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May 22, 2007

Doctors push back on drug company data mining

Three weeks ago, a federal judge ruled that New Hampshire's ban on drug company data mining was unconstitutional.

As I learned when I worked in pharmaceutical advertising, the prescribing report is one of the most powerful tools in a sales rep's arsenal. I used to write the canned scripts that helped them turn those numbers into prescriptions.

Drug salesmen walk into doctors' offices knowing exactly how many prescriptions that doctor for which drugs. Often, doctors don't even realize that the rep has their complete prescribing stats. The reps use this information to strong-arm doctors into prescribing more of their medications.

A favored tactic is to make the doctor conversationally commit to prescribing the rep's drug more frequently. Doctors wouldn't be so quick to say "yeah, yeah, how 'bout a penlight?" if they realized that the rep can track whether they follow through or not.

Despite the legal setback, opponents of the practice haven't given up the fight.

"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 of directors.) "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. [WaPo]

New Hampshire plans to appeal the federal court ruling.


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People who have no experience working with a real relational database program generally have no idea how powerful they are. Big Brother is here, and he's sitting right next to you.

Several years ago I was stunned when a drug rep showed me my prescribing statistics for his company's drug and for their competitor's products. It was an interesting and puzzling strategy that caught me completely off guard and made me so angry that I went into my expressive aphasia mode but was then enlightened enough through this encounter that I have always since assumed they know pretty close to what I do prescribe. (There are some holes in their data bases... for instance not all companies seem to have Walmart Pharmacy data.) I have never totally mastered drug rep counter insurgency tactics but have sometimes managed to sabotage their script by asking for their Blackberry rather that the penlight, acting really disappointed that they are not giving those away and quickly escaping before the rep can recover to make their next move. I am a family physican and do not belong to the AMA for reasons similar to what is mentioned in this post.

As a person with a major genetic illness, this might be a good opportunity to push my favorite piece of advice. It's so important I'm even going to violate my principles of "never use all caps":


Think about it: if insurance companies are data mining doctors, why wouldn't they mine MySpace for who's got what illnesses? Why wouldn't they mine online support groups?

If you admit publicly to having an illness and you use your real name, you're stupid. Sorry to be so blunt, but no insurer will touch you if they know you're sick.

Protect yourself. Nobody's going to do it for you.

thanks for highlighting this article. it's maddening that sales folks have this kind of access to physicians prescribing habits and that the American Medical Association actually makes over 44 million dollars a year just selling this information to sales folks.

I'd like to add that the National Physicians Alliance is a neat organization ( and has a newish blog at A few of us put together the blog, and we're stoked about the possibility for physicians to discuss issues like these, issues that are often not discussed by physicians in the "blogosphere". Disclaimer: i'm on the board of the organization.

Further to Anjali's point, I meant to link to this when this entry first appeared. I plan to print that page out and give a copy to every clinician I know, see as a patient, or work with.

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