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MEDICINE MERCHANTS / Tracking the Doctors High-Tech Stealth Being Used to Sway Doctor Prescriptions November 16, 2000 - As a busy internist in West Palm Beach, Fla., Dr. Bruce Moskowitz frequently prescribes cholesterol-lowering medicines and osteoporosis drugs for his elderly patients. Like most physicians, he is no stranger to pharmaceutical sales representatives, and he often chats with them about his preference in medication. But the drug companies know more about Dr. Moskowitz than he realizes. Over the past decade, with the advent of sophisticated new computer technology, pharmaceutical manufacturers have been quietly compiling résumés on the prescribing patterns of the nation's health care professionals, many of whom have no idea that their decisions are open to commercial scrutiny. These "prescriber profiles" are the centerpiece of an increasingly vigorous — and apparently successful — effort by drug makers to sway doctors' prescribing habits. To create them, pharmaceutical marketers are buying information from pharmacies, the federal government and the American Medical Association, which generates $20 million in annual income by selling biographies of every American doctor. The profiles do not contain patient names. But they do offer drug companies a window into one half of the doctor-patient relationship. And they are raising important public policy questions, both about the privacy of doctors' prescribing decisions, and how much commercial pressures influence them. "As an extension of the doctor- patient relationship, doctors are entitled to privacy," said Lawrence O. Gostin, an expert in health privacy at the Georgetown University Law Center. In describing the profiles as "a fundamental violation" of that privacy, Mr. Gostin said they also raise "an extremely important policy question, which is to what extent are health care prescribing practices influenced by commercial concerns?" That question is now front and center in the political debate. With the price of prescription medication high on the national agenda, the impact of marketing on the cost of pharmaceuticals is at issue. But while the public discussion has focused largely on the recent trend toward advertising directly to patients, the industry still spends most of its money wooing doctors. Of the $13.9 billion that the drug companies spent promoting their products last year, 87 percent, or about $12 billion, was aimed at doctors and the small group of nurse practitioners and physicians' assistants who can prescribe some medications, about one million prescribers all told. "The pharmaceutical industry has the best market research system of any industry in the world," said Mickey C. Smith, a professor of pharmaceutical marketing at the University of Mississippi. "They know more about their business than people who sell coffee or toilet paper or laundry detergent because they truly have a very small group of decision makers, most of whom still are physicians." Pharmaceutical sales representatives have been a staple of American medicine for decades. Their courtship of doctors is intensive and expensive, and their largess runs the gamut, from trinkets like prescription pads and pens, to staff lunches at hospitals and medical offices and offers of free weekends at resorts. Prescriber profiles play a significant role in the courtship; pharmaceutical marketers say they use the reports to help determine which doctors should be offered certain perks. And the perks themselves worry ethics officials at the American Medical Association, who are trying to discourage doctors from accepting them, even as the association's business side sells information that facilitates the giving of gifts. By SHERYL GAY STOLBERG and JEFF GERTH Copyright 2000 The New York Times Company http://www.nytimes.com/2000/11/16/science/16PRES.html janet paterson, an akinetic rigid subtype parkie 53 now /44 dx cd / 43 onset cd /41 dx pd / 37 onset pd TEL: 613 256 8340 URL: http://www.geocities.com/janet313/ EMAIL: [log in to unmask] SMAIL: POBox 171 Almonte Ontario K0A 1A0 Canada