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You might think you're just writing a prescription and signing your name. But the innocent ink (or pixels) you leave behind in your daily routine turns into liquid gold for an entire industry that makes big profits from understanding and interpreting your behavior to pharmaceutical and insurance companies.
As Lawrence Gostin points out in a JAMA editorial, CVS, Walgreens, and almost all major pharmacies make a bundle by selling your prescribing information to "data miners," who sort all of us physicians' identities (by name) and behaviors into elegant, valuable spreadsheets, pie charts and computer models. The data miners then sell this processed data to pharmaceutical companies, who deploy drug detailers to your door, armed with the exact number of prescriptions of their drugs you've written, and when.
It's not chump change on the table: the largest of these data mining companies, IMS Health, made $1.75 billion in 2005, essentially entirely from sales of physician prescribing data to pharmaceutical companies.
How do they achieve this -- through black-suited ninjas, grungy hackers, or white collar criminals conducting industrial espionage? No -- they just call up the American Medical Association, which controls the AMA Physician Masterfile, a comprehensive record of every physician who has trained or practiced in the U.S. -- including you.
The AMA worked out a deal with the Accreditation Council for Graduate Medical Education years ago, to enter you into their Masterfile automatically upon your entry into an ACGME accredited training program. You're listed in there by your "ME number" (medical education #). The AMA sells access to the list to ... well, whoever's willing to pay the big licensing fee for your valuable personal information. You can read the promotional materials from one of the AMA's marketing partners on its website. The AMA is careful to say on their own website they don't sell access to your prescribing data. That's true, they don't -- they just sell your identifying information, so the data miners can find you in the pharmacies' databases and access your personal prescribing information that way. The AMA made $44 million in 2005 from this practice, according to the National Physicians' Alliance.
Companies like IMS Health crossmatch data from the Masterfile, purchased from the AMA, to information in other databases, selling the product of this "data mining" to their pharmaceutical company customers, who use it in their marketing activities and give it to their reps to use when detailing physicians. Insurance companies can also buy AMA data, using the identifying information in the Masterfile and from the AMA's proprietary CPT code system to help gain a better understanding of billing patterns in each market and using that information to increase leverage in negotiations for payment rates with physician groups and health systems.
The AMA emphasizes that they also sell the information to friendly and helpful agents like people doing research on physician behavior, people who want to give you a job, etc., which surely they do.
But do you want to opt out of this system that records your every prescribing move without your knowledge or consent and sells it to anyone with a few shekels?
Yeah, me too: Click here.
Gostin LO. Marketing Pharmaceuticals: A Constitutional Right to Sell Prescriber-Identified Data? JAMA 2012;307:787-788.