The Times had this interesting story yesterday about doctors’ objections to the collection by pharmaceutical companies of data tracking drug prescriptions by doctor. The companies can use this data to tailor their “marketing” efforts — a word I place in quotes because that marketing can include simply pressuring doctors to prescribe more of a particular drug and, especially, targeting “gifts” to do the most use for the drug companies. If you have a copy of the April issue of the Atlantic around (no, we don’t just read The New Republic around the Prawfsblawg offices — we’re intellectually diverse!), the Times story can be read profitably alongside a great piece by Carl Elliott about the practices of pharmaceutical reps, called “The Drug Pushers.”
The story says that the AMA intends to give individual doctors the choice of opting out of the provision of prescription records to drug reps. This is a pre-emptive measure, because some states have proposed blocking such sales altogether.
Now, there is an underlying problem here, involving the drug companies’ increasing pressure on doctors to prescribe high-profit drugs, whether or not these are the best drugs for a given occasion. But is the solution the AMA and the states have proposed actually the right fit for the problem? The drug reps’ vehicle of choice, as Elliott’s article makes clear, is money: throw “gifts” at doctors, medical students, and others, from pens and notepads up to truly scandalous inducements; underwrite every aspect of a doctor’s life from medical school on; attempt to co-opt doctors by placing them on advisory boards and other sinecures; and so on. All of it legal, and most of it leaving unstated the expectation that these relationships will, in the long run, lead to individual doctors’ being at least somewhat more pliable in their prescription choices.
So how does removing prescription-by-doctor tracking data help resolve this problem? Drug companies could decide that without the data, they do not know where to focus their efforts, and so will retreat from their spiral of inducements offered to doctors; but, as a data tracking company executive in the Times story suggests quite rightly, “Limiting the access to our data will not stop pharmaceutical marketing.” That being the case, what do doctors gain by eliminating the flow of that data? Viewed through a public choice lens, it would seem to me that giving the informational advantage to the physicians means the drug companies don’t know to whom they should be offering their quasi-bribes, and so must spread the financial lubricants around as widely as possible. I don’t see that it is necessarily in the public interest to ensure that the bribery is widespread rather than targeted.
Many doctors insist, of course, that the “bribery” is nothing of the sort and that they, in any event, are strong enough in their professionalism to withstand the blandishments. Elliott’s article suggests that the data show otherwise, and the fact that the drug reps are spending the money in the first place suggests they agree. Better, I think, to address the problem at its root and set steep limits on what doctors can accept in the first place, than to address it in a fashion that will simply encourage the drug companies to make sure the gifts go out as widely as possible. Such a move, unfortunately, is opposed by many in the profession and in its professional associations. But not by everyone!
Posted by Paul Horwitz on May 5, 2006 at 04:19 PM