For Sale: Physicians' Prescribing Data

Article · July 2006with17 Reads
DOI: 10.1056/NEJMp068125 · Source: PubMed
Abstract
Health care information companies compile and sell individual physicians' prescribing data to pharmaceutical manufacturers. Dr. Robert Steinbrook writes that more and more physicians have rebelled after becoming aware that drug companies have access to their data.
    • An important part of this vision is the creation of a mechanism that aids supervisors in understanding when feedback is likely to be unhelpful or even detrimental , to avoid negatively impacting performance via the provision of performance feedback. Computer-supported feedback message tailoring may also resemble techniques used by pharmaceutical sales representatives who collect and analyze physician characteristics and behavioral data to individually tailor persuasive interventions that target prescribing behavior [55,56] . Research about individually tailoring marketing communication for physicians suggests that marketing techniques could also provide helpful models for computer-supported feedback message tailoring [57].
    [Show abstract] [Hide abstract] ABSTRACT: Background Evidence shows that clinical audit and feedback can significantly improve compliance with desired practice, but it is unclear when and how it is effective. Audit and feedback is likely to be more effective when feedback messages can influence barriers to behavior change, but barriers to change differ across individual health-care providers, stemming from differences in providers¿ individual characteristics.DiscussionThe purpose of this article is to invite debate and direct research attention towards a novel audit and feedback component that could enable interventions to adapt to barriers to behavior change for individual health-care providers: computer-supported tailoring of feedback messages. We argue that, by leveraging available clinical data, theory-informed knowledge about behavior change, and the knowledge of clinical supervisors or peers who deliver feedback messages, a software application that supports feedback message tailoring could improve feedback message relevance for barriers to behavior change, thereby increasing the effectiveness of audit and feedback interventions. We describe a prototype system that supports the provision of tailored feedback messages by generating a menu of graphical and textual messages with associated descriptions of targeted barriers to behavior change. Supervisors could use the menu to select messages based on their awareness of each feedback recipient¿s specific barriers to behavior change. We anticipate that such a system, if designed appropriately, could guide supervisors towards giving more effective feedback for health-care providers.SummaryA foundation of evidence and knowledge in related health research domains supports the development of feedback message tailoring systems for clinical audit and feedback. Creating and evaluating computer-supported feedback tailoring tools is a promising approach to improving the effectiveness of clinical audit and feedback.
    Full-text · Article · Jan 2015
    • As a result they become aware to the need of market and thus focus on such drugs which are most repeatedly prescribed [5, 6, 7]. American Medical Association (AMA) and other medical associations have given a number of suggestions to reduce the use and distribution of physician's prescription data [8].The result of most of researches is that unethical marketing is going on around the world but these are more common in backward countries. It is also fallowed in pharmaceutical marketing.
    [Show abstract] [Hide abstract] ABSTRACT: Marketing of Pharmaceutical products is a very vast field after their production in the Pharmaceutical Units. Pharmaceutical industry of every country contains its own marketing unit. The objective of the present work was to highlight various illegal ways that are adopted in Pakistan to promote one’s product in market. A questioner containing 19 questions was designed regarding unethical marketing i.e. who is responsible for Unethical marketing; its impact on the purchase of brands, tools used for it and Doctor’s Views about sales promotion officers (SPO’s) etc. Study was conducted in 400 doctors of Pakistan. Survey highlighted that 50% of the doctors prescribe medicines on the basis of their self-experience, 73% declared that they keep patient compliance in their minds while prescribing rather than personnel benefits. 35% of the doctors consider themselves for the unethical marketing while 46% declare pharmaceutical companies as major culprit for this act. 46% of the doctors showed that national companies invest more on them rather to invest on product. 56% of doctors said that samples are most frequently used promotional tool. Due to this unlawful practice excellent quality products are losing their markup value in market. Moreover, it will result in poor patient compliance, large impact on patient’s economical status and provision of poor medical treatment to population. This will only be possible when role of pharmacist is implemented in the profession. There should be proper, strict check and balance on the prescription written by Medical officers. Role of Pharmacist should clearly be implemented. Pharmacist along with duties of care giver should provide excellent knowledge and way of ethical marketing of drugs.
    Article · Nov 2013
    • Prescribers are identified by number (usually state license or Drug Enforcement Administration numbers). IMS obtains records on about 70% of prescriptions filled in community pharmacies.6 Prescription information is also obtained from pharmacy benefit managers and wholesalers.3
    [Show abstract] [Hide abstract] ABSTRACT: Monitoring and modifying physicians' prescribing behavior through prescription tracking is integral to pharmaceutical marketing. Health information organizations (HIOs) combine prescription information purchased from pharmacies with anonymized patient medical records purchased from health insurance companies to determine which drugs individual physicians prefer for specific diagnoses and patient populations. This information is used to tailor marketing strategies to individual physicians and to assess the effect of promotions on prescribing behavior. The American Medical Association (AMA) created the Prescription Data Restriction Plan in an attempt to address both the privacy concerns of physicians and industry concerns that legislation could compromise the availability of prescribing data. However, the PDRP only prohibits sales representatives and their immediate supervisors from accessing the most detailed reports. Less than 2% of US physicians have registered for the PDRP, and those who have signed up are not the physicians who are targeted for marketing. Although it has been argued that prescription tracking benefits public health, data gathered by HIOs is designed for marketing drugs. These data are sequestered by industry and are not generally available for genuine public health purposes.
    Full-text · Article · Jun 2008
    • Beginning in the 1990s, they were able to purchase physician level data. One major data provider to pharmaceutical …rms, IMS Health, collected information on 70% of all prescriptions …lled in community pharmacies (Steinbrook (2006) ) and had revenues over $2.7 billion in 2007. Since 2005, the AMA has received $44 million/year from licensing physician data (the AMA Master…le) which contains physician pro…les for 900,000 physicians that can be used with pharmacy prescriptions data to construct physician prescribing pro…les (Greene (2007) ).
    [Show abstract] [Hide abstract] ABSTRACT: The following is a model of psychological contracting with unmonitorable performance, implicit offers, and screening for non-performance by the announcement of the expectation of performance. It is motivated by the $250 billion prescription drug industry, which spends $19 billion per year on marketing to US doctors, mostly on `gifts', and often, as at Yale, with no monitoring for reciprocation. In one revealing incident, a drug firm representative closed her presentation to Yale medical residents by handing out $150 medical reference books and remarking, "one hand washes the other." By the next day, half the books were returned. I model this with a one shot psychological trust game with negative belief preferences and asymmetric information. I show that the `shame' of accepting a possible bribe can screen for reciprocation inducing `guilt'. An announcement can extend the effect. Current policies to deter reciprocation might aid such screening. I also discuss applications like vote buying when voting is unobservable and why taxis drivers in Naples announce inflated fares after their service is sunk.
    Article · Jan 2008
    • This suggests that even brief encounters may have substantial impact. This may reflect the success of sophisticated marketing techniques that enable pharmaceutical representatives to track the prescribing patterns of individual physicians and to succinctly deliver tailored marketing messages, employ influence techniques, and regulate the content of the visit all the way down to the firmness and duration of the introductory handshake [10,22,58,59]. While we are unaware of other studies published in the medical literature that use methods similar to ours, other reports have found a range of real or perceived impacts of pharmaceutical detailing on prescribing [1].
    [Show abstract] [Hide abstract] ABSTRACT: Sales visits by pharmaceutical representatives ("drug detailing") are common, but little is known about the content of these visits or about the impact of visit characteristics on prescribing behavior. In this study, we evaluated the content and impact of detail visits for gabapentin by analyzing market research forms completed by physicians after receiving a detail visit for this drug. Market research forms that describe detail visits for gabapentin became available through litigation that alleged that gabapentin was promoted for "off-label" uses. Forms were available for 97 physicians reporting on 116 detail visits between 1995 and 1999. Three-quarters of recorded visits (91/116) occurred in 1996. Two-thirds of visits (72/107) were 5 minutes or less in duration, 65% (73/113) were rated of high informational value, and 39% (42/107) were accompanied by the delivery or promise of samples. During the period of this study, gabapentin was approved by the US Food and Drug Administration only for the adjunctive treatment of partial seizures, but in 38% of visits (44/115) the "main message" of the visit involved at least one off-label use. After receiving the detail visit, 46% (50/108) of physicians reported the intention to increase their prescribing or recommending of gabapentin in the future. In multivariable analysis, intent to increase future use or recommendation of gabapentin was associated with receiving the detail in a small group (versus one-on-one) setting and with low or absent baseline use of the drug, but not with other factors such as visit duration, discussion of "on-label" versus "off-label" content, and the perceived informational value of the presentation. Detail visits for gabapentin were of high perceived informational value and often involved messages about unapproved uses. Despite their short duration, detail visits were frequently followed by physician intentions to increase their future recommending or prescribing of the drug.
    Full-text · Article · May 2007
    • Anything that improves the relationship between the rep and the client usually leads to improved market share. to the AMA [5]. Pharmaceutical companies are the primary customers for prescribing data, which are used both to identify " highprescribers " and to track the effects of promotion.
    [Show abstract] [Hide abstract] ABSTRACT: This article, which grew out of conversations between a former drug rep and a physician who researches pharmaceutical marketing, reveals the strategies used by reps to manipulate physician prescribing.
    Full-text · Article · May 2007
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