like New York: put effort into a solid ban on prescription data-mining, there's no chance now that it'll get overturned.

Of course, legislators in New York have plenty of kicks in their pants these days.

Massachusetts prescription law

Beantown? More like, Thanks for the offer of free beans mr. drug rep but no thanks town!

And by that I mean: Massachusetts is trying to get their anti-prescription-data-mining grooooove on!

Which can obviously be translated into: the home of Paul Revere is making a good faith effort to limit the marketing influence of pharmaceutical companies on physicians. You can see the entire bill here. But as they say in blogging and other sleazy industries, here's the money graf:

G. Before utilizing health care practitioner prescriber data for marketing purposes, manufacturers must give health care practitioners the opportunity to request that their prescriber data :
i. be withheld from company sales representatives, and
ii. not be used for marketing purposes.

H. Nothing in this section shall prohibit pharmaceutical manufacturing companies from using prescriber data to:
i. impart important safety and risk information to prescribers of a particular drug or device;
ii. conduct research;
iii. comply with FDA mandated risk management plans that require manufacturers to identify and interact with health care practitioners who prescribe certain drugs or devices; or
iv. track adverse events of marketed dugs, biologics or devices.

At first glance it looks great. I'm reading section G, and I'm seeing that Pfizer has to come to me and ask my permission before using my prescription data. It's sounding good.

But I stroll over to section H, and now Pfizer is allowed to use my prescription data, to "impart safety and risk information."

Now, I don't want to offend anyone by impuning the integrity of pharmaceutical companies. But wouldn't Pfizer argue that all those free lunches and dinners are "impart[ing] safety and risk information"?

By which I mean to say: can't they continue to operate exactly as they have been?

Sure, I get it, that's not how the law was intended. But I have a feeling that the lawyers who work for Eli Lilly are going to choose to interpret this law in a way that let's them do exactly what they've always done.....

Thanks for the anecdote, Tara!

Here's the opening graf of a recent New York Times piece on health.

Recently, I went to the drugstore to fill a prescription. Instead, I left with a costly lesson in health care economics.

At the checkout, I was surprised when the clerk billed me for $100 instead of my usual small co-payment. It was only then that I realized my doctor had traded me up to a costly branded migraine drug, even though the old drug had worked just fine. And I had allowed it.

This article has nothing to do with prescription data-mining. At least it thinks it doesn't. The writer seems blissfully unaware of drug reps, and their ability to find out every detail of a physician's prescribing habits. Hence the title of the article, "A Hurdle for Health Reform: Patients and Their Doctors".

But please, Ms. Tara Parker-Pope, tell us how your doctor made the decision to switch from the cheap generic to the expensive brand name? Why did she decide you needed a more expensive drug when the old one was working just fine?

Odds are, the pharmaceutical industry got to Ms. Parker-Pope's doctor somehow. A free lunch, a free mug, a few note pads at a medical conference. And suddenly the catchy brand name was stuck in her head.

Did this doctor think she was hurting anyone by switching to a "newer" and "better" medicine? Quite the opposite. And yet the doctor ended up saddling a poor underpaid NYT blogger with a fat co-pay she can't afford.

We doctors have to stop pretending that medicine and money aren't intertwined. And that free gifts from pharmaceutical reps don't affect us.

NY Prescription Data-Mining Bill

I know you're excited. It's here.

Pushing from one side, pulling from the other

The main thrust of this blog is prescription data-mining: the way pharmaceutical companies can buy the prescribing habits of any doctor, and know exactly how many prescriptions she's written for every drug.

One of the reasons this is problematic is that drug reps can then ply doctors with various incentives, like food and entertainment, and monitor see if it's having an effect on how many prescriptions they write. Doctors who are susceptible get more goodies. Doctors who aren't get kicked off the gravy train. An unspoken quid pro quo develops between doctor and drug rep.

Banning the prescription data-mining that lets drug companies profile doctors in this way is an important part of fixing the problem. But a devoted group of advocates is working from the other side. And by the other side, I mean the "goodies" side.

Last week's New England Journal of Medicine perspective discussed the movement toward online disclosure of payments, gifts and consulting fees to physicians.

They appropriately lauded the bills at the state and federal level that would bring transparency to physician-industry relationships.

One problem is that most of these regulations are targeted at big-time payments, in the range of thousands. Gifts in the smaller range (less than $100 in the federal law, and less than $50 in the Massachusetts law) don't have to be reported at all.

This means that a drug rep can buy you dinner three times a week, and it won't have to appear on any online disclosure website.

Obviously, disclosure of big consulting fees is essential. But let's find a way to report the small gifts too. Pressure can be applied with a hundred tiny pushes as well as one giant shove.

More research on prescription costs

There's a recent NYT article on the issue of prescription drug costs. The article discusses a recent study by the Center for Studying Health System Change, which showed that over the past 5 years the number of people who couldn't afford their drugs jumped by 30%.

The increase in affordability problems likely stemmed from higher prescribing rates, drug prices that are rising faster than workers’ earnings, higher patient cost sharing in private insurance and the introduction of expensive new medications.

So there are all these new expensive medications, and doctors are prescribing them a lot, and people can't afford them. But hmm....maybe some of these medications aren't really necessary. Maybe some of them have cheaper generic alternatives that work just as well.

So people aren't taking all their medicines, but those medications aren't necessarily ones they need. They do need SOME kind of medicine for that hypertension or high cholesterol, but it doesn't have to be the fancy new model, all shiny and fresh from the show room.

The problem is, patients don't always know when they can switch to a generic drug. So if they can't afford the fancy new medicine, they just take nothing. Which is a real tragedy, because for just about every real medical problem that exists, there's at least one cheap medicine out there.

Let it not be said that this is an anti-Pharma blog. It's just as much an anti-physician blog. I myself am a physician, and I too find those catchy brand names popping into my head when I'm considering which statin to prescribe, or how to treat neuropathic pain. On a busy day in the clinic, it's easy to prescribe the drug that pops into your head, rather than taking the time to think about whether the patient can afford it.

Which is why doctors need to give ourselves space from Pharma, so we have the room to make the right decisions for the right reasons.