A front page article in The New York Times reports that doctors are beginning to rebel against  corporate Big Brother watching over their shoulder, recording each and every prescription they write for a brand name drug.
 
The embarrassing fact that they are watched has led some doctors to be genuinely upset. Others, no doubt, are chastened by questions from their patients who may be questioning whether the doctor is influenced by the ‘detail men’ who hang around the waiting rooms.  The fact that the American Medical Association sells its U.S. physicians’ Masterfrile to commercial outfits, only underscores the corruption of medical practice.

The commercial value of the AMA masterfile was first reported in an excellent investigative report by Times reporters Sheryl Stolberg and Jeff Garth on Novermber 16, 2000. One of the opponents of the commercialization of medicine, Dr. David Blumenthal, a professor of health policy at Harvard Medical School, said: “The sale of the master file to drug companies hands the weapon to the drug company that the A.M.A. is saying is an illicit weapon." [1]

It is apparent that the AMA cares more about money—no matter how unethically obtained—than medical ethics. As former Eli Lilly drug salesman, Jamie Reidy, author of the book, “Hard Sell,” a humorous expose of the pharmaceutical industry, acknowledges:
"It’s the most powerful tool a drug rep has, for sure. The pharmaceutical representatives received updated prescription data every two weeks. The information also sometimes characterizes each physician’s prescribing patterns.”

It is reassuring to note, that we were not off-base (as some had suggested) when we referred to some physicians as “medical cowboys.” According to Reidy, "early prescribers" — also known among drug representatives as "cowboys" — are those doctors who start prescribing a drug as soon as it comes to market. If you are a drug sales representative, "you go to see that doctor in the first week.”

In 2000 the AMA sold the physician prescribing profiles for $20 million. Today, the AMA garners at least $40 million annually.

HBO’s BILL MAHER wrote a hillarious OpEd piece in the Los Angeles Times (below), in which he skewers the drug industry’s methods of marketing invented “diseases;” doctors who jump at every free (expensive) dinner invitation and honoraria for listening to sales pitches;  and the complicity of the FDA and Congress who, as he says, are also accepting bribes:

“Drug companies are pushers, and Congress and the FDA are the cop on the beat who’s been paid off to look the other way.”

“Just in the last two years, the drugs that have made the headlines under the category "Prescription Medicines That Hurt People" have included Vioxx and Ambien. And yet it was marijuana last week that was declared by the FDA to have no known medical value. Actually,
what marijuana has is no known lobbying value.”

1. See:  High-Tech Stealth Being Used to Sway Doctor Prescriptions By SHERYL GAY STOLBERG and JEFF GERTH, A-1
http://www.nytimes.com/2000/11/16/science/16PRES.html?

Contact: Vera Hassner Sharav
veracare@ahrp.org

THE NEW YORK TIMES
   May 4, 2006
Doctors Object to Gathering of Drug Data
By STEPHANIE SAUL

Although virtually unknown to consumers, the information has long been considered the most potent weapon in pharmaceutical sales — computerized dossiers showing which physicians are prescribing what drugs. Armed with such data, a drug sales representative can pressure a doctor to write more prescriptions for a name-brand medicine or fewer orders for a competitor’s drug.

But now a rebellion is under way by some doctors, who consider the data-gathering an intrusion that feeds overzealous sales practices among the nation’s estimated 90,000 drug company representatives. Public officials are also weighing in. A vote on a state bill to clamp down on the practice is scheduled for today in New Hampshire, and similar bills have been introduced in other states, including Arizona and West Virginia.

To appease the doctors and try to stave off the state restrictions, the American Medical Association will soon give individual physicians the choice of declaring their prescription records off limits to drug sales representatives. The new measure is viewed as a self-policing move that the drug industry and the A.M.A., which has lucrative contracts with data-mining companies, hope will keep states from banning sales of prescription data altogether.

If the A.M.A effort succeeds, "legislators will turn their attention elsewhere, and the industry can hang on to one of its most valuable data sources," according to an article this week in the industry trade magazine Pharmaceutical Executive, which was co-written by an A.M.A. official and an executive with the leading vendor of prescription data. Even many critics concede that patients’ privacy is apparently not an issue, because the tracking systems identify only the prescribing doctors, not patients. But many doctors find the use of the data by sales representatives an intrusion into the way they practice medicine.

"These doctors were outraged that people came into their office and talked to them about how many times they prescribed a particular drug," said Dr. John C. Lewin, the chief executive of the state medical association in California, one of the states where complaints about the current system arose.
The California group is beginning its own program under which doctors who do not opt out under the A.M.A. system will get comparisons of their prescribing patterns in 17 classes of drugs from the data companies, said Dr. Lewin, who added that the program was being started as a pilot effort that he hoped would be extended statewide.

Among the doctors who raised an early complaint about the system was Dr. Brad Drexler, an obstetrician in Healdsburg, Calif., who said he was surprised four years ago when pharmaceutical representatives began thanking him for writing prescriptions — the first time he realized that the drug representatives had information he assumed was private.

"I think it adds to the potential that physicians could be targeted one way or another for perks," said Dr. Drexler, alluding to the practice by drug companies of deciding which doctors to reward with the gifts, meals and other perks that sales representatives have dangled over the years, or to gauge which physicians might be worthy of signing up as paid speakers or consultants.

"It’s the most powerful tool a drug rep has, for sure," said Jamie Reidy, a former drug salesman who was fired last year by Eli Lilly & Company after writing "Hard Sell," a humorous exposé of the pharmaceutical industry. Mr. Reidy said the pharmaceutical representatives received updated prescription data every two weeks. The information also sometimes characterizes each physician’s prescribing patterns, Mr. Reidy said.
For example, "early prescribers" — also known among drug representatives as "cowboys," according to Mr. Reidy — are those doctors who start prescribing a drug as soon as it comes to market. If you are a drug sales representative, "you go to see that doctor in the first week," Mr. Reidy said.

Although the drug representatives are told not to share the prescribing details with doctors, some nonetheless have confronted doctors with the data. A representative might become frustrated, for example, if after providing numerous lunches to a doctor’s staff, the data show that the doctor is not writing prescriptions for the company’s drug.  "It just creates a weird atmosphere," Mr. Reidy said.

State Representative Cindy Rosenwald of New Hampshire, lead sponsor of her state’s bill, said she was motivated partly by high Medicaid drug costs, which she said she believed had been driven up by the pharmaceutical industry’s success in coaxing doctors to prescribe expensive brand-name drugs.
"To me this is a money issue," Ms. Rosenwald said. "When I look at our state’s budget, the fastest-growing part of the Medicaid program here in New Hampshire is for prescription drugs. It’s an enormous cost for a small state like New Hampshire."

Ms. Rosenwald’s legislation has been adopted by the New Hampshire House and is tentatively set for a Senate vote this afternoon.
She said she did not believe the A.M.A.’s self-policing measure would provide enough protection, partly because even if doctors specify that their prescription records not be available to drug sales representatives, the information would still be sold to drug companies for other marketing and research purposes. The drug companies, she said, would be on their honor not to share the data with their sales staffs. A Gallup Poll commissioned by the A.M.A. in 2004 found that two-thirds of doctors surveyed were opposed to the release of such data to pharmaceutical representatives, and that 77 percent felt that an opt-out program would alleviate concerns about the release of data. Nearly a quarter of the doctors were not even aware that the pharmaceutical industry had access to such information.

That same year, the American College of Physicians requested that the A.M.A. prohibit the release or sale of doctors’ prescribing information. The college represents internists and related medical subspecialties, while the A.M.A. is a broader trade group whose members include all doctors, including surgeons.

Dr. Dean Abramson, an Iowa physician, is among the doctors who plan to opt out under the new A.M.A. process, which will involve a sign-up registry that goes into use on July 1. His opposition began nearly a decade ago, he recalled, when a representative from TAP Pharmaceutical Products let slip during a sales call that Dr. Abramson wrote more prescriptions for Prevacid, a treatment for acid reflux, than any other doctor in the state.
"I was pretty surprised that they kept that data, and I was not happy at all," Dr. Abramson said. "I said, ‘Why is that data even kept?’ She didn’t really give me an answer."

Since then, Dr. Abramson has become something of an activist against the lunches and gifts that the pharmaceutical industry dispenses to doctors. His gastroenterology group in Cedar Rapids, Iowa, accepts neither, he said.

The leading compiler and vendor of prescription data is IMS Health, a publicly traded company based in Fairfield, Conn., that had revenue last year of $1.75 billion. IMS and its competitors gather the data through contracts with retail pharmacy chains and companies that manage drug plans for insurers, then sell it to pharmaceutical companies.
IMS and its competitors — the main ones are Verispan, Dendrite International and a Dutch company, Wolters Kluwer — also pay the A.M.A. for access to its repository of information on approximately one million doctors who are graduates of American medical schools, as well as foreign medical school graduates licensed in the United States.

The A.M.A., which calls this repository Masterfile, begins collecting the information when a doctor enters medical school. Over doctors’ careers, additional material includes information on their board certifications, types of practice and disciplinary records. The Masterfile information is among data that companies like IMS use in developing physician profiles.

In an interview, IMS officials said they believed that state efforts to curtail their activities were misguided. "Limiting the access to our data will not stop pharmaceutical marketing," said Robert J. Hunkler, whose job with the company includes serving as a liaison with the medical profession. Mr. Hunkler also says that the data his company collects is valuable for medical research and is sometimes shared free with researchers.

Mr. Hunkler was a co-author of the Pharmaceutical Executive article describing the new A.M.A. program. The other writer was Robert A. Musacchio, the A.M.A.’s senior vice president for publishing and business services. While Mr. Musacchio declined to disclose the exact value of its Masterfile contracts with the four main data companies, he said that the organization made $40 million a year selling information, which also includes mailing lists and a service through which hospitals can check the credentials of doctors. Mr. Musacchio said that doctors had always been able to put a "no contact" status on their Masterfile record, meaning their name would not be licensed for marketing by mail, telephone or fax.
The A.M.A.’s new registry, administered partly through a Web site, will enable doctors listed in its Masterfile to indicate that they do not want their prescribing data shared with pharmaceutical sales representatives. The decision will remain in force for three years.

And yet, even those doctors’ prescription information will still be collected and transmitted to drug companies, whose other uses of the data include tallying bonuses paid to pharmaceutical representatives, which are based on sales. "What we’ve always stressed is that physicians have rights and they can always tell pharmaceutical representatives that they don’t want to be called upon," said Mr. Musacchio. But he said the organization had always made clear to the pharmaceutical industry that its representatives should never "badger or embarrass or harass" physicians.
"They sometimes try to get their point across a little too strongly," he said.

Copyright 2006 The New York Times Company

Los Angeles Times
Pill popper nation: Drug companies are the pushers, the FDA a cop paid to look the other way.
By Bill Maher
Thursday April 27, 2006
Opinion piece

 IF I HAD every problem the TV ads say I do — breathing, lifting, walking, sitting, sleeping and my toes rotting off — I’d welcome death. Al Qaeda? Bring it on. Nerve gas? Please, I’ve got seasonal allergies.

   It seems as if every time I turn on the TV these days, I see some ad for some drug I never heard of to treat some disease I never heard of. You don’t have a stomachache because you ate the chili-cheese fries at Johnny Rockets, you have irritable bowl syndrome, or IBS, or, as I call it, BS.

   Which would also apply to the dreaded "social anxiety disorder," or, as we used to call it, shyness. And we treated it with an old home recipe — Scotch and water — because it’s not a disorder at all. It’s normal to be anxious when you walk into a room full of strangers. Especially if they’re lacrosse players.

   Your wife doesn’t get turned on? It couldn’t be because you’re a snowman-shaped sausage casing so full of beer you sweat hops. It’s because she has "female sexual dysfunction." Short of breath? Well, you could lose 100 pounds, or you could take this pill.

   And before they came up with "restless leg syndrome," did it even exist? Did you ever hear someone say, "Sorry I couldn’t make the party, Bill, the old restless leg was acting up." Next time you have an uncontrollable urge to move your feet, maybe you should move your feet. Your feet are trying to tell you the same thing your dog is trying to tell you when he’s been cooped up inside the house all day:
"I want to go for a walk!" But be careful, there’s a Tasmanian devil living under your toenail.

The problem is, the profits are so enormous for magic pills that drug companies invent the pill first and then conjure up something it can treat.

   Right now, the Food and Drug Administration is considering a petition from the drug lobby to get rid of the warnings in drug ads. The Coalition for Healthcare Communication — which sounds a lot nicer than "the Pushers Union" — says that alerting people to side effects "over warns" consumers. So forget all that mumbo-jumbo. Who are you going to trust, a lot of small print or a talking bee? Come on, take this pill. It’ll make a football go through a tire swing. Side effects? You bleed from your pores, then explode and die. And/or dry mouth.

   Just in the last two years, the drugs that have made the headlines under the category "Prescription Medicines That Hurt People" have included Vioxx and Ambien. And yet it was marijuana last week that was declared by the FDA to have no known medical value. Actually,
what marijuana has is no known lobbying value.

   And yes, back in 1999, when we still believed in science, the National Academy of Sciences’ Institute of Medicine said what millions who simply have gotten relief already know: that pot is useful in treating pain, nausea and AIDS-related weight loss, and that lab rats exposed to it were more likely to forget the maze and just kick it old school.

   But the FDA, you see, protects us from marijuana. Is there anything more laughable than the thought that the FDA is protecting anything but the profit margins of pharmaceutical companies? And the bribery doesn’t stop with the FDA and Congress. Doctors get whisked off to exotic locales for weekend "seminars," all paid for, of course, by drug companies, and suddenly Monday morning everyone needs OxyContin — which in reality is a powerful, morphine-like narcotic
meant to be used only by those in severe physical pain and, of course, celebrities.

"Ask your doctor if it’s right for you" has become, "Tell your doctor to shut up and fork over the pills."

   Drug companies are pushers, and Congress and the FDA are the cop on the beat who’s been paid off to look the other way. New drugs used to have to go through a rigorous process of testing. Now they just give it to Courtney Love, and if she lives, it’s approved.

   By the way, that FDA report about marijuana having no medical value was issued, on purpose I’m sure, on April 20 — 4/20. That joke only makes sense to stoners. So Mom and Dad, if your kid just laughed, you might need to search his room.

BILL MAHER is the host of HBO’s "Real Time with Bill Maher."

 
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