Doctors, states fight drug firms' collection of data

Seattle pediatrician Rupin Thakkar's first inkling that the pharmaceutical industry was peering over his shoulder and into his prescription pad came in a letter from a drug representative about the generic drops Thakkar prescribes to treat infectious pinkeye.

In the letter, the saleswoman wrote that Thakkar was causing his patients to miss more days of school than they would if he put them on Vigamox, a more expensive brand-name medicine made by Alcon Laboratories.

"My initial thought was, 'How does she know what I'm prescribing?' " Thakkar said. "It feels intrusive ... I just feel strongly that medical encounters need to be private."

He is not alone. Many doctors object to drugmakers' common practice of contracting with data-mining companies to track which medicines physicians prescribe and in what quantities — information that marketers and salespeople use to fine-tune their efforts. The industry defends the practice as a way of better educating physicians about new drugs.

Now the issue is bubbling up in the political arena. Last year, New Hampshire became the first state to try to curtail the practice, but a federal district judge three weeks ago ruled the law was an unconstitutional restriction on commercial speech.

This year, more than a dozen states, including Washington, have considered similar legislation, according to the National Conference of State Legislatures. The Washington state bill died in committee in March.

Data-mining companies and the pharmaceutical industry say patient names are encrypted early in the process and cannot be accessed, even by the data-mining companies.

But the concerns are not merely about privacy. Proponents of the legislation say using such detailed data for drug marketing serves mainly to influence physicians to prescribe more expensive medicines, not necessarily to provide the best treatment.

"We don't like the practice, and we want it to stop," said Dr. Jean Silver-Isenstadt, executive director of the National Physicians Alliance. "We think it's a contaminant to the doctor-patient relationship, and it's driving up costs."

The American Medical Association 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.

After complaints from some members, the AMA last year began allowing doctors to "opt out" and shield their individual prescribing information from salespeople, although drug companies can still get it. So far 7,476 doctors have opted out, AMA officials said.

Since at least the early 1990s, drug companies have used the data to identify doctors who write the most prescriptions and go after them the way publishers court people who subscribe to lots of magazines.

They zero in on physicians who prescribe a competitor's drug and target them with campaigns touting their own products.

Salespeople chart changes in a doctor's prescribing patterns to see whether their visits and offers of free meals and gifts are having the desired effect.

"It's a key weapon in determining how we want to tailor our sales pitch," said Shahram Ahari, a former drug detailer for Eli Lilly.

Seattle Times staff reporter Carol Ostrom contributed to this report.