Fwd: [drugawareness] Pharmaceutical Secret Reports Outrage Doctors

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Mon, 26 May 2003 14:46:20 EDT

[drugawareness] Pharmaceutical Secret Reports Outrage Doctors

 

 

 

Read the excerpts and article below from the Boston Globe to see what drug

companies are doing to persuade your doctor to give you drugs and you to take

them. How a doctor is prescribing determines whether or not he will be receiving

free gifts and trips for doing so.

 

And with all the prescribing history of the doctors DRUG REPS are the ones

encouraging doctors to up the dosages of the drugs when they are not working for

a patient! Sound familiar?

 

How many on SSRIs, after reporting the drugs are not working, are told they

need to increase their dose?

 

This is exactly what happened to Officer Stephen Christian in Dallas, TX. One

of Dallas' finest officers with a 23 year career and 19 commendations. After

complaining that Prozac was producing hallucinations and delusions for him he

was told that Prozac does not cause hallucinations and delusions (guess his

doctor could not read the package insert!). He was then admitted to a hospital

where his dose was TRIPLED and he was released.

 

Two weeks later he ran into a police substation wearing plain clothes and

shooting. Lilly settled the wrongful death suit in his case and took care of

damages for the officer he shot.

 

But now the question arises, " WHO was it that recommended the increase in

dose? " Was it the drug rep? And how liable is he in this tragic incident?

 

Dr. Ann Blake Tracy, Executive Director,

International Coalition For Drug Awareness

www.drugawareness.org & author of Prozac: Panacea

or Pandora? - Our Serotonin Nightmare (800-280-0730)

 

 

" Prescriber profiles, albeit in a more rudimentary form, are a key element in

the whistleblower lawsuit David Franklin filed against his former employer,

Parke-Davis, now part of Pfizer, alleging illegal and off-label marketing of

the company's top-selling epilepsy drug, Neurontin. Federal investigators are in

settlement talks with Pfizer, which declines to discuss the case.

 

" Franklin, who worked as a medical liaison for Parke-Davis from April to July

1996, said his supervisors would provide him with a doctor's prescribing

record for the previous month before he went on a sales call.

 

" A month later, they would send him the physician's new prescriptions, so he

could see if the information he gave to the doctor led him to prescribe more

Neurontin or other Parke-Davis drugs. Now sales reps can see within days if a

doctor is responding to a pitch, he said.

 

" If a doctor was prescribing a competitor's product, Franklin knew that his

presentation should focus on undermining that product, he said.

Sales people also reviewed doctors' prescribing habits to determine who was

loyal and should receive trips and gifts. The industry has since put in place

voluntary guidelines discouraging lavish trips and gifts.''The doctors it

didn't work on didn't get the gifts anymore

 

" If a drug company, for example, finds doctors are switching patients off of

its cholesterol-lowering drug after they don't respond to a 40-milligram dose,

the company can direct its sales force to focus on telling doctors to

increase the dose.

 

 

http://www.boston.com/dailyglobe2/145/metro/Drug_companies_secret_reports_outrag\

e_doctors+.shtml

 

Drug companies' secret reports outrage doctors

 

By Liz Kowalczyk, Globe Staff, 5/25/2003

 

Several months ago, a pharmaceutical company salesman told Dr.

Mario Motta something that surprised him. The salesman, who had scheduled a

15-minute appointment with Motta, said he knew that the doctor had been

prescribing a competitor's cardiac drugs -- and he wanted Motta to switch.

 

Motta had never discussed his personal prescribing habits with the salesman.

''I said `How would you know that?' '' Motta recalled. ''I couldn't get it out

of him, so I told him to leave.''

 

Drug makers, in a level of detail unknown to many physicians, are spending

millions of dollars to develop secret reports about individual doctors and their

patients, according to consultants to the drug companies.

 

Most physicians know drug companies collect some information about which

medications they prescribe. But they are often surprised by the depth of detail

pharmaceutical makers now are buying about almost every US physician, mostly

from large pharmacy chains. The details include whether doctors are switching

specific patients from one drug to a competitor within days of it happening, and

whether they treat many poor patients and may want free samples.

 

With many doctors now holding sales representatives to strict time limits

when they visit, these ''prescriber profiles'' allow reps to tailor their

pitches

to individual physicians. They are an increasingly important tool in drug

company marketing to doctors, which accounts for the largest portion, $16

billion, of the $19 billion that pharmaceutical companies spent on marketing in

2001,

according to IMS Health, a Connecticut-based compmany that collects

prescriber data.

 

''Average sales calls are shorter, and physicians are seeing fewer sales

reps,'' said E.M. ''Mick'' Kolassa, a professor at the University of Mississippi

and managing partner of Medical Marketing Economics, which provides consulting

services to drug companies. ''Because of this, the sales call has become a

more precious commodity and companies need to make sure they're putting their

resources in the right place.''

 

But even though patient names are removed from the data, some doctors believe

these secret reports -- which they say sales reps almost never discuss openly

with them -- are an unwelcome intrusion into the doctor-patient relationship.

Doctors worry that the reports allow sales reps to push expensive drugs more

effectively in a health care system that already is struggling with soaring

costs.

 

''The amount of information they have about us and our prescribing is

staggering,'' said Dr. Mark Rohrer, an internist and geriatrician at St.

Elizabeth's

Medical Center in Boston. ''The important thing is how it's used. If it's used

by a rep to pressure me to provide a different drug than the one I'm

prescribing, especially if there's a generic alternative, I don't think that's

right.''

 

Several drug makers, including Eli Lilly and Wyeth, and the Pharmaceutical

Research and Manufacturers of America, the industry trade group, would not

comment on prescriber profiling.

 

Michael Barnes, vice president of business intelligence solutions at Dendrite

International Inc., which provides prescription data to drug companies, said

the data are used to promote safety.

 

For instance, the Food and Drug Administration buys Dendrite's prescribing

data, which allows the agency to monitor cases in which large groups of patients

are taking drugs that could have dangerous interactions, he said. The agency

can then direct the company to educate doctors about the potential harm.

 

Prescriber profiles, albeit in a more rudimentary form, are a key element in

the whistleblower lawsuit David Franklin filed against his former employer,

Parke-Davis, now part of Pfizer, alleging illegal and off-label marketing of the

company's top-selling epilepsy drug, Neurontin. Federal investigators are in

settlement talks with Pfizer, which declines to discuss the case.

 

Franklin, who worked as a medical liaison for Parke-Davis from April to July

1996, said his supervisors would provide him with a doctor's prescribing

record for the previous month before he went on a sales call.

 

A month later, they would send him the physician's new prescriptions, so he

could see if the information he gave to the doctor led him to prescribe more

Neurontin or other Parke-Davis drugs. Now sales reps can see within days if a

doctor is responding to a pitch, he said.

 

If a doctor was prescribing a competitor's product, Franklin knew that his

presentation should focus on undermining that product, he said.

 

Sales people also reviewed doctors' prescribing habits to determine who was

loyal and should receive trips and gifts. The industry has since put in place

voluntary guidelines discouraging lavish trips and gifts.

 

''The doctors it didn't work on didn't get the gifts anymore because it was

throwing money away,'' he said. ''Your physician would be stunned to find out

what pharmaceutical reps know about them before they walk into the office. We

were trained in how to use this information without letting the doctor know we

had it. It was absolutely imperative that you never referred to the report.''

 

Documents recently unsealed in Franklin's lawsuit in US District Court in

Boston also show Parke-Davis conducted prescriber profiling to determine whether

dinner meetings, lectures, and teleconferences persuaded physicians who

attended to prescribe more Parke-Davis drugs. Sometimes it worked, according to

the

company's analyses, and sometimes it didn't.

 

Since the mid-1990s, drug companies have hired outside firms that purchase

data on physicians from pharmacies and used the information in marketing. It's

legal in the United States as long as patients are not identified. However, the

Canadian province of British Columbia outlawed the practice in 1996. But in

the last two years, the data have gotten more sophisticated. ''What's really

changed in the last year or two is the speed at which they can get it,'' Kolassa

said.

 

Companies that buy data and sell it to drug makers are creating and

advertising new products.

 

Verispan, based in Pennsylvania, promises on its website that a new product

called Market Mover will deliver changes in doctor prescribing behavior four

days after the close of the week. It's ''the fastest available indicator of

changes in individual prescribing behavior,'' the company says. The company now

sends these prescriber ''alerts'' directly to the sales rep's laptop. Verispan

executives would not discuss prescriber profiling.

 

Companies such as IMS Health purchased computer records or tap directly into

the pharmacy computer and extract information on the 3 billion prescriptions

US pharmacies fill annually, according to industry specialists. They combine

this information with biographies on nearly 850,000 physicians compiled by the

American Medical Association, which earns $30 million annually licensing

detailed reports on physicians, including where they went to medical school,

their

fax numbers, and their specialties. About 20,000 doctors have opted to be

removed from the list.

 

AMA past president Dr. Richard Corlin said the list serves an important

safety function: It allows drug companies to immediately alert doctors to a

problem

with a drug or change in how a medication should be used. But after some of

its own members began criticizing the AMA for providing the list for marketing

purposes, the organization a year ago adopted guidelines for drug companies

that license the data, saying they should not use it to pressure doctors to

change drugs.

 

AMA officials said they would consider suspending a licensing agreement with

any drug company that violated these guidelines, but that they haven't

received any complaints from doctors to that effect.

 

Verispan, IMS, and other companies also now buy data not just on individual

doctors, but on individual patients and the medications they're taking.

Executives at CVS and Walgreens, as well as Dendrite's Barnes, said pharmacies

remove

patient names and identifying details from the data and assign each person a

non-traceable number. But the data include information such as a patient's

insurance provider, all the drugs a patient takes, and their doses. Pharmacies

would not say how much they charge for the data.

 

Barnes said the patient data are crucial because they follow individual

patients, so drug companies can see whether doctors are merely placing new

patients

on a competitor's drug or whether they're actually switching existing

patients off of one drug and onto another -- a greater cause for alarm.

 

If a drug company, for example, finds doctors are switching patients off of

its cholesterol-lowering drug after they don't respond to a 40-milligram dose,

the company can direct its sales force to focus on telling doctors to increase

the dose.

 

With doctor-specific data, drug companies could tell only if a doctor was

writing more prescriptions for a particular medication, but nothing about who

was

getting the drugs. The patient-specific data allow drug companies to see

changes in physician prescribing behavior eight months sooner, ''which could

save

tens of millions of dollars for the company,'' Barnes said. Barnes said the

more advanced data also are used to promote safety. The FDA buys Dendrite's

prescribing data, for example; this allows the agency to monitor cases in which

large groups of patients are taking drugs that could have dangerous

interactions. The agency can then direct the company to educate doctors about

the

potential harm.

 

But even when it comes to pure marketing, Kolassa said he doesn't believe

prescriber profiling is unethical. ''It's done throughout business. Frito-Lay

knows a lot more about you than Merck knows about individual physicians. They

know whether you bought beer or Diet Coke with your corn chips. Besides,

physicians can always tell sales reps to take a hike.''

 

Liz Kowalczyk can be reached at kowalczyk.

 

This story ran on page A1 of the Boston Globe on 5/25/2003.

© <A HREF= " http://www.boston.com/globe/search/copyright.html " >Copyright</A>

2003 Globe Newspaper Company.

 

 

 

 

 

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