Wednesday, January 21, 2009

First, Data Mining; Now, "Patient Priming"

Thought you'd seen it all? Well, the infiltration of drug company marketing into every corner of our lives scoffs at boundaries. Now that nearly half of all states are considering laws banning prescription data mining, the industry is developing a new technique: "patient priming."

What is it, exactly? It's so breathlessly new that I'm not entirely certain what it is. But it can't be good. You can certainly learn more if you register for this webcast to take place February 5, produced by Medical Marketing & Media magazine and sponsored by HealthGrades. Here's how they describe the event:

"Understanding and Priming the Pre-Visit Patient

The point at which a patient plans and schedules a visit to their doctor represents a significant window of opportunity for promoting treatment options and maximizing the growth of specific brands. Experts in patient engagement and marketing from the pharmaceutical, agency and media fields discuss pharma's role in priming the pre-visit patient for a more beneficial dialogue with their physician.

Featured speakers:
Jan R. Rutherford, Jr., Senior Vice President, Sponsorship and Advertising, HealthGrades
Robert Palmer, Managing Partner, S&H Digital, Sudler & Hennessey Company"

I'm guessing this is a scheme cooked up by HealthGrades to convince more drug companies to advertise on their site. I just went to the HealthGrades page evaluating me as a doctor, and noticed a banner ad for Concerta. I assume Mr. Rutherford will entice companies to use HealthGrades to prime "pre-visit patients" and encourage them to demand specific brands from their physician. Yes, this is just another version of direct-to-consumer advertising, but the Orwellian language makes it all sound particularly insidious.


Your Pre-Visit, Pre-Primed Physician


Anonymous said...


I wish they'd make public the list of docs who sign up (that's the audience, right?). Then we could make sure to avoid them.

DDx:dx said...

I know it's fiction, but the idea of data mining doesn't have to always be sinister.

"We have developed a compatibility program that will help match patients with doctors. You know how they try to match people with a good partner? Matchmakers would consider families, try to find good matches for marriage. There are programs for personal compatibility that use a few questions to line up personality types. We have developed this tool for health care. Some people benefit from a doctor that is tall and powerful, authoritative. Others want a quiet soft-spoken thoughtful kind. So this program will align the needs of the patient with the strengths of the doctor so the two will match. Improve satisfaction in care. Improve outcomes"

Silver said...

Alas, I'm working that day and seeing (unprimed) patients, unless someone has started 'priming' the clozapine clinic... improbable, I'm thinking.
So I won't be able to watch this little gem.

Given that the same site is talking about targeting medical group practice managers and administrators, I have to wonder if they'll be 'helpfully' encouraged to send out some 'helpfully' supplied and pre-postage-paid educational information based on the stated visit reason. Say, let's bypass the medical staff altogether and pitch it to the office staff as a way to increase the kept-appointment rate...

Here's a twist on this. I take a branded AED for seizures. (And, damn it, I am annoyed to report that it works fairly well.) I filled the initial rx at a retail pharmacy, not via the mail-order service.
I received a separate mailing - sponsored by the manufacturer, but in the pharmacy's envelope, so a joint venture - on "living with" the other condition that the AED treats (which I don't have.)
I receive monthly mailed reminders, again sponsored by the manufacturer, that my rx is about to run out.
Never has happened with any other drug I've taken, ever.

At $450/month, I bet the manufacturer, and the pharmacy, are damned motivated for me to keep taking it. If I were taking it for less clearcut reasons and were at high risk of dropout, I could see them wanting to follow up like this.

For what it's worth, I haven't had anyone contact any of my practice sites about prescanning my appointment lists to send "helpful" prescreening or education materials... yet.

If I were a drug company and doing this, or a marketing group and doing this, I'd make this kind of pre-scan/screen part of one of the big EHR programs that also does scheduling; that would make it quite easy to scan the appointment lists, as well as demographics, recorded diagnoses, and known meds. And then you could generate custom 'educational' materials with very subtle bias that would be sent out as appointment reminders / "we care" letters.
And then I'd offer the EHR at a discounted rate.
Somewhat like the "free" version of epocrates.

Anyway, I can't wait to find out what fresh hell this will be.

Anonymous said...


May I ask why you are annoyed that your medication works well?

How does this mindset serve your ability to treat patients, which it seems you do, without bias and with their best interests (and the best of science) in mind?

This oppositionally defiant attitude seems a strong undercurrent in much ostensible pharma muckraking. It just confirms my sense that all the fuss is largely not about disclosure, marketing, or anything along those lines. That's just convenient cover. It's more kind of weird anger that these meds are necessary for some people, including for most of the people who rail against their existence.

As for your med-refill reminder, do you know how many people with ADHD would be so grateful if their prescribing physicians understood their challenges enough to implement such a routine? The best doctors do make a point to call and remind that refills are due. Most don't. Thus, ADHD symptoms re-assert themselves, thus making it difficult to get back on schedule.

Maybe pharma is actually doing the job that docs should be doing. Did you ever think of that? Again, we let docs off the hook repeatedly in these conversations -- except when the mob is ready to hang Biederman et all. This is all pretty nutty and, IMHO, out of touch with reality.

Silver said...

Well, Gina, in this particular case, I'm annoyed because the pharmaceutical manufacturer is sending me unwanted reminders and educational materials without my request in what looks like a pretty blatant attempt to drum up business; thus far I've received four notes suggesting I might want to talk to my doc about increasing my dose. (I was amused; he wasn't.) This drug is priced by the milligram, rather than by the capsule, so that's pretty interesting.
Although it is nice to know that my insurer isn't disclosing my epilepsy diagnosis to them, which would have been required via prior authorization.

I'm also annoyed because the retail price on this drug is outrageous and the manufacturer is spending the money on marketing after at least 10 years (to my recollection) of saying that they must charge these prices for the R&D. Which... as it turns out... has not been their priority. This has been discussed in depth elsewhere.

Please don't assume that I rail against the necessity to take medication. You don't know me nearly that well.

Moving on:
I believe that Shire at one time offered a rather elaborate medication reminder system for Adderall XR; are they not doing this for Vyvanse? I recall similar programs for the other branded ADD treatments.

And, er, speaking of hanging the doc --
-- with my patients with ADD, I often sit with them and my laptop and let them log into their Google calendar (or watch them set up a Google calendar, if we talk about it, and the patient thinks it's a viable solution.)
We then set up a SMS-based reminder to a) take their medication daily, b) remember to pick up refills as appropriate, c) any other essential tasks, d) to plug in the cell phone so that the SMS/text messages keep coming. Step D is important. I thank my nephew for teaching me that one.

And I give all stimulants in 28 day increments so that there is no problem with running out on a Sunday. That way the appointment is always on a "Monday at 1 pm" (or whatever.) My office manager sends that to the patient's Google calendar with a SMS reminder as well, and we have the patient call us to confirm.

We've come up with many other solutions over the years. Treatment adherence is kind of a "thing" for me. Kind of a "thing" I've spent several years working on in academic and public health settings, actually.

So I like to think I find a good balance between not infantilizing my patient and allowing the patient to develop skills that she can use in daily life and generalize to other situations. I find that my patients do best when they find the ways that work to do the jobs that they should be doing.

Thanks for not assuming that I wouldn't understand such challenges, as I'm sure you didn't intend to imply that.

And as to the "patient priming" - I'm seeing the next steps of it. Multi-company sponsored "educational guides" to chronic conditions with helpful guides for your next visit.
More on this later, as I'm visiting a pharmacologist friend tomorrow and I hope to pick his brain for information.

Dan said...

Pharmacies sell prescribing data, also known as prescriber-identifiable data, to the pharmaceutical industry’s providers of this information. This is known as, ‘data mining.’

The two largest data mining companies are IMS and Verispan in this 2 billion dollar a year data mining industry.

The data on individual prescribers is purchased from the American Medical Association. As a result, this association receives between 40 and 50 billion dollars a year, which is nearly 20 percent of the AMA’s budget.

Over 1 billion prescriptions are monitored every year due to this process.

Advocates of the pharmaceutical industry have continuously told the public that this prescriber data is to facilitate the care the prescriber gives the patient.

Nothing could be further from the truth. In 10 years, I worked as a drug representative for 3 of the largest pharmaceutical companies in the world.

With each employer, the prescribing data that we had on the prescribers was used entirely to increase the market share of the drugs promoted with these companies by manipulating the prescribers targeted for financial gain of these pharmaceutical corporations.

Also, data mining is utilized by drug companies to target those who need to be gifted, and those who will not,

Dan Abshear