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Paper text:
health information organizations ( hios ) combine prescription information purchased from pharmacies with anonymized patient medical records purchased from health insurance companies to determine which drugs individual physicians prefer for specific diagnoses and patient populations .
this information is used to tailor marketing strategies to individual physicians and to assess the effect of promotions on prescribing behavior .
the american medical association ( ama ) created the prescription data restriction plan in an attempt to address both the privacy concerns of physicians and industry concerns that legislation could compromise the availability of prescribing data .
however , the pdrp only prohibits sales representatives and their immediate supervisors from accessing the most detailed reports .
less than 2% of us physicians have registered for the pdrp , and those who have signed up are not the physicians who are targeted for marketing .
although it has been argued that prescription tracking benefits public health , data gathered by hios is designed for marketing drugs .
these data are sequestered by industry and are not generally available for genuine public health purposes .
the ama met with industry and surveyed physicians , finding that although two - thirds of physicians opposed the availability of prescribing data to drug representatives , 77% of those would have their concerns alleviated if doctors could choose to protect their individual prescribing information.3 in response to industry and physician concerns , the ama created the prescription data restriction plan ( pdrp ) .
interested physicians visit a website ( http://www.ama-assn.org/go/prescribingdata ) and fill out a form requesting that their prescribing data be withheld from pharmaceutical sales representatives . to activate one s pdrp rights online
, a physician must check off or provide a reason for opting out and accept the vaguely ominous statement that ,  some of the information provided may be shared with entities outside the ama in order to register and/or follow up on your concern . 
requests expire 3  years from when the physician signs up , and requests may take 6  months to take effect because drug companies are required to check the list quarterly and then have 90  days to restrict sales representatives access to these data.12 a pilot version of the pdrp was launched in california and several other states in may 2006 ; the program officially launched nationally in july 2006.7 few doctors know about the pdrp .
soon after the program launched , a poll of 210 physicians found that only 18% were aware of the program ; more than half ( 53% ) were interested in signing up.13 the ama mailed no announcements to physicians because studies have shown that  direct mail to physicians is very inefficient ,  according to the ama s media outreach coordinator,7 who also noted that office staff often intercept physicians mail .
instead , the ama placed ads or announcements in ama publications and several medical journals , and e - mailed announcements to about 100,000 physicians , about 1,000 of whom subsequently signed up for the pdrp.7 by july 18 , 2006 , 2,900 of 800,000 practicing physicians had signed up for the pdrp.13 by may 2007 , a year after the program began , about 1% of active physicians ( 7,476 ) doctors had opted out.14 by january 2008 , almost 12,000 doctors ( 65% of whom are not ama members ) have signed up.15 such low participation in the pdrp is predictable because opt - out options  are designed to maximize participation while preserving a patina of choice.16 default choices are perceived to be socially preferable , so opt - out options have resulted in increased default participation in situations as diverse as prenatal hiv testing , 401(k ) savings plans , and medical journal reviewing.16 in its current form , the pdrp withholds some information from some industry representatives some of the time .
all other employees retain full access to all the individual - specific prescribing information . as an industry article puts it ,
 the information available to the  home office will not change , regardless of physician enrollment in pdrp .
this program will not affect headquarter business systems.17 the most relevant information is still available to pharmaceutical representatives because the pdrp exempts information on  ( a ) deciles at the market or therapeutic class level , ( b ) segmented data that are not likely to reveal the actual or estimated activity of an individual physician , or ( c ) data on products ordered by physicians from pharmaceutical companies.17 in other words , the pdrp does not restrict pharmaceutical companies from seeing , analyzing , and using prescribing data to promote specific drugs to the doctors who have opted out .
x is in the top 10% of doctors in terms of prescribing volume for antidepressants ; in the top 20% for antibiotics ; and is an  early adopter  of drugs .
pharmaceutical representatives enjoy full access to drug - specific details on chemotherapy or any other drugs dispensed or administered in physicians offices .
an industry article notes that that although the pdrp  limits reps and their supervisors from accessing data on some physicians , it nonetheless enable companies to continue to run essential business applications that rely on prescriber data.17 whereas a massive physician sign - up of high prescribers for the pdrp would inconvenience pharmaceutical companies ,  the opt - outs to date are generally lower - prescribing physicians , with 72% in the market - five decile or lower.3 doctors in the bottom half of prescribers are not targeted for marketing anyway .
in 2006 , new hampshire passed a law banning commercial sale of prescribing data and was promptly sued by ims and verispan .
on april 30 , 2007 , a federal judge ruled the new hampshire law unconstitutional on the grounds that it restricts commercial free speech.18 the state plans to appeal the decision .
other states are considering similar bills , but the decision in new hampshire and the availability of the pdrp has had an effect .
a preliminary injunction was granted to prevent enforcement of a maine law ( which is also being appealed ) , and vermont is now modifying a law that it passed.15 the availability of the pdrp was key to a 2006 decision not to reintroduce california assembly bill 262 ( narrowly defeated in 2004 ) , which would have severely restricted the sale and use of prescription data.5 an industry publication explains ,  pharmaceutical manufacturers need to make the pdrp work , since the alternative , government legislation , is not in anyone s best interest . without pdrp , long - term access to physician - level data within the healthcare system is called into question.5 the ama s pdrp brochure states that the program  responsibly honors the opinions of all physicians  and provides a more reasonable alternative to a 
one - size - fits - all  legislative ban that ignores vital aspects of prescribing data use.19 the industry - friendly nature of the pdrp is revealed in an article coauthored by ama and ims employees , which states ,  the rules allow the industry to retain access to prescribing data for most purposes , but they require companies to police their own sales forces . if they succeed , legislators will turn their attention elsewhere , and the industry can hang onto one of its most valuable data sources.17
pharmaceutical interests argue that unrestricted access to prescribing data saves lives , money , and physicians time .
the pharmaceutical research and manufacturers of america ( phrma ) has argued that prescriber data are needed to send out communications informing doctors of drug recalls and serious adverse effects.20 however , when the fda orders a recall or mandates a new black box warning on a drug , the manufacturer is usually required to send a 
access to prescriber data allows pharmaceutical companies to target necessary prescription information to physicians which helps avoid a saturation of less relevant information to a broader physician audience.20 an industry article states that ,  prescribing data allow pharmaceutical promotion to be relevant and specific , making the whole process more cost - effective ( and sparing physicians from being bombarded with extraneous promotional materials and sales calls)  .17 certainly , these data enable the identification of physicians relevant and specific to drug sales .
sales calls and promotional materials are preferentially showered on high - prescribing physicians and others who affect market share.1 the ama , in testimony opposing legislation to restrict industry access to prescriber data , states that ,  this information is critical to improving the quality , safety , and efficacy of providing patient care through evidence - based medical research.21 the ama is misguided on this point .
researchers do not need hio data , which are too expensive for most individual researchers to purchase anyway.4 ( ims has occasionally provided limited data to some researchers without cost or at discount.20 anecdotally , free data are older data and do not contain dates of service or other information routinely provided to paying customers . ) although hios claim that the fda relies on their data , the use of hio data by the fda for public health purposes is trivial . according to ims 2006 annual report , 
sales to the pharmaceutical industry accounted for substantially all of our revenue in 2006 , 2005 , and 2004.22 it bears noting that hios are not the only source of prescription data .
medicare , medicaid , the military , the veteran s administration , and large health maintenance organizations ( hmos ) all have databases of medical and prescription information that have been extensively used by health services researchers .
the inclusion of race and ethnicity data makes medicaid ideal for researching health outcomes in diverse populations ( medicaid covers 1 in 5 americans , including 1 in 3 african americans and 1 in 4 latinos).23 government data may be the most reliable for research purposes .
one recent analysis found prescription data available from the center for medicaid and medicare services ( cms ) superior to medicaid data available from a commercial vendor.24 the coverage of outpatient prescription drugs through medicare part d will create a trove of prescription data on elders for researchers .
hios package physicians names with prescriptions and patient medical records to facilitate pharmaceutical marketing efforts to manipulate individual prescribing habits .
there is no obligation for hios to share information with government regulators  even when such information affects public health .
for example , sluggish sales of a migraine drug in 2003 led an unnamed company to hire ims health to determine why.25 ims researchers hypothesized that lower - than - forecasted sales of the migraine drug could be because of decreased menopausal hormone use .
millions of women stopped taking menopausal hormones in mid-2002 when the women s health initiative showed that risks outweighed benefits for the most popular estrogen  progestin regimen .
ims examined the medical records of 41,403 women with migraines and found that those who stopped hormone therapy halved their use of migraine drug prescriptions .
women filled an average of 2.94 prescriptions for migraine medication during a 6-month period on hormone therapy compared with an average of 1.49 prescriptions during a 6-month period after they stopped hormones .
more than half of the women ( 54% ) filled no migraine drug prescriptions in the 6  months after quitting hormones.25 this very large study , which definitively linked migraines and hormone therapy , was never shared with physicians nor published in the medical literature .
it was mentioned , in a publication directed exclusively at pharmaceutical marketers , as an example of the services hios provide to pharmaceutical companies .
pharmaceutical companies are required by law to report adverse events associated with their products to the fda .
the commercial sale and use of prescriptions and medical records compromises the privacy of individual prescribers and patients , is not necessary for health services research , and may well have adverse effects on public health .
the purpose of prescription tracking is to promote the use of the newest , most expensive drugs , a practice that threatens rational prescribing .
assessment of the benefits and harms of medications should be a government function , implemented by researchers without commercial ties , and conducted solely in the public health interest .
public monies should be allocated to integrate existing public sources of health data and expand accessibility to researchers who will use these data in the interests of patients rather than industry profits .
introductionmonitoring and modifying physicians prescribing behavior through prescription tracking is integral to pharmaceutical marketing . 
 health information organizations ( hios ) combine prescription information purchased from pharmacies with anonymized patient medical records purchased from health insurance companies to determine which drugs individual physicians prefer for specific diagnoses and patient populations . 
 this information is used to tailor marketing strategies to individual physicians and to assess the effect of promotions on prescribing behavior.discussionthe american medical association ( ama ) created the prescription data restriction plan in an attempt to address both the privacy concerns of physicians and industry concerns that legislation could compromise the availability of prescribing data . 
 however , the pdrp only prohibits sales representatives and their immediate supervisors from accessing the most detailed reports . 
 less than 2% of us physicians have registered for the pdrp , and those who have signed up are not the physicians who are targeted for marketing.conclusionalthough it has been argued that prescription tracking benefits public health , data gathered by hios is designed for marketing drugs . 
 these data are sequestered by industry and are not generally available for genuine public health purposes .