Slate's Medical Examiner: 'Prescriber Profiles'

Drug company whistleblowers have warned government officials that pharmaceutical companies are tracking how many and what brand of pills doctors are prescribing — a practice known as "prescriber profiling." Madeleine Brand talks to Slate contributor Shannon Brownlee about what influences the drug prescription habits of doctors, who are sometimes showered by drug companies with expensive perks.

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MADELEINE BRAND, host:

This is DAY TO DAY. I'm Madeleine Brand.

We know that medical records are supposed to remain private, but what about the prescribing habits of doctors? Well, it turns out that drug companies keep very close tabs on which drugs doctors prescribe, how often and how certain gifts affect their behavior. Writing in slate.com, journalist Shannon Brownlee describes a meeting with five whistle-blowers drawn from government agencies and drug companies where they discuss this practice. Shannon Brownlee spoke with me earlier.

Shannon, every time you walk into a doctor's office, you're almost assaulted by the soft marketing or the advertising. You can see drug companies' names and medicine names on pens, on pads of paper, on calendars. Doctors also get free trips from drug companies. So how is this all affecting their decisions on which medicines to prescribe?

SHANNON BROWNLEE reporting:

If you ask many doctors whether or not it affects their prescribing habits, they will tell you no. They do it on the basis of the scientific evidence. But if you ask the industry, they know that it does affect their prescribing habits. That's why the industry puts the effort and the money into doing it.

BRAND: You write that the companies actually know right down to the pill whether or not these sales pitches and this soft marketing works.

BROWNLEE: Yes, they do. And they way they do that is they have these weekly reports where every individual sales representative gets a report on the prescribing that was done by all the doctors in their territories. So they know all the prescriptions that were filled by the patients in their doctor's territory. And so they can see whether or not their efforts were successful or not.

BRAND: And you heard from several whistle-blowers about this issue, including one person from the drug companies, a drug rep. What did that person have to say?

BROWNLEE: The drug rep said that what sales reps are doing in many kinds of drugs are trying to get their doctors to prescribe more of their drug rather than another drug in the same class.

BRAND: Do the doctors know they're being tracked like this?

BROWNLEE: A lot of doctors have no idea. In fact, we heard from a couple of drug reps, not just the drug rep that was at our meeting, it's really not a good idea to let your doctors know that you're tracking them this way. In the words of one drug rep, `When you let a doctor know that they're being tracked this way, they go ballistic.'

BRAND: So the doctors presumably can say no to any of this. I mean, they're not being forced to prescribe these medicines. Why don't they?

BROWNLEE: I think there are a lot of reasons. One reason is that they're really busy, and sales reps come in with a lot of information that seems to help them. Means they don't necessarily have to pour through all those journals that are piling up in the corners. They like the sales reps, and they've been getting a lot of freebies. Now this is not all doctors, obviously, but a lot of doctors can pad their income significantly by having these financial relationships with the drug industry.

BRAND: Isn't that a professional responsibility for doctors to actually read these studies about these medicines that are supposedly conducted independently of the drug companies and make their own informed decisions, rather than taking the easy way out and accepting the drug company's word for it?

BROWNLEE: Well, there are sort of two parts to the answer. One, I have an awful lot of sympathy for doctors because they really are deluged with information. But the second part is that even the stuff that is appearing in the journals is hugely biased by the industry. The industry pays for the majority of clinical trials. And numerous studies have found that when the industry pays for a study, it is more likely to report positive results for that company's product.

BRAND: Opinion and analysis from journalist Shannon Brownlee. You'll find her article on how drug companies keep tabs on doctors online at slate.com.

Thanks for joining us, Shannon.

BROWNLEE: My pleasure.

BRAND: And that article on slate.com was co-authored by Jeanne Lenzer.

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