Jeremy A. Greene, MD, PhD
Acknowledgments: The author thanks Laura Carroll at the AMA Archives and Greg Higby and Elaine Stroud at the American Institute of the History of Pharmacy for their assistance with archival materials and Jerry Avorn, Andrew Ellner, Harry M. Marks, Allan M. Brandt, Charles E. Rosenberg, Elizabeth Siegel Watkins, and Deborah Levine for their comments on earlier versions of this article.
Grant Support: Research related to this article was funded by the Whiting Foundation for the Humanities, the Charles Warren Center for Studies in American History, the American Institute of the History of Pharmacy, and a Medical Scholar Training Program Grant from the National Institutes of Health.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Jeremy A. Greene, MD, PhD, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.
Prescriber profiling—use of detailed data from pharmacies and clinical practices to target and influence physician prescribing habits—is a widespread pharmaceutical marketing practice whose historical development is relevant to clinicians and policymakers.
Data products relevant to prescriber profiling are collected and sold by private health care information organizations; these data products have been a central plank of pharmaceutical marketing for the past 50 years and have some secondary use in practice management and public health research.
Historically, prescriber profiling products and services have been sorted into 4 major classes: 1) prescription audits and claims databases, which collect and sort prescriptions sold in pharmacies; 2) physician panels, which enlist physicians to record their own prescribing patterns and clinical experiences on a daily basis; 3) physician databases, which link prescription claims data to detailed information about physician practices; and 4) specialized studies composed by pharmaceutical companies or health care information organizations on an ad hoc basis.
The data systems that enable prescriber profiling were developed through mutual interactions of pharmaceutical marketers and sales representatives, pharmacy chains, individual physicians, and physician organizations.
Current policy responses to prescriber profiling must take into account the historical role of physicians and physician organizations in enabling these practices.
Market research in the pharmaceutical industry does not merely require the collection of certain statistical and commercial data. … It covers a much broader field, and requires constant observation of the entire medical and pharmaceutical horizon, so that the physicians' prescription habits can be thoroughly studied. For this purpose special personnel should be trained.
Example of a search results screen on a handheld device.
[F]rom the data we can learn how a given drug or class of drugs is being used. We can learn the relative frequency with which our sample of physicians sees or treats a given illness. We can learn how the illness is being treated. We can learn the sex and age distribution of patients. And in most cases we can learn the extent to which the condition is treated by specialists rather than by physicians in general practice. In fact, the possible types of tabulations and crosstabulations are almost limitless.
Promotional flyer for a computerized physician directory, circa 1953.
Promotional report on survey data, circa 1953.
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Greene JA. Pharmaceutical Marketing Research and the Prescribing Physician. Ann Intern Med. 2007;146:742-748. doi: 10.7326/0003-4819-146-10-200705150-00008
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Published: Ann Intern Med. 2007;146(10):742-748.
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