Wednesday, October 19, 2005

When did I sign away my privacy?

Last night I went to a pharmaceutical dinner, for which I candidly must admit I have a love/hate relationship. I like the networking, but dislike the implication that they're buying my scripts [which they never are]. As a solo practitioner [actually doesn't matter if you're solo or in a group -- everyone wants new business], one way to gain patients (especially when starting out) is to meet and create relationships with other physicians. We all know that is essential to a practice's survival; plus as a primary care physician you really need to get to know the people you are referring your patients to. I have a very high criterion for selecting those referrals: if I would trust them with one of my own family members, I will trust them with my patients. However, the point today is not networking, but how these pharmaceutical companies gain access to the quantity of prescriptions that I write. Unbelievable! They know how many prescriptions of _______ [e.g. Nexium] I wrote last month. It's almost like Santa Claus. They know if you've been naughty or nice. Haha.....or ho-ho-ho.

Yes, they actually can retrieve pooled data from local pharmacies and figure out how many of their prescriptions a doctor is writing, and compare the quantity to equivalent drugs in the same class. This gives the pharmaceutical representatives knowledge of whom to target, who to woo, and who to wine and dine extensively in return for their high prescription volume. This I have seen. It's almost like interest groups lobbying congresspersons and contributing to their campaigns in order to influence their voting behavior. It concerns me that this, along with speaking engagements, creates a financial incentive for prescribing certain drugs over others, without considering cost and which one is really best for the patient.

I'm curious to know why are they allowed to gain access to this information? I never signed a waiver giving them full view of my prescribing behavior. Should there be a waiver? And if so, should prescribing behavior then be made public, for the public eye to review any possible favoritism? Perhaps it's something to consider. Perhaps we should be lobbying our congresspersons to not allow drug companies access to this information.

Then you add the extra layer -- becoming a speaker for these pharmaceutical companies. You can't just go to a dinner and speak about their product. You actually have to go to their little "training camp" for doctors that want to become speakers and learn HOW to talk about their drug. Usually, these conferences end with the conclusion that the featured drug of the sponsoring pharmaceutical company is superior to the others in its class for such and such reasons. The data and slides are provided by the same drug company sponsoring the dinner, affording this conclusion. Usually negative data is obscured, or down-played. The speaker is paid an honorarium for discussing their medication in a favorable way. To many speaker's credit, I must say that not all speakers I have seen talk in magical tones about the featured drug of the evening. Some actually do provide a more objective view of the topic matter, but there are those who do not, and you have to wonder. Have we sold ourselves to the drug companies?

Let me say, returning to the opening line. I have a love/hate relationship with these dinners. They are educational programs. Most of the time one learns good new information from an expert that can be applied to one's practice. Oftentimes the topic veers away from just talking about prescribing and more into management, diagnosis, etc... Not to mention, it benefits patient care by integrating the network of physicians in the area. So there are good reasons for continuing to allow these functions. Congress did do away with the more flagrant abuses of influential money expenditures by the pharmaceutical companies by banning golf outings and other leisure, but non-educational, activities. I'm not sure that that accomplished much, except removing from the public eye activities that were more blatantly obvious attempts to buy one's prescriptions.

So what do you think? Should the drug makers be able to view a physician's prescribing behavior? Should it be limited to regional patterns, but not individual physicians? Should it banned all together? I think doctors should be asked for permission to access this information, so that they may have the right to refuse. Blindness to the number of scripts written per prescriber would force the pharmaceutical representatives and drug companies to focus more on the merits of their drug, and not on prescribing behavior.


Anonymous Anonymous said...

Interesting post. I absolutely think that a doctor should have privacy as it relates to prescribing medication, just as a patient should have as much privacy as possible with medical records.. It's abhorrent to think that information is used for marketing.

5:42 PM EDT  
Blogger Medicine Man said...

Thank you for your input. I aim to make others aware.

7:09 PM EDT  

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