Your Health: For Sale to Big Pharma by the AMA

The American Medical Association (AMA) is selling you out by manipulating your physicians—with the docs' permission.

Yeah, yeah, the AMA has the high-and-mighty mission of promoting the "art and science of medicine and the betterment of public health," which it strives to accomplish through one of its core values of "integrity and ethical behavior." But it's still selling you out.

According to a story in today's Washington Post, the AMA makes "millions of dollars each year by helping data-mining companies link prescribing data to individual physicians. It does so by licensing access to the AMA Physician Masterfile, a database containing names, birth dates, educational background, specialties and addresses for more than 800,000 doctors."

The AMA says that info is entered into the masterfile when a doc enters any medical school accredited by the Liaison Committee on Medical Education: the doc's name, name of medical school attended, year of graduation, sex, birthplace, and birthdate, and details on residency training, state licensure, board certification(s), geographic location and address, type of practice, present employment, and practice specialty. "Physician records are never removed from the AMA Physician Masterfile, even in the case of a physician's death. The AMA maintains information on more than 130,000 deceased physicians. These data are shared with other organizations and agencies who credential physicians and are used to identify individuals who attempt to fraudulently assume the credentials of deceased physicians."

Sounds fine and dandy; the AMA is protecting us consumers against fake physicians. But the AMA turns around and does this: After any giant pharmaceutical pays enough bucks to the AMA, it can search the masterfile to find which docs it wants to target.

Some AMA members complained about this practice, says the Post story, so last year the AMA began allowing physicians to opt out and "shield their individual prescribing information from salespeople, although drug companies can still get it. So far, 7,476 doctors have opted out, AMA officials said.

" 'That gives the physician the choice,' said Jeremy A. Lazarus, a Denver psychiatrist and high-ranking AMA official.

"Some critics, however, contend that the AMA's opt-out is not well publicized or tough enough, noting that doctors must renew it every three years."

Want to hear something ridiculous? The Post story says:

Data-mining companies and the pharmaceutical industry argue that the practice has value far beyond the corporate bottom line. The information helps companies, federal health agencies and others educate physicians about drugs, track whether prescribing habits change in response to continuing medical education programs, and promote higher-quality care, they say. They stress that patient names are encrypted early in the process and cannot be accessed, even by the data-mining companies.

Do you believe that part about the inaccessibility of patients' names? I sure don't, knowing, as I do, about the federal database that monitors who gets what prescription drugs that are considered controlled substances (such as meds for attention-deficit/hyperactivity disorder [AD/HD]).

Not all physicians like this sort of spying:

"We don't like the practice, and we want it to stop," said Jean Silver-Isenstadt, executive director of the National Physicians Alliance, a two-year-old group with 10,000 members, most of them young doctors in training. ... "We think it's a contaminant to the doctor–patient relationship, and it's driving up costs."

According to the NPA's web site, the organization is supporting anti–data-mining bills in various state legislatures. That's great, but this fight needs to get nationwide recognition. You need to get involved by writing your senators and representatives, at both the state level and the national level. Need more proof that this is a huge underground problem that leaves you with drugs you might not need, at a higher cost than they otherwise would be?

An editorial* in the May 15 issue of the Annals of Internal Medicine reports that Big Pharma spends more than $23 billion each year marketing to physicians and that the industry now has 1 sales rep for every 5 physicians working in offices. Think these docs are all pure and uninfluenced by all those sales reps with all that money? Bwahahaha! They're wined and dined and given gifts and drug samples.

So, once the pharmaceuticals have a batch of docs to look at more closely, where do they get info on what drugs the docs provide? Says the editorial:

Currently, retail pharmacies sell de-identified patient prescription records with limited physician identifiers to data intermediaries known as health information organizations (HIOs). [Using the AMA's masterfile], HIOs can link individual physicians to prescription records by using identifiers common to the pharmacy databases and the AMA database, such as a physician's U.S. Drug Enforcement Agency and medical license numbers. They also can track a physician's demographic and practice characteristics. The HIOs build prescribing profiles on the basis of these linked databases and sell them to pharmaceutical companies, which use the profiles to identify sales targets and plan detailing visits.

All during the courting of physicians, pharmaceutical sales reps tell the docs that their patients really need the giant's meds instead of the meds they've been prescribing. They help change the docs' prescribing habits in the particular pharmaceutical's favor (favor here = $$$$), which may not necessarily be in your favor (favor here = health).

Madder than hell yet? Then start writing letters to your legislators and governor right now!


Updated at 1:10 p.m.: Think that your docs know when to listen to pharma sales reps and when to blow them off? Most don't, according to this Associated Press story:

Four out of five doctors surveyed said they let drug and device makers buy them food and drinks despite recent efforts to tighten ethics rules and avoid conflicts of interest.

The national survey also found that family doctors were more likely to meet with industry sales representatives, and that cardiologists were more likely to pocket fees than other specialists. ...

The survey, published in Thursday's New England Journal of Medicine, was done by researchers from Massachusetts General Hospital, Yale University and the University of Melbourne in Australia. ...

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*Grande D: Prescriber profiling: time to call it quits. Annals of Internal Medicine 2007;146(10):751–752.



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