New Hampshire takes on Rx data mining

At press time, the Granite State was slated to become the first in the nation to prohibit the sale of physician prescribing data for most commercial purposes.

The law the governor is expected to sign cites a number of commercial activities-advertising, marketing, promotion, among them-but its true target is the "data mining" conducted by healthcare information organizations (HIOs). These companies collect, analyze, and sell data about prescribing patterns to, among others, drugmakers. In theory, this information is supposed to make drug reps more knowledgeable and efficient in their interaction with their physician customers. And, in some cases, that's precisely what happens. But in too many instances, say critics, theory and reality collide.

"With very specific information in hand about our prescribing patterns, drugmakers have been able to manipulate our behavior," says Marc M. Sadowsky, president of the New Hampshire Medical Society, which strongly backed the prescribing data bill.

Drug makers don't condone rogue tactics, but they do think New Hampshire lawmakers got it wrong. In fact, even before the bill made it through the legislature, PhRMA, the industry trade group, predicted dire "unintended consequences" if it passed. Among other things, said PhRMA, drugmakers will find it harder "to alert physicians to important new information about medicines in a timely fashion."

The AMA-which licenses its Physician Masterfile to HIOs so that they can match individual doctors with their prescribing data-has also come out against efforts like New Hampshire's. (Several other states have introduced similar legislation.)

As an alternative, beginning immediately, the AMA will give doctors who want to limit access to their prescribing data the chance to "opt out." Doing so will deny data to reps and their direct supervisors, but not to pharmaceutical employees engaged in marketing, compensation, and research. If companies breach that wall, say AMA officials, they'll call them to task. (For more details, go to http://www.ama-assn.org and click on "Prescribing Data Information Center.")

But, with the New Hampshire model shortly before them, will doctors in other states sit tight? "I hope the state medical societies will give us a chance," says Robert A. Musacchio, the AMA's point person on the opt-out program, in the works since 2004. "At the least, I'd like to see the program have time to succeed."

Some doctors are willing at this point to give him that time. "If physicians are given a clear mechanism for opting out, that will meet a lot of our concerns," says internist William E. Golden of the American College of Physicians. ACP was the first national organization to bring the data mining issue to the AMA's attention.

Golden's patience isn't infinite, however. As he says: "We're comfortable with the legislative approach taken in New Hampshire. And while we're not advocating for such an approach at present, the selling of physician prescribing data is a real issue and needs to be addressed one way or another."