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KAI RYSSDAL:You'd probably like to think that what happens between you and your physician stays between you and your physician. But the truth is that that's just not the case.
Specifically, information about which drugs doctors prescribe for you often ends up in the hands of big drug companies, which then turn around and use it to market their products to doctors.
It's a phenomenon called drug data mining. It's a multi-billion dollar business -- but some states are passing laws to ban it. This week, the legislature in Massachusetts takes up the debate.
From the Marketplace Health Desk at WGBH in Boston, Helen Palmer reports.
HELEN PALMER: I was at the doctor's office recently. The physician's assistant I see, Karen, told me an interesting fact.
KAREN: We don't let drug reps come into the office. We find they influence our prescribing too much.
Karen says even the free samples reps hand out aren't really a benefit -- they're invariably costly new drugs that aren't on the insurers preferred lists. Physicians and hospitals increasingly bar the door to drug reps, and doctors are increasingly suspicious of what the sales people know about them, and what they prescribe.
STEVEN GAMBOA: My DEA number -- my licensing information -- is sold to a central data collection agency.
Family Physician Steven Gamboa.
GAMBOA: That collection agency combines my unique identifying numbers with data gathered from pharmacies on what drugs I've prescribed, and when, and then that information is sold in turn to drug marketers.
There's nothing illicit about this -- the American Medical Association, the doctors' own professional group, sells the data. It shares its master list of all 800,000 U.S. physicians with health information companies. Those companies pay a hefty fee, says the AMA's Jeremy Lazarus.
JEREMY LAZARUS: The licensing in 2006 brought in about $46 million in revenue to the AMA, so it is a considerable part of our business.
That's cash the AMA uses for advocacy, like their current campaign to cover the uninsured. The data collecting companies use the information for public health research, to track drug use or side effects. But they also sell it to the pharmaceutical industry. Doctors can opt out of having their data used for marketing, Lazarus says. But as a psychiatrist himself, he finds it useful that drug companies have this information. It cuts down on the useless reams of stuff people send him.
LAZARUS: This would have the tendency to provide information that's more tailored to the kind of practice that I have.
But that's precisely what makes critics of drug data-mining so mad: It helps pharmaceutical companies target doctors, to get him to switch from the cheap generic to their expensive brand-name products. States pay for that in higher Medicaid bills -- one reason they're taking it up in court, says Maine representative Sharon Treat.
REP. SHARON TREAT: Overall, 17 states introduced legislation, and it's still pending in a number of those states.
Treat introduced Maine's legislation to limit the use of prescription drug data earlier this year. It's not just the cash, Treat says -- commercial use of this information compromises patient privacy and interferes with the doctor-patient relationship. But the drug makers, who buy and mine the data, say they're not the ones interfering. Julie Corcoran of the industry's lobbying arm, PhRMA:
JULIE COCORAN: Our concern is when states -- and in this instance, New Hampshire, Maine and Vermont -- legislate in a manner that we believe interferes with the physician-patient relationship and/or the ability of the FDA and our industry to disseminate valuable information.
PhRMA and the data-collecting companies are contesting these laws in court on First Amendment grounds. They scored a victory earlier this summer when New Hampshire's law was ruled unconstitutional by a district court. That decision in turn is being appealed by the states and various consumer groups. Maine's Sharon Treat is confident they'll win, and that several other states will introduce data-mining laws next year.
TREAT: States, as Thomas Jefferson anticipated, have become the laboratories of democracy, and I think this is an example where things can be tried out at the state level. And I do think that the states' involvement has pushed this issue nationally.
But there'll be no national legislation soon -- the tug-of-war between those who pay for health care and want to clamp down on costs, and drug makers who want to sell us ever-more-expensive medications, is likely to play out at the state level for years to come. In Boston, I'm Helen Palmer for Marketplace.