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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Friday, May 04, 2007

    Define "Free": New Hampshire passed a law last year that would prevent pharmacies from selling physician prescription information to pharmaceutical representatives. Drug reps use this information to better target their sales pitches. This week a judge ruled the law unconstitutional. He says it violates the right to free speech.

    Here's some insight into his thinking:

    ...some of his comments Wednesday showed his skepticism about key arguments -- including the state's contention that detailing drives up drug prices. The datamining companies argue that many new drugs are more effective than older treatments or cause fewer side effects, and sales reps are educating doctors about those improvements to the benefit of patients.

    "If reasonable medical people disagree" about the relative merits of various drugs for the same medical condition, "you have a stronger argument that speech restrictions are dangerous," Barbadoro said.

    The liveliest exchange came when a lawyer for the datamining companies, Tom Julin, asked Barbadoro to state that the law does not prohibit the sale or use of individual prescriber data for clinical drug trials.

    Barbadoro commented that Julin had argued previously the law was so vague it could bar using the data for research.

    "Are you going to ask me to put it in so you can argue at the court of appeals that I'm crazy to conclude that?" the judge asked.

    Barbadoro stated during the trial he disagreed the statute was vague, and Julin said he simply wants the ruling to reflect that.

    "I'm asking that your honor's own views of the statute be incorporated," Julin said.

    He also asked Barbardoro to change language saying drug companies "co-opt thought leaders" -- doctors and researchers whose views about particular drugs influence the prescribing habits of other physicians -- by entertaining them and paying them to serve as consultants.

    Barbadoro agreed to both requests, although he said he thought "co-opt" was an appropriate word.

    "My understanding is most thought leaders understand what's going on here," he said. "They have to recognize the pharmaceutical companies are trying to trade on their reputations."

    The judge also debated Senior Assistant Attorney General Richard Head's contention that sales reps expect doctors who accept free drug samples and small gifts like pens and stethoscopes to write more prescriptions for their brands.

    "People who are prescribing a lot of a drug may get more samples because they're more likely to use them," and the evidence only showed that small gifts get sales reps better access, the judge said.

    "I characterize those as efficiencies -- you characterize those as something closer to graft," he said.

    It's important to remember here that the law does not restrict pharmacies from sharing this information for care management, clinical trials and education. It also doesn't prevent drug reps from "educating" physicians, if that's what they do. It just prevents them from targeting their educational efforts so precisely.

    The data mining company is already profiting.

    The state plans to appeal.

    How is it that my prescribing habits fall under someone else's free speech? It seems to me that there's a three-way privileged professional relationship here between the patient, the doctor, and the pharmacist. What passes between the three isn't public information, but private information that deserves protecting.

    There's no mention of what the state's pharmacy board thinks of all of this. One would think they would have an interest in protecting their professionalism.

    UPDATE: Speaking of professionalism. Here's a declaration on behalf of data mining by a distinguished cardiologist. Are you reassured that such a thought leader relies so heavily on salesmen for his information?

    posted by Sydney on 5/04/2007 08:10:00 PM 0 comments


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