Should Clinician Prescribing Data Be Sold?

Jeffrey A. Lieberman, MD


July 25, 2011

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Hi. This is Dr. Jeffrey Lieberman of Columbia University speaking to you for Medscape. Today, I want to [present for discussion] something that concerns the flow of information about prescribing practices of physicians. In this age of the Internet, many issues have emerged that we are struggling to manage as they become apparent and rapidly evolve. At the same time, several other groups are trying to determine how to use the information and how to commercialize it. We are aware of the potential ramifications in terms of ethics, confidentiality, and uses of the information that are different from the purposes that they may have been originally intended for or appropriately used for.

In the field of medicine and healthcare, the prescribing practices of physicians that are gleaned from pharmacies, pharmacy benefit organizations, and any provider of medication or insurance benefits, a practice has emerged to make this information available to various private corporations or entities including pharmaceutical companies. Now, the practice of analyzing administrative data is widespread and very constructive in many respects. Marketing data are used for the development of new products and for marketing products. In medicine, we look at administrative databases to evaluate healthcare trends, to look at the frequency of various types of medical problems or medical illnesses, and to see what treatments are administered or combined to treat these problems. We use databases to look at continuity of treatment vs nonadherence to treatment. There are many useful reasons for analyzing administrative data that have been collected in the course of delivery of healthcare and its reimbursement.

However, this information can also be put to inappropriate uses or not clearly intended purposes. This has emerged with respect to prescription information. What is being done is several-fold. Pharmacies or pharmacy benefit organizations are making available, I’m sure for a price, information on the prescribing practices not just of physicians in general but of specific physicians. The characteristics of these specific physicians can then be provided to sales representatives who can use these data to tailor the information they provide about their products to doctors. Presumably, this could be useful, but it could also be misused in the sense that they can target specific doctors who are prescribing a particular company's products or prescribing a particular company's competitor's products and result in a more targeted "detailing" than is ordinarily the practice.

Recently, a case was brought before the California Superior Court, the Murphy vs Walgreens corporation suit. This suit was brought against Walgreens for making their pharmacy information available to pharmaceutical companies for various types of marketing research purposes. The questions are, really, who owns this information, can it be distributed, and what limitations should be placed on it? This could be useful in terms of examining prescribing practices and marketing patterns, but it can also be used for commercial purposes to target doctors and change their practices, not necessarily for clearly justified scientific or evidence-based clinical reasons; basically, to foster specific types of marketing practices and salesmanship tactics.

Thus, with the Internet and computerized information, we have the ability to aggregate information and to share it with many different entities, which raises various types of ethical if not legal concerns. This is part of life in the modern age; part of the practice of 21st century medicine. I'm not suggesting that we prohibit these practices, but this is something we need to be more aware of, need to examine carefully, and need to determine a policy going forward so this information can be used for constructive and intended purposes and not misused.

I'm sure I'll have more to say about this as it evolves, but I wanted to raise this issue now to begin to get people thinking about it and also to invite comments about people's experiences and perspectives on this newly recognized emergent practice. For today, I'm Dr. Jeffrey Lieberman speaking to you from Columbia University for Medscape. I'll talk to you soon.


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