[Ip-health] John Mack on IMS efforts to defend use of physician prescribing data for marketing purposes

[James Love]

http://pharmamkting.blogspot.com/2006/05/specious-arguments-in-favor-
of-rx-data.html
Pharma Marketing Blog
John  Mack
Thursday, May 18, 2006

Specious Arguments in Favor of Rx Data Use

IMS Health -- the company that sells physician prescribing data to
pharmaceutical companies -- is working overtime these days to stem
the rising tide against the use of physician prescribing data for
pharmaceutical marketing purposes. New Hampshire, for example, has
just passed a bill to make the sale of physician prescribing data
illegal for marketing purposes (see "Who's Data Is it Anyway?").

To combat further erosion of their business, IMS has teamed up with
the AMA to write a Pharmaceutical Executive Magazine article
extolling the virtues of the AMA's Prescribing Data Restriction
Program (PDRP). You can download the article ("More Than a Game of
Keep-Away") here.

The article states flatly:

"If the industry cannot police itself effectively, state legislatures
are likely to pass laws banning reps'=92 access to prescriber data.
Legislation has been introduced in several states this year, but the
prospect of the PDRP program has stalled most of the bills. Only
effective self-regulation can keep such laws off the books."

I have no beef with that goal. I do believe, however, that the
authors (Hunkler is Director of Professional Relations at IMS and
Musacchio is CIO at AMA) are not presenting the best arguments to
support their case. In fact, some of their arguments may be
counterproductive and at least one is laughable.

As I have said elsewhere, physician prescribing data can be useful to
target specific promotions to physicians and offer them more relevant
information and thereby improve pharma-physician relationships.
Considering the poor state of this relationship, I believe this
argument is a sufficient defense of the use of Rx data for marketing
(assuming, however, that the data is actually used that way).

The authors of the PE paper, however, go much further. I think they
go too far, in fact. They argue, for example, that use of Rx data by
pharma actually LOWERS healthcare costs!

"Opponents of prescribing data have argued, erroneously, that using
prescribing data to support pharmaceutical sales and marketing
somehow burdens the healthcare system with additional cost. The facts
suggest just the opposite. Prescribing data allow pharmaceutical
promotion to be relevant and specific, making the whole process more
cost-effective (and sparing physicians from being bombarded with
extraneous promotional materials and sales calls)."

I don't know who has said that use of prescribing data by pharma for
marketing purposes burdens the healthcare system. Yes, there are
those people who say that pharmaceutical marketing, in general,
increases drug costs, but that's a different issue. Nevertheless, by
using this argument, the authors admit that "bombarding" physicians
with "extraneous promotional materials and sales calls" adds cost to
the healthcare system!

To accept the authors' argument, you have to believe that high-
prescribing physicians are visited LESS by pharma reps and this just
isn't generally true. Much of pharmaceutical marketing is aimed at
"high decile" physicians. Of course, it may not be marketing
originating from the brand that the physician prescribes frequently.
Generally, if a physician is a high prescriber of drug X, then
competitor drug Y's sales reps will set upon him/her like flies on
dung. Also, I'm not so sure that drug X salespeople ignore these high
prescribers.

Another argument in favor of pharma use of Rx data the authors of the
PE paper make is that it allows pharma companies to more quickly
notify physicians of product recalls.

"[Physician prescribing data can] Help prioritize the release of
public safety news alerts Based on physician prescribing details,
companies can identify which physicians need to be contacted first in
the event of a newly identified side effect or a product recall."
PhRMA makes a similar argument:

"Foreclosing all access to prescribing data could also hamper
manufacturers' ability to alert physicians of important new
information about medicines in a timely fashion." See "PhRMA
Statement on New Hampshire Prescribing Data Legislation."

Yes, prescribing data could be used that way and it could make drug
safety surveillance much more efficient. Unfortunately, the
information is not used that way. Pharmaa companies notoriously
engage in non-targeted physician marketing (see, for example, "A
Crisis in Professional Detailing"), so why would they be any better
when it comes to notifying physicians of problems with their drugs?
The best they can do is send "Dear Doctor" letters to ALL physicians
who may (or may not) prescribe their drugs. In fact, this is what the
FDA requires!

The PE article authors also argue that physician prescribing data can:

"Give physicians a unique view of their own practice HIOs [ie, IMS
and companies like them] are piloting information products to
physicians (as recommended in the 2004 AMA board report) that can
reveal important facts about a physician's own practice: the degree
to which patients comply and persist with treatment, patients'=92 use
of generics, and how the physician'=92s prescribing practices compare
with those of his or her peers. The data can also be used to provide
valuable information for pay-for-performance systems that drive
improved clinical practices."

This is true, but irrelevant to the case of use of Rx data by pharma
companies for marketing purposes (the NH law, for example, would not
prohibit use of Rx data for these purposes).

Use of Rx data to measure physician performance and pay for that
performance is a whole 'nuther can of worms that IMS should have been
smart enough to leave unopened! Physicians hate HMOs and performance
measures probably more than they hate pharma marketers. This issue,
in fact, is one which aligns pharma and physician interests -- pharma
is leery of evidence-based performance measures because they could
hurt sales of their expensive drugs, which may be no more effective
than generics. IMS and AMA, by using this argument, are not doing the
industry any favors nor does it help the industry build better
relations with its physician customers.

OK. Those were the unproductive arguments. Here's the laughable
argument:

"...what is not widely known is that the pharmaceutical industry's
commercial interest in the data ultimately makes possible a variety
of other research applications. The industry underwrites the
substantial costs that HIOs incur when collecting and processing the
information. Without this support, the data would not exist for use in:

* Evidence-based drug safety studies
* Public health monitoring to set and promote public health policy
* Outcome studies and pharmacoeconomic analyses that look at value
vs. cost
* Bioterrorism surveillance
* Development of clinical practice guidelines
* Disease management programs
* Analysis of changes in government healthcare programs (e.g., the
uptake of Medicare Part D coverage)."

OMG! The whole healthcare system would come tumbling down! If the
pharma industry is the only payer for these data, then we are surely
going to Hades! Where's government? Where's the insurance companies?
Isn't their money any good? What is IMS saying? That it overcharges
the pharma companies to subsidize giving away this information to the
government and insurance companies? And the pharma industry has never
crowed about this and taken credit for it? What's up with that PhRMA?

My conclusion: The cafeteria of arguments IMS and AMA offer against
limiting use of Rx data for marketing purposes goes beyond the real
issue (marketing) and is more self-serving than it serves the
pharmaceutical industry.


---------------------------------
James Love, CPTech / www.cptech.org / mailto:james.love@cptech.org /
tel. +1.202.332.2670 / mobile +1.202.361.3040

"If everyone thinks the same: No one thinks."  Bill Walton