The AMA last month voted to try to control the flow of information to drug companies about doctors' prescribing patterns.
While some physicians see prescription profiling as an invasion of the doctor-patient relationship, others see the AMA action as much ado about little.
Resolutions on the touchy subject were heard before AMA Reference Committee B during the annual House of Delegates meeting, held in Orlando, Fla.
One resolution called for AMA trustees to study "legally appropriate means" to prevent drug companies from assessing physician prescribing patterns, including preventing the use of Drug Enforcement Agency physician identification numbers "as a pharmaceutical marketing tool." The resolution also called for the AMA to find ways to block pharmacies from releasing this information and "protect physicians from the use of this prescribing pattern information by pharmaceutical companies."
The delegates approved an amended resolution nearly identical to the original.
In reporting only the amended resolution, the committee rejected a second, more aggressive resolution that called for the AMA to seek federal legislation supporting an existing AMA policy against the use of the DEA license number for any purpose other than verifying that the prescriber has federal authorization. It would limit use of the license numbers to drug law enforcement agencies only.
The committee heard testimony from delegates who called profiling "an inappropriate intrusion into the privacy of the physician-patient relationship" and accused the government, health plans, and insurance and drug companies of violating that privacy.
Testimony also warned about companies touting electronic prescribing tools that use the data the devices generate "to track prescribing patterns and sell the information for marketing purposes." Some of the devices link doctors to their diagnoses and their prescriptions, a medical blending of particular interest to data vendors.
AMA trustee John Nelson, M.D., says the board would like to partner with the drug industry to find mutually satisfactory ways of aggregating prescription data, but that right now, "it's being done for the wrong reason . . . so they can sell drugs."
Nelson, an OB/GYN at LDS Hospital in Salt Lake City, says he works in one of the most data-intensive hospitals in the country. At LDS, data is collected and deployed to improve patient care, and in that use doctors and data collectors could find common ground.
The AMA resolution, he says, is a reaction by doctors to increased pressure from drug companies and managed care plans that use the data to influence or even pressure doctors to prescribe drugs for financial reasons.
"What we want is the freedom to make the decisions we want to best benefit our patients," Nelson says.
The AMA board will look at ways to implement the resolution, either through cooperation or legislation, Nelson says.
Edward Fotsch, M.D., is the chief executive officer of Medem, the Internet joint venture sponsored by the AMA and 19 other medical societies. Fotsch says pharmaceutical firms sponsor some of the 20,000 physician professional Web sites hosted by Medem.
"We don't sell physician data," Fotsch says, but he quickly adds such sales by others have been going on for years and the long-established practice isn't a major concern for physicians.
During his 10 years in medical practice, Fotsch says he saw his own profile compiled by IMS Health, a Westport, Conn., firm specializing in gathering drug sales information, "and they had data down to the latest script."
The hullabaloo now, he says, "sort of reminds me of the scene from 'Casablanca' where the French guy says he's shocked there's gambling going on in the place he's shutting down. Give me a break."
Richard Barker is president and CEO of iKnowMed in Berkeley, Calif. His company sells electronic medical records software for oncologists and operates a Web portal for them and their patients. The software issues reports to physicians about their prescribing habits, but the company only sells to others what Barker calls "blended data" that does not identify physicians or patients.
Of the AMA resolution sponsors, Barker says: "I have some sympathy with them.
The data in the wrong hands could be abused."
Susan Pisano, spokesperson for the American Association of Health Plans, says health plans are being held accountable for improving quality of care and outcomes, for example, by ensuring that heart patients who need beta blockers receive them.
"You have a healthcare system that's moving in the direction of accountability," she says. "You have to have a way to make sure that happens."
Kathy Freeman, spokesperson for IMS Health, makes no apology about one line of the company's business-gathering and selling prescription profiles. Drug companies save money by knowing a physician's prescribing habits and directing their sales force accordingly, Freeman says. It saves doctors time, too.
"If the doctor is not seeing many asthma patients, why go in there with an asthma drug?" she says. "The benefit of it would be to get the right message to the right doctors at the right time."
ePocrates of San Carlos, Calif., loads its clinical drug reference software onto handheld Palm Pilots used by 80,000 doctors. Bristol-Myers Squibb recently sponsored the purchase of Palm Pilot Vx devices to be distributed free by ePocrates to cardiologists.
Michelle Snyder, vice president of marketing and strategic planning for ePocrates, would not specify the number of doctors sponsored by Bristol-Myers Squibb, but said for such sponsorships, "we're looking for minimums of 10,000 physicians for some specialties."
What the drug companies get for their investment is a pipeline into a doctor's office.
"One of our revenue streams moving forward is aggregating data about drugs," Snyder says. Doctors will not be profiled, she says.