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Darkside of health data

Ano Lobb | Monday 9th November 2009

You may take it for granted that you have some level of medical privacy: That a company couldn't, for example, buy a list of all the medications your doctor has prescribed you, the better to entice your doc to change to newer, more expensive drugs that are riskier but no better than the old generics you currently take. You might think you have that privacy, but you don't.

That's thanks to prescriber-identifiable prescription tracking, a marketing practice that sells your health information to commercial interests, spreading handsome profits to everyone but you the patient. To be fair many doctors aren't aware of this practice, and most see very little if any gain from it. Commonly used throughout the US, it is growing in Europe and other markets with computerized prescription drug fulfillment. Each year approximately $20 billion is spent marketing drugs to physicians in the US, and evidence indicates that it is a worthy investment, providing returns on investment of anywhere from $1.23 to nearly $12 for every $1 spent.

This is how it works: When you fill a prescription, the pharmacy's computer system records every detail: The doctor and drug name, your age, sex, any other health conditions on record. Everything but your name. The pharmacy collects this data for every prescription, selling it to Health Information Organizations (HIO) such as IMS Health, Verispan or Wolters Kluwer. HIOs combine it with detailed doctor information gleaned from sources such as the American Medical Association's "master file" of physician members. The AMA sells this database, which includes such information as physician's specialty and contact information. After analyzing the aggregated data, HIOs sell it to drug marketers, who utilize it for targeted sales campaigns. The maker of a new diabetes drug, for example, can identify a doctor with scads of diabetic patients taking a competitor's product, and lavish that physician with attention and gifts in an effort to get them to switch drugs. Gifts amount to far more then pens and coffee mugs: In many cases they amount to $50,000 a year or more. Studies show that marketing works: Prompting physicians to write prescriptions for more expensive, newer drugs that are no-more effective and generally less safe than older, established choices. Bad for health, but good for business.

HIOs claim their data is for research, or to ensure rouge docs aren't overusing inappropriate meds. And their databases could be goldmines for the right research. Unfortunately, the cost of accessing them generally exceeds academic research budgets, and I have heard from colleagues who were denied access to the data when it became clear that their research was not in the HIO or pharmaceutical industry's best interest.

Want to know how much your doctor has received from industry? Only a handful of states in the US have laws requiring public disclosure of such information. In addition to being the only ones that are harmed from this practice, patients are being left in the dark about who is being corrupted by it.

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Ano Lobb 12 November 2009

This particular data could not be used to check up on individual patients, since patient data is de-identified (names and identifiers removed). Its actually the prescriber who is under the most scrutiny, since he/she essentially undergoes a prescription pad audit by whomever is reviewing the data.

That being said, there may be other similar sources for patient-identifiable data, especially for payers, perhaps through PBMs (prescription benefits managers). The legality of amassing patient-identifable data for resale is a bit cloudy.