data mining


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hi Dr. Dave- what are your thoughts on data mining, prescription data? Do you ever think about or care that reps have access to your prescribing habits? Have you ever had a rep try to use this info in a visit to you? Assuming you don't block it. Not many docs in my area do, most don't even know they can. I have no problem letting docs know how to hide their data, but it's too big of a hassle and not worth most of their time. The ama certainly doesn't advocate doing this or facilitate the process-they're in bed with pharma!
 


hi Dr. Dave- what are your thoughts on data mining, prescription data? Do you ever think about or care that reps have access to your prescribing habits? Have you ever had a rep try to use this info in a visit to you? Assuming you don't block it. Not many docs in my area do, most don't even know they can. I have no problem letting docs know how to hide their data, but it's too big of a hassle and not worth most of their time. The ama certainly doesn't advocate doing this or facilitate the process-they're in bed with pharma!

Dr. David,

Our practice is aware because a representative pulled out information about how I was prescribing. I was a junior partner at the time and had no idea that they could obtain that information. The senior partners had some inkling and confirmed it.

The partners blocked not only access to our prescribing habits but let the pharmaceutical company know. Our practice will not let any representative in our practice.

We have a Physician Assistant that did presentations for that company. This individual told us what type of tactics pharmaceutical representatives are involved in to obtain more prescriptions.
 


  • DrDave   Jul 07, 2012 at 11:44: AM
A few years back, there was a thread about this very subject. I apologize that it's a little tedious to read as the quotes were altered by a later software upgrade as I recall. See:

This thread.

The subject came up again about a year later:

Here.

To the preceding poster, I certainly respect your practice's decision regarding how you want to manage rep interactions. It's an individual choice. I just wanted to point out that it's an informed choice only if you make it with the knowledge that the data still gets sold (as far as I know) even if you opt out or choose not to see reps.

It may sound like a rationalization, but, as discussed in these referenced threads, if my data is being sold anyway, I would like to have the opportunity to get a little value from it if possible.

If you are members of the AMA (I'm not), you may wish to lobby your organization to stop facilitating the process, as it sounds like you have strong feelings about it.

Thank you both for your posts!
 


It is a shame this is what it has come down to. There are really not that many reps left and (one would hope) the ones that are left, are probably tenured. The data is important to decide if you are using a company's product and provide your office with samples/vouchers, patient education or even HCP education and prescribing information. Without that data, representatives have to make educated guesses about where to go and what to talk about or what questions to ask. I know of no doctors that regularly read all the PI for the medications they Rx. Pharmacies do not provide this either and (despite ads saying otherwise), they do not track to ensure medications are not contraindicated or have warnings for use together or in certain conditions. I spend a great deal of time with nursing staff ensuring my product(s) is used correctly and safely. It is new and most of them have no idea what to look for or how it should be used and they are the ones that must train the patient. This is but one value offices lose when they choose to not have their data collected and/or not see representatives. (I do have some health systems where I train one of their staff to train the rest of the practice.) But suit yourself. I know in the end, it is the patient that most likely suffers or benefits. The offices that still provide samples are much busier than the ones that do not. That is just a fact. Samples/vouches help a patient decide if the side effects are tolerable without having to buy a 30 or 90 day supply. The doctors that will spend some time with a few good reps are usually a little more up-to-date than the ones that don't.
 


I'm a PA in the practice the MD posted about. I've not only done several presentations for that company but I was employed by pharma eons ago. What is disturbing about getting information about how our prescribing habits is that it puts pressure on us. The reps. should know not to share that information but unfortunately they do. It has caused quite a stir in our medical community. It is very common for us to talk about this type of information. I think it is unscrupulous and leads to many practices not wanting welcoming reps. Look at this board and I'm not talking about Dr. Dave's but the company boards paint practitioners in a very negative light. It is extremely offensive. We don't say negative things about reps. in our practice. I don't know what happens in other practices. This practice will stop and I predict in the near future.
 


  • DrDave   Jul 09, 2012 at 01:07: PM
Thanks for your post. I personally see this as 2 issues that sometimes get inappropriately (IMHO) combined into 1.

1) Is it appropriate that prescribing data is available to pharmaceutical companies?

This is a very complex issue to be sure. I will say that I do feel that it is inappropriate that the American Medical Association facilitates the process even for the prescriptions of physicians who are not members. As many of you already know, the American Medical Association has an identifying number for every physician, not just its members. Check my facts on this, as this is only my understanding of the process in general - the physician information from the AMA's masterfile is licensed to Health Information Organizations (HIOs) who use it to connect physician data with prescription data they get from pharmacies. This combined information is sold to pharmaceutical companies.

Opting out does not change what I just described; it changes whether a field rep can see the data. Consequently, I do not see opting out as an effective way to undermine the selling of our data. Cynically, I feel the offer to opt out is a bit manipulative - it gives the some physicians the good feeling that goes along with taking action on an issue. However, if the issue is the selling of the data, the action doesn't pertain to it in any meaningful sense.

If physicians in general feel that the selling of the data is inappropriate, we could lobby for legislation to prevent it. But who is our major lobbying organization? The AMA, which discourages opting out. Consequently, I would think the next approach would be for AMA members to threaten to leave if the AMA's masterfile continues to be used for this purpose.

I'm skeptical that refusing to see reps on a grand scale would result in the end of prescription datamining. I'm sure the information is so valuable in so manay other ways, pharmaceutical companies will continue to buy it as long as they can.

Once again, don't take the above as gospel - please correct me if I have any of those facts wrong.

2) Should reps see individual prescribing data?
If this is the only concern, opting out does solve this problem on an individual basis. I feel that as long as my data is being sold, I would like to have the opportunity to use that information. I don't personally mind discussing this data directly or indirectly with a rep. However, I recognize that others feel differently, and if a physician finds interacting with reps unpleasant, I can understand why s/he would stop.

Over time, my "system" has evolved as follows: I do not see every rep that drops by. If a rep has a new or unfamiliar product in a disease state that's relevant to my population, I will see them at least once, research the product and determine if there is any likely long term value in seeing them regularly. If there is a rep who has a product I use regularly in a disease state I see commonly, assuming I find him/her pleasant and professional, I will generally continue to see them over time.

I realize that what works for me may not work for others. I also realize that discussing my prescribing habits with reps is comfortable for me but may not be for others. I enjoy asking questions about my prescribing habits - e.g., "I perceive I prescribe more X than Y - does that appear to be correct?" Obviously, I don't get a 100% straight answer every time, but I generally get a sense. Of course, that's not the only reason I see them. I find updated formulary information, PI updates, new indications, etc. valuable for products I use regularly. Once again, that's me, not everyone.

Once again, thanks for your post! Definitely a complex, charged issue.
 
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I am the rep who posted and I find it very unprofessional and it is against every company policy to share this information. Prescribing information is only used to help us decide from the hundreds of doctors in any given territory where we should go with our resources (since they are certainly not unlimited). The data is extremely imperfect and by no means a "tracking" tool. I always like to check in with my doctors to see where they are at. The data just helps me to allocate my time and the company resources to the appropriate doctor. The idea is to not waste the HCP's time. Personally, if I were an HCP, it would not bother me. I think it is important for any company to know who their clients are and who is using their products and for what. If this is cut off, any bond between industry and clinical practice will end. I hope you realize that it is industry that funds 80 percent of research for new drugs even if those innovations come out of academic medicine. Severe the bond and you severe this line of communication. There is a strong linear correlation between the negative press, the lack of shared data/communication and the downfall of new research and new drugs in the U.S. . .
 


Thanks Dr. Dave,
I had a conversation with a FP doc last week. He was saying that he brought this up at an IPA meeting and proposed that perhaps physicians could be compensated and take back some control by providing data that pharmacies can't track. For example, more outcomes based data. tracking any patient who is given a sample or an rx of a given product-did they take it? fill the rx? respond? have side effects? bring up cost? etc. I would find this data much more helpful. However, ultimately, I wish all docs would block their data. It would reduce our tracking, micromanagement, and paperwork. It would also force more reps to sell on the merits of their products.
I don't know that a mall ipa would realistically be able to change the system and mine this data in a way that physicians were compensated, not pharmacies. I do think that'd be great though.
 


While I agree with the PPs statement on many counts, where would you go with a new product, a launch, a product intended for doctors who see primarily geriatric patients? Often where a representative goes (our dreaded "target" list) is to the physicians who have a patient population most likely to benefit from a new product. There are too many specialties and too many in FP/IM that do specialize to know exactly what to talk about in two or three mintues. The days of being invited back to the physician's office for coffee and a great discussion are long gone. Sadly, no representative really has that kind of time nor any doctor. We have to be able to make educated guesses on prescribing habits in order to provide the right information and the most value in a very short period of time. No one is ever going to give out patient specific information. AEs should be reported more and there is a tracking system in place for that. It's called the FDA. Many offices do not take samples anymore because they cannot be easily tracked and even the offices could not monitor the mess inside some sample closets.
 


Back in the dark ages before data mining, DDD, etc, we simply made pharmacy calls. We had relationships with the pharmacists, often sold direct to them, sold "deals" of discount bulk sizes/quantities. We asked the pharmacists who was writing what and for what patient type, etc. With the cancerous chains running the independents out of business that is virtually impossible today plus several of the big chains do not allow reps to talk to the pharmacists or techs.

In nearly every other business, you know who buys what and how much. In pharma, we have no contact with the true customer, the patient. We sell to the wholesalers, depend on the pharmacies to stock our product, promote to MDs, PAs, RNPs so that they can prescribe to the ultimate true customer. We are now plagued by managed care and mail order pharmacy.

With all these roadblocks, how can you resent pharma for trying to figure out who is really responding to our efforts, who is actually prescribing and if it is at recommended doses, and which pharmacies are supporting us with shelf stocking.

FYI, I do draw the line at having access to patient information. Of course, when a coupon is used to reduce the cost/co-payment of a prescription, the patient furnishes most of their information in exchange for that price reduction.

We used to call on everyone, shotgun the 5 or so products we promoted to all of them and hoped some would be honest about their use of samples and prescriptions (many would tell us nothing--back to the pharmacist to tell us).

Another angle: how effective would a practitioner be is he/she were not allowed to see patient histories, not allowed to know weight, BP, temp, etc, OR to ask the patient ANY questions?? That is what you are asking reps and pharma to do.
 
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  • DrDave   Aug 02, 2012 at 02:02: PM
I think WE makes some good points. I personally don't have strong philosophical objections to the data mining itself. I primarily intended to point out to those who do that:

-Opting out doesn't stop the mining, only field reps from seeing it;

-A physician organization (the AMA) facilitates the process;

-IMHO there is utility in discussing prescribing habits and rationales, and the data can therefore be useful for prescribers if it were available to them.

There are some who believe that discussion of such data is inappropriate and unprofessional; for them, assuming they choose to see reps at all, I would think personal limit setting would work.

I've never really understood the argument some physicians make that reps use this information to "pressure" prescribers. Perhaps I'm being trite and/or parsing words, but "pressure" is an uncomfortable feeling that comes from within. If a rep has a valid point about my prescribing, I consider it. If s/he is using invalid or irrelevant information or a fallacy of logic, I say so and disregard it. I just don't feel pressured by someone who is a guest in my office and to whom I have no direct accountability.

Thanks, all, for your interesting posts!
 


Doc, the biggest problem with the data available to reps is that it is OLD--3-6 months old. There are newer services available that can show data that is only 2 weeks old, but it is for a very limited percentage of Rx's written. I have had doctors ask why I ask about what they prescribe when I have it all in my computer and I explain as above---my data is old and limited. I had an area of my territory that was invisible because three pharmacies had sold their files to WalMart and the the last independent did not have a wholesaler computer and there fore the data was not gatherable. Result: the doctors dropped off my call list. I could have called on them , gained usage of my products, but could not prove I did so.
 


  • DrDave   Aug 04, 2012 at 06:51: AM
Thanks, Walking Eagle - I have heard many reps question the reliability of this data in my area as well. 95+% of my rxs go to 3 independent pharmacies which I assume do not report, Wal-Mart (which does not report, correct?), and CVS. I suspect the same is true for all of our local doctors. A rep recently told me that I was the only physician on her call list in our county, which seemed very odd and likely attributable to chance with small numbers being reported overall.
 



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