BIG PHARMA WANTS TO KNOW ALL ABOUT YOU!

If you're handed a laptop at your doctors office to type in your medical information, don't use it - unless you don't mind your personal medical information being sent straight to a pharmaceutical company. Phreesia, a New York company, distributes wireless "WebPads" that patients use to input medical histories and other information, including why they're seeing the doctor. A 2005 Phreesia press release states, "After completing the interview patients are directed to a health education portal where they are able to read targeted material about their health that reduces their perceived wait time."(1) Targeted material, of course, means articles meant to increase a patient's use of targeted drugs. The company's website notes that: "Phreesia partners with pharmaceutical and medical device companies to provide sponsored newsletterarticles to patients before they see their physician often stimulating conversation and helping to educate patients on health issues relevant to their visit." (1)

Subtle advertising isn't the only way pharmaceutical companies benefit. Your doctor gets an electronic copy of your health questionnaire, but so does the pharmaceutical (or medical device) company, which uses the information for marketing purposes. And no, that's not illegal, because patient names are stripped from the questionnaire before being transmitted to the sponsoring company. Your doctor gets the opportunity to "code higher," which means choosing a diagnosis that reimburses more from insurance companies. (1)

Drug and device companies have invaded waiting rooms in other ways as well. A company called The Healthy Advice Network has installed silent TVs permanently tuned to a mixture of drug ads and health news in 95,000 waiting rooms across the U.S. Customized messages can be included or certain advertisements blocked. Healthy Advice tells physicians that any specific ads can be removed from the newsletterarticles with "no questions asked."(2) (I wonder whether the company would honor requests for an entirely ad-free version?)

Does your doctor have a web site? It may be a present from Big Pharma as a way to gather information about patients, coax consumers to visit web sites and increase their demand for specific drugs, and increase doctors' receptivity to visits from drug reps. HealthBanks is one company that develops web sites customized to doctors' practices and/or specific diseases. (Other companies that offer web sites to physicians include Amicore, a joint venture by Pfizer, IBM, and Microsoft; MyHealth.com, from Schering-Plough; and MyDocOnline, from Aventis.) These Big Pharma-sponsored sites are made available through the companies' drug reps, a ploy to provide "a compelling role for pharmaceutical sales representatives."(3) Big Pharma sponsors use the web sites to collect information about the concerns of specific practices' clients. Sharing this information with doctors provides drug reps with more face time with physicians. But doctors aren't the only ones getting this information. HealthBanks collects data on the interests of the sites' users and shares that with the pharmaceutical companies that fund the web sites.(4)

HealthBanks' Chief Executive Officer has stated: "Helping make the health information connection between the prescriber and the patient is the big opportunity for pharmaceutical companies today. In addition to becoming a valuable contributor to the health care process by supporting a physician-to-patient channel, pharmaceutical companies will also benefit by gaining proprietary access to aggregate data about physician and patient behaviors, questions, opinions, and preferences."(5)

Drug reps are only too happy to promote these sites, since they provide opportunities to interact with physicians. Other incentives exist as well. According to HealthBanks, Schering-Plough's drug reps "freely discuss an aggressive incentive program which pays them $1 per patient 'log-in' to the site (log-ins are most likely counted when a patient registers for any one of the Schering sites linked from MyHealth); one representative reported a $3,000 payment for one month's log-ins."(6)

Drug companies don't gather this information to improve health care. Information provided to an industry-funded web site may be used to market drugs directly to individual consumers. Information collected from laptops in doctor's offices doesn't have individual names, but your personal medical information is aggregated with other patient records and used to promote increased consumption of the most expensive drugs.

Are these programs successful? Of course they are. HealthBanks reports that, in 2000 alone, the number of prescriptions written by medical practices that receive HealthBank services for drugs that are produced by one of its Big Pharma sponsors increased by 23 percent.(6)

REFERENCES
1. See http://phreesia.com/Phreesia_Adopter_1122006.pdf. Accessed April 9, 2006.
2. See www.healthyadvicenetworks.com.  Accessed April 9, 2006.
3. See www.healthbanks.com. Accessed April 9, 2006.
4. "Private matters: doctor - patient companies have traditionally been shrouded in secrecy. Now, drug marketers are trying to gain a voice in the discussion, raising concerns about confidentiality and undue influence." Brandweek 2005; 46(31):22.
5. Robinson JT. "Changing the face of detailing by motivating physicians to see pharmaceutical sales reps." Product Management Today 2003; Nov.:24-27.
6. Brown MS, Barrette J. "Owning the Channel: Pharmaceutical companies race to dominate patient-physician communication." Rx White Paper. On-line at: http://www.healthbanks.com/PatientPortal/Public/support_documents/OwnTheChannelWhitepaper.pdf. Accessed April 9, 2006.

Adriane Fugh-Berman, M.D., is an associate professor in the Georgetown University School of Medicine, Department of Physiology, and a former chair of the NWHN.