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Dr. Mike Minch, Tennessee Medical Association Board of Trustees.

It's a new world. Gone are the glory days when that white coat signified the doctor knew best about how to treat his patients — and his business.

Because of outside corporate and government interferences, the profession has undergone dramatic changes. Physicians are now caught in the cross hairs between managed care, insurance companies, pharmacy benefit mangers and pharmaceutical representatives trying to tell them how to run their business, how many prescriptions to write, and how to treat patients.

Even patients are getting more demanding.

Heated debates are ongoing between the American Medical Association (AMA), which attempts to protect and empower its own, and pharmaceutical companies. The ever-growing misuse of prescribing data for marketing purposes has led the AMA to develop the Physician Data Restriction Program, which gives doctors an opportunity to opt-out of releasing their prescribing practices to pharmaceutical reps and a way to complain against them for violations. The AMA is also rapping at the door of companies to get them to stop marketing "ask your doctor" on drug ads.

Dr. Mike Minch, vice chairman of the Tennessee Medical Association Board of Trustees, said there is a legitimate concern over the information that pharmaceutical representatives are getting and how that information is being used.

Every doctor's office keeps information to use for treatment of their patient that is not allowed for use by anyone else. Corporations should have the same restrictions to use that information for medical purposes, not for marketing," Minch said.

"You almost feel you have to defend the decisions you make because you're not prescribing a certain medication," he said. "We make our choices based on many factors. Maybe you're prescribing a similar medication that has better or the same results for less money. There are other things that go into your decision, like side effects and other things not clearly noted in commercials. Commercials make patients think they know what's right for them with only half the information. Another player is the third-party payor, which have formularies with restrictions that have to be met. We've got the pharmacy companies with their reps and information, we've got the Internet and TV advertising drugs and insurance companies, all of them pressuring physicians to make choices that they feel is best for them."

Members of Pharmaceutical Research and Manufacturers of America (PhRMA) invested an estimated $39.4 billion in 2005 in discovering and developing new medicines. Industry-wide research and investment reached a record $51.3 billion in 2005.

PhRMA senior vice president Ken Johnson issued this statement: "Banning access to prescriber data could result in significant unintended consequences that may have an adverse impact on activities aimed at enhancing patient care and the appropriate use of medicines. Foreclosing all access to prescribing data could also hamper manufacturers' ability to alert physicians of important new information about medicines in a timely fashion."

According to Johnson, numerous healthcare entities would be negatively affected with a ban on prescribing data. For example, the FDA depends on pharmaceutical companies to relay critical drug information to physicians in case of recall, shortage or drug counterfeiting or tampering.

But Lindstrom said that doctors usually aren't the first to find out if there's a problem. In fact, they usually don't know until they've read it for themselves in newspapers such as USA Today.

There are also other issues at stake. The AMA licenses certain health information offices. Restricting the use of prescribing data would impact the business interest. Health insurance organizations (HIOs) would have to gather data from other organizations, which would lead to termination of their agreements with the AMA.

Rather than risk losing control of the data, the AMA is encouraging pharmaceutical companies to exercise responsible use of physician prescribing data through the use of its 2001 "Best Practice Guidelines for Use of Prescribing Data."

But the news is not negative for everyone. Verisipan CEO Wayne P. Yetter said the new AMA restrictive policy could actually "open up additional opportunities for Verispan and clients."

Pharmaceutical companies will not be able to show their sales representatives specific prescribing information for physicians who opt-out. However, they will still be able to use the granular information in the corporate office, Yetter said. "Further, pharmaceutical companies will still be able to send specific messaging to representatives for opt-out physicians," he added.

To opt-out of sharing your prescribing information, visit www.ama-assn.org and log in with username and password to the Prescribing Data Information Center.



Janauary 2007

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