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Every time a doctor writes a prescription, the information is collected by a group of vendors, which in turn sells it to drug companies anxious to analyze how their pharmaceuticals are making out on the frontlines of medicine. And for an uncomfortable group of physicians, that data has occasionally been read back to them by a visiting drug representative.

But that is about to change.

Leveraging its relationship with the data vendors, the American Medical Association has set up the Prescribing Data Restriction Program (PDRP), an opt-out program for doctors who no longer want their prescribing information in the hands of an aggressive drug salesperson. Beginning this month, doctors need only visit the AMA web site — www.ama-assn.com — to list themselves on a database of physicians who no longer want their data to be shared with the reps.

"There are a lot of emotional issues at stake here," says Bob Musacchio, senior vice president of business and publishing at the AMA. The AMA began to detect unrest in its ranks over the use of this information back in 2003, when it decided to take a detailed look at the issue. And three-quarters of the people surveyed by the AMA said they would like to have the option to keep their prescribing data out of the hands of the sales reps.

For years, pharmacies and other drug retailers have compiled a massive database on the drugs each doctor prescribes. The information does not contain who gets the prescription, but details which prescriptions a doctor gives out for individual drugs. That information can be priceless in the hands of a drug company competing for a larger market share against a host of competing pharmaceuticals.

But in the hands of some drug reps, says Musacchio, it turned into an open offense for many doctors.

"They were just surprised that this information was out there," explains Musacchio, who emphasized that the AMA was never in the business of gathering or selling prescribing data. "A significant number of doctors didn't know that these companies had access to that information. Those that were aware of it were concerned that their privacy was being invaded and that people were trying to influence their prescribing patters by putting hard sale tactics in place."

Not so, says the drug industry trade group PhRMA. Drug reps use the data "responsibly and appropriately," insists PhRMA Chief Medical Officer Dr. Paul Antony. And the data gives drug reps and others a chance to work on behalf of patients.

"Physician prescribing data can benefit patients by helping America's pharmaceutical research companies distribute drug samples, address specific patient needs and provide more pertinent educational information to doctors about specific diseases, drug safety and efficacy, disease management and the benefits and risks of certain medicines," says Antony. "Appropriate use of prescribing data allows pharmaceutical sales representatives to work with physicians to help them provide the best quality care for their patients."

But that approach is unlikely to deter the AMA's new opt-out program.

"It's going to take several months to work this through the system," says Musacchio. Data has to first be collected by the AMA (membership in the group is not a prerequisite to signing up for the list), then passed on to the vendors, where it will take months more to fully process before they begin throttling back access to the information.

IMS Health is one of the most prominent vendors of prescribing data, along with Verispan, Wolters Kluwer and Dendrite International.

"Even though we don't have prescribing data — we don't license it — we do have a considerable amount of clout with those companies," adds Musacchio. "We worked with them for a long time, and we can use our contractual and economic clout to get physician preferences."

In fact, says Dr. William Golden, chair of the board of regents at the American College of Physicians, the AMA has been playing a key role in the whole process. The AMA leases its Physician Masterfile data on doctors, which allowed the data miners to link the physician with the prescription information. The ACP voted more than two years ago to rein in the practice, and the AMA has finally set the opt-out program in place.

"I think that you can do very elaborate things with this kind of data," says Golden, "and I think it's not necessarily good medicine for commercially-biased sales pitches to be targeted on this information."

Now that the AMA has made good on its planned opt-out program, he adds, the ACP is fine with the association's response. Now, he adds, "It's time for the AMA to promote it."

The vendors — and the AMA — also have another reason to cooperate. The New Hampshire Legislature just passed a bill that makes the sale of physician prescribing data illegal for marketing purposes. And several other states are exploring legislation limiting the use of prescribing data. Many lawmakers, however, are now waiting to see how this new program plays out before making their next move.

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